Safety & TeamSTEPPS - NUR 337

True or false: teamwork cannot occur in the absence of a clearly defined team

TRUE

What is a critical part of TeamSTEPPS for implementation planning?

understanding a team’s structure and how multiple teams interact

Definition of a team

Two or more people who interact dynamically, interdependently, and adaptively toward a common and valued goal, have specific roles or functions, and have a time-limited membership.

True or false: teams are only considered in-person, permanent positions.

FALSE - teams can be in-person or virtual, temporary or permanent, and frequently changing due to staff scheduling.

True or false: patients are members of the core team.

TRUE → a family caregiver also may be!

What are some strategies for involving patients and family caregivers in teams?

• include the pts in bedside rounds

• conduct handoffs at the pts bedside

• provide pts and family caregivers with tools for communicating with their care team (email, phone #, etc)

• involve pts on key committees (ex: stroke survivors)

• actively encourage pt and family caregiver participation

How can we foster pt and family caregiver involvement?

• embrace pts and family as separate, valuable, and contributing partners

• listen and ask for feedback

• assess preference regarding involvement

• ask about concerns

• speak in layman terms

• allow them time

• treat pts and family as distinct

• help them have access to relevant info on a pt portal

How can pts and family caregivers function effectively in teams?

• provide accurate info

• collaborating to create a care plan they will follow

• asking questions + voicing concerns about their care

• monitoring + reporting changes in the pts condition

• coordinating & communicating with other family

• encouraging + showing appreciation to other team members

Who all is included in the multi-team system for pt care?

• core team + pt

• contingency teams

• coordinating teams

• ancillary + support services

• administration

Core team

A group of care providers who work interdependently to manage a set of assigned patients from point of assessment to disposition.

True or false: core team members have the closest contact with the pt

TRUE

Contingency team

a time-limited team formed for emergent or specific events and composed of members from various teams.

• ex: rapid response

Ancillary Services

Provide direct, task-specific, time-limited care to patients.

• ex: pt or dieticians

Support Services

Provide indirect service-focused tasks that help facilitate the optimal healthcare experience for pts and their families.

Role of Administration

• establish + communicate vision

• develop policies and set expectations for staff related to teamwork

• support & encourage staff during implementation + culture change

• hold teams accountable for team performance

• define the culture of the organization

Leadership

• ensures the patient remains the focus for all team decisions

• holds a teamwork system together

• ensures a plan is conveyed, reviewed, and updated

• is facilitated by communicating, continuously monitoring the situation, and fostering an environment of mutual support

Designated (Formal) Team Leader

The person assigned to lead and organize a team, establish clear goals, and facilitate open communication + teamwork among team members

• ex: charge nurse

Situational Team Leader

Any team member with the skills to manage the situation at hand

• ex: BLS-trained individual helps heart attack pt

What do effective team leaders do?

• ensure the pts needs and preferences are understood and prioritized

• define, assign, share, monitor, & modify a plan

• review the team’s performance

• establish “rules of engagement”

• manage + allocate resources effectively (prioritize telemetry monitors)

• provide feedback regarding assigned responsibilities + progress toward the goal

• facilitate information sharing

• encourage team members to assist one another

• facilitate conflict resolution (ex: crucial conversations)

• model effective teamwork

What should team members consider when developing a plan?

• Patient: What does the pt need and how can the team best provide it?

• Time: How much time is available to complete all the necessary tasks and activities?

• People: Do available staff have the necessary knowledge and skills to perform their roles?

• Equipment: Is the needed equipment available and working?

• Information: Has all the needed information been collected and reviewed?

What must be done to properly assign tasks & responsibilities?

• determine the tasks + roles to be assigned

• determine which roles must be filled and allocate tasks appropriately

• communicate clear expectations of what team members need to do

• request feedback

True or false: a team brief is an effective strategy for sharing the plan

TRUE

• ex: pt has an MI in the community. ER nurse will pre-brief everyone and gather a team for the incoming pt.

What is the purpose of briefs?

• form the team

• designate team roles + responsibilities

• establish climate + goals

• engage team in short and long-term planning

What is covered in the brief checklist tool?

• who is on the team?

• do all members understand and agree upon goals?

• are roles and responsibilities understood?

• what is our plan of care?

• what is provider availability throughout the shift?

• how is workload shared among team members?

• what resources are available?

When is a TeamSTEPPS huddle called?

DURING THE EVENT!

• when we monitor and modify the plan to re-establish goals

What problem solving occurs during a TeamSTEPPS huddle?

• ad hoc “touch base” meeting to regain situational awareness

• discuss critical issues

• anticipate outcomes + likely contingencies

• assign resources

• express concerns

• elicit input + answer pt questions when appropriate

When does a TeamSTEPPS debrief occur?

following the event!

• review the team’s performance

How do debriefs foster process improvement?

• brief, informal information exchange + feedback sessions

• occur after an event or shift

• designed to improve teamwork skills

• designed to improve outcomes:

  • accurate recount of key events

  • analysis of why the event occurred

  • discussion of lessons learned + reinforcement of success

  • revised plan to incorporate lessons learned

What is part of the debrief checklist?

• was communication clear?

• were roles and responsibilities understood?

• was situational awareness maintained?

• was workload distribution equitable?

• was task assistance requested or offered?

• were errors made or avoided?

• were resources available?

• what went well?

• what is one thing that should improve?

How do effective leaders facilitate conflict resolution?

• facilitate conflict resolution to avoid compromising patient safety + quality of care

• do not allow interpersonal or irrelevant issues to negatively affect the team

• help team members master conflict resolution techniques

How do effective leaders cultivate desired team behaviors and skills?

• open information sharing

• role modeling + effective cuing of team members to use prescribed teamwork behaviors & skills

• constructive and timely feedback

• facilitation of briefs, huddles, debriefs, and conflict resolution

• mitigation of conflict within the team

Tools & Team Strategies Summary

True or false: hand hygiene is the number 1 way that we can prevent the spread of disease

TRUE

True or false: we wear gloves at all times around the pt

FALSE - only when we may come in contact with bodily fluids

True or false: in standard precautions, you may use additional PPE if performing certain procedures to avoid bodily fluids

TRUE → gown/face shield during NG tube application to avoid emesis

True or false: all patients in the hospital at baseline are on standard precautions

TRUE

When do we need to wash our hands during standard precautions?

• when entering the room

• as needed in the room

• when leaving the room

Contact precautions

Where spores can attach to the clothes you are wearing.

• PPE = gown, gloves

• Ex = C-Diff

Droplet Precautions

• PPE = surgical mask

• Ex = meningitis, influenza, COVID-19

True or false: influenza & COVID-19 can become airborne during some procedures

TRUE

Airborne Precautions

Finer particles that can remain airborne for a longer period of time

• PPE = N95 surgical mask

• Ex = TB

Environmental Awareness for Nurses

• across room assessment

• bed in lowest position + locked

• non-skid footwear

• room free of clutter

• top 2 side rails up (NOT bottom 2)

• good lighting

• call light + tray table in reach

• bed/chair alarm on if necessary

• O2 and suction available and working

• infection control risks

• get report from RN + check white board

• ANY SAFETY PRECAUTIONS?

• Identify if the pt is NPO

• Any limb restrictions? (mastectomy)!

• Trust your gut!

What can a pt be at risk for?

• aspiration

• falls

• injuries

• seizures

• suicide/self-harm (1:1 sitter)

• PI (nutrition → protein)

What occurs during a transition to an inpatient unit from the emergency department?

• systems for communication vary

• receiving RN’s responsibilities → understand patho behind admitting diagnosis, review assessment for appropriate admission to unit, clarify unclear issues, welcome + communicate with pt

• begin admission procedures → safety screening, orientation to room, assessment of IV access, assessment, history

What do we use to determine risk for injury with fall?

ABCS -

• A = Age > 85

• B = Bone health (Fx risk or history → osteoporosis, bone mets, steroid use)

• C = Coagulation (coagulopathy or on anticoagulant meds)

• S = Surgery (within 14 days)

Where do failures occur with risk for injury with falls?

• failure to communicate changes in assessments

• failure to implement and document prevention interventions

• unclear handoffs

• insufficient safety instructions

• pt or family confusion from nurse teaching

• assuming it is only important to teach the pt

• education that fails to be individualized