Effectiveness of Team Training on Fall Prevention

Transcription

1 Effectiveness of Team Training on Fall Prevention Margaret Michelle Kimrey, MSN, RN, PCCN-CMC Beverly Green, MSN, RN LeeAnna Spiva, PhD, RN, PLNC Bethany Robertson, DNP, CNM Marcia L. Delk, MD, MBA Sara Patrick, MSN, RN Erin Gallagher, BS

2 Disclosure This work was supported through the 2011 Prevention Above all Discovery Grant, Medline Industries The authors had full access to all of the study, take responsibility for data integrity, accuracy of the data analysis, and presentation

3 Background/Significance Falls are the most frequently reported safety event among U.S. hospitalized patients 1-7 Falls are associated with increased risk of mortality and morbidity and an estimated cost of $20 billion a year 8,9 Annual direct and indirect costs of falls estimated to reach $54.9 billion 8 Evidence exists on fall risk factors, interventions, and prevention guidelines, yet reducing falls in the acute care setting has been challenging 5,10-16 Little evidence is available demonstrating interdisciplinary team efforts 17

4 Purpose To evaluate the effect of a training curriculum based on TeamSTEPPS with video vignettes focusing on fall prevention for debriefing and reinforcement on team members safety culture, teamwork attitude, teamwork perception, and communication as a mediator to reduce falls and injuries

5 Design Methods A longitudinal, quasi-experimental, repeated measures, with intervention & comparison groups Setting/Sample 2 community acute care hospitals; 4 medical-surgical acute care units Intervention group: 16-bed orthopedic unit & 17-bed neurology unit (received training) Control group: 22-bed orthopedic unit & 30-bed neurology unit (received no training & continued with usual practice) registered nurses, pharmacists, physical therapists, & physicians

6 Measures Demographic Hospital Survey on Patient Safety (HSOPS) 18 TeamSTEPPS Teamwork Attitudes Questionnaire (T- TAQ) 19 TeamSTEPPS Teamwork Perceptions Questionnaire (T- TPQ) 20 Trained observers recorded teamwork communications and behaviors bedside shift report (patient handoff), safety huddle, interdisciplinary care meeting, & unit-level observer assessments Falls data

7 Training Intervention Based on TeamSTEPPS curriculum, four domains: communication, situational monitoring, mutual support, and leadership 21 Three 30-minute training sessions; held on the units Brief didactic lecture Custom designed patient video scenarios Facilitated debriefing of the content covered

8 Intervention: Training Content Session I Didactic: purpose of team training Video: lacking behaviors from the 4 domains Debriefing: role team work plays in fall prevention Session II Didactic: communication and situational monitoring Video: demonstrated optimal bedside shift report, safety huddle, and SBAR Debriefing: effectiveness of these team strategies

9 Intervention: Training Content Session III Continued Didactic: mutual support and leadership utilizing Video: vignette of team briefs, huddles and hand-offs Debrief: information sharing fosters mutual support and task assistance; leadership for communication events; knitted all 4 domains from training together Sample Video

10 Study Time line Activity April 2012 May June July Aug Sept Oct Nov Dec Jan 2013 Feb Recruitment x x Champion Training Training (Intervention) x x x x Observations x x x Surveys x x x

11 Data Analysis Plan SPSS 18.0: Statistical methods- descriptive, chi-square (χ 2 ), repeated measures analysis of variance (ANOVA), and t tests Chi-square (χ 2 ) or t tests were used to compare demographic variables of the 2 groups Post-hoc comparisons were performed to evaluate mean differences NVivo 10 used to identify patterns in observers hand written notes Descriptive statistics were calculated for the patterns Repeated measures conducted to evaluate the effects over time A p value of <.05 was considered statistically significant

12 Findings Demographics (SD = 10.45) sample mean age Most were registered nurses (29.4%), female (97.1%), white (64.7%), baccalaureate prepared (41.2%), & primarily worked day shift (79.4%) Differences between the 2 groups for age, gender, & education (P <.001) 72% of the intervention group sample attended all 3 training sessions

13 Questionnaire Findings- Intervention Group Only HSOPS Subscales Feedback & communication about error (F = 4.95) & communication openness (F = 5.46) improved over time (P <.01 ) Teamwork within hospital units (F = 4.07, P =.03) improved mid compared to post-intervention Teamwork across hospital units (F = 4.81, P =.02) improved from pre compared to post-intervention Teamwork Attitude Improved (P =.009) mid (M = 4.16) compared to post-intervention (M = 4.55) Teamwork Perception Decreased (F = 3.92, P =.03) pre (M = 2.35), mid (M = 2.23), & postintervention (M = 1.66)

14 Questionnaire Findings Continued No statistical differences found within the control group- scores decreased over time on all measures except teamwork within hospital units & teamwork attitudes slightly increased No significant differences in the study variables between the 2 groups Subsequent analysis, the 2 groups were combined & analyzed as 1 group to compare the change of study variables over time HSOPS subscales differed for the entire sample significantly over time for 4 of the 5 subscales: feedback & communication about error (F = 4.382, P =.017); communication openness (F = , P <.01); teamwork within hospital units (F = 6.037, P <.01); & teamwork across hospital units (F = 9.248, P <.01) Teamwork attitudes improved over time (F = 3.240, P =.04) with a significant increase pre compared to post-intervention Teamwork perceptions decreased over time (F = 5.207, P <.01) with a significant decrease pre compared to post-intervention

15 Observation Findings Bedside shift report - Intervention group (n = 137) improved over time conducting report in patients room, discussing patients mobility status, & improving communication between caregivers regarding patients care plan compared to the control group Safety huddles (n =16) & interdisciplinary meetings (n = 25) - Intervention group improved over time expressing less uncertainty about patients care plan & frequently communicated patients fall risk status compared to control group Observer assessments (N = 54) - Over time intervention group improved communication related to patients fall risk status (F = 7.480, P <.01) Fall related observations included consistent implementation of fall preventative interventions such as signage & visual fall reminders (arm bracelet, yellow socks, & door sign), bed alarm usage, & ambulation assistance improved in the intervention group (F = 6.67, P <.01) The control group had no significant observation findings

16 Fall Data Findings The number of falls decreased by 13 (62% reduction) & fall-related injuries by 5 (71% reduction) in the intervention group Pre-fall rates were 2.69 (SD =.12) & 1.03 (SD =.43) post-fall rates (t = 4.27, P =.15) Pre-injury rates were.97 (SD =.55) &.24 (SD =.34) post-injury rates (t = 5.05, P =.122) Fall & injury rates increased in the control group

17 Limitations Training sessions were not always interdisciplinary Even though training sessions were short & unit based, staff had difficulty attending & managing care duties Local variations in patient volumes, staff turn over, etc impacted all aspects of the study Low statistical power may have limited ability to detect certain differences because of a small sample size Questionnaire length may have resulted in instrument fatigue

18 Conclusion Unique study: control group, self-report survey and observations all over time Team training was found to be an effective intervention to reduce falls and related injuries Steady improvements in perceptions of safety culture and teamwork attitude; clinical significance was achieved in a reduction of falls Observed improvements with caregivers implementing fall preventative interventions and improved communication between caregivers related to a patients fall risk status

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