Integration of QSEN Competency: Teamwork and Collaboration within a Simulation Center Marie N. Bremner DSN, RN Professor of Nursing Mary Beth Maguire MSN, RN, NP-C Lecturer Kennesaw State University WellStar School of Nursing
Objectives Describe a framework to fulfill QSEN competency development in teamwork and collaboration within a simulation center. Demonstrate use of the TeamSTEPPS(Strategies and Tools to Enhance Performance and Patient Safety) within low, moderate, and high fidelity simulations. Discuss team debrief strategies and team simulation evaluation for outcome measures and assessment.
TeamSTEPPS Team Strategies and Tools to Enhance Performance and Patient Safety Developed by the Department of Defense Patient Safety Program along with the Agency for Healthcare Research and Quality A teamwork system designed for health-care professionals: Improve patient safety Improve communication and teamwork skills among health care professionals
Patient Safety Movement Department of Defense MedTeams Emergency Department Study To Err is Human Institute of Medicine Report Executive Memo from President Joint Commission on Accreditation of Hospital Organizations National Patient Safety Goals Institute for Healthcare Improvement 100K lives Campaign TeamSTEPPS 1995 1999 2001 2003 2004 2005 Healthcare Team Training October 2005 2006 4
Quality & Safety Education for Nurses (QSEN) Competencies and TeamSTEPPS 1. Patient-centered care 2. Teamwork and collaboration 3. Evidence-based practice 4. Quality improvement 5. Safety 6. Informatics
Integrating Teamwork & Collaboration Into Simulation What is essential for nursing educators is helping students make the connections between acquiring and using knowledge. We call this teaching for a sense of salience. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating Nurses. A Call for Radical Transformation, p.94. San Francisco: Josey-Bass.
TeamSTEPPS Mapping First Semester Holistic Nursing Second Semester Adult Health Nursing Third Semester Parent & Child Nursing Fourth Semester Senior Practicum
First Semester Holistic Nursing TeamSTEPPS Skills: Cross Monitoring, STEP I m Safe Checklist Check-Back, DESC Infection Control Level of Fidelity: Low Equipment Needed: Facilitator, dressing supplies to provide wound care, emphasis on Infection Control and introduction to TeamSTEPPS.
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Conflict Resolution DESC Script A constructive approach for managing and resolving conflict D Describe the specific situation E Express your concerns about the action S Suggest other alternatives C Consequences should be stated Ultimately, consensus shall be reached. 12
A DESC Scenario Two nurses meet in the supply room: GN# 1: Recent graduate, assigned to patient with MRSA. She has on gown and gloves, mask around the neck and is gathering supplies. RN # 2 : Enters the supply room and states What are you doing?! You are spreading infection and have now contaminated this room and unit! I don t think you will last here long! 13
This is NOT Mutual Respect!
First Semester: Day Two Four hour session Review TeamSTEPPS overview Two Concurrent Sessions Leadership Communication Overall debrief of day Evaluation Concurrent Sessions Leadership Review objectives Activities Communication Review objectives Activities
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Case Study: Elaine Bromiley for Just a routine operation! Elaine Bromiley was a fit and healthy young woman who was admitted for routine sinus surgery. The attending anesthesiologist and his assistant were both quite experienced. A pre-operative assessment raised no cause for concern. Prior to the star of the procedure her pulse rate was 81 bpm with oxygen saturation of 98%. 1. Review the case situation, reviewing the outlined influencing factors, biases and situation assessment and awareness. Discuss what could the nurses have done differently to intervene? When should they have begun to be assertive regarding Ms. Bromiley s deteriorating condition? Describe how the nurses could have made a difference in the overall outcome for Elaine Bromiley. 2. All of you are now OR nurses in the care of Elaine Bromiley. Decide at what point in the care do you call a huddle? Call a huddle to determine a plan of action (problem solving). Role play selected teamstepps strategies. 3. Debrief. Discuss what went well, what could have been improved in the delivery of your teamstepps methods. 4. Change roles to allow all group members to practice teamstepps strategies and tools.
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Communication Watch the following video. Summarize this incident. Who were the key players? What were the key variables that led to the incident? How could this incident have been avoided? How is this story similar to healthcare? Who are the key players in healthcare? What are the key variables in healthcare that lead to miscommunication? What TeamSTEPPS strategies can be implemented in healthcare to avoid instances of miscommunication? What outcomes are associated with miscommunication in healthcare?
Debrief Strategies Who: experienced educators knowledgeable of simulation teaching/learning strategies What: team debrief, non-scripted, no video playback When: immediate, average of 30 minutes per competency Where: in the simulation area Why: utilizing experiential learning theory to support teaching for a sense of salience Raemer, D., Anderson, M., Cheng, A., Fanning, R., Nadkarni, V., & Savoldelli, G. (2011). Research regarding debriefing as part of the learning process. Simulation in Healthcare, 6(7), S52-S57.
Evaluation Pre and post first semester assessment Control with final semester student assessment Future considerations include assessment of practical application in clinical environment Retrieved from: http://teamstepps.ahrq.gov/taq_index.htm#intro
Second Semester Adult Health Nursing TeamSTEPPS Skills: Advocacy & Assertion CUS, Call-Out, Handoff, I pass the baton SBAR, Debrief Level of Fidelity: Moderate Equipment Needed: Facilitator, Human Patient Simulator (HPS) able to provide basic assessment information of a patient experiencing Acute Opioid Intoxication (Laerdal SimMan)
Third Semester Parent & Child Nursing TeamSTEPPS Skills: Two Challenge Rule Advocacy & Assertion Brief, Huddle, Debrief Collaboration, Feedback Level of Fidelity: High Equipment Needed: Facilitator, HPS able to simulate a Postpartum Hemorrhage (Laerdal SimMom)
Fourth Semester Senior Nursing Practicum TeamSTEPPS Skills: Situation Monitoring Call-Out Two-Challenge Rule Debrief Error Disclosure Level of Fidelity: High Equipment Needed: Facilitator, HPS able to simulate an Acute Myocardial Infarction Secondary to a Potassium Overdose (Laerdal SimMan 3G with preprogrammed scenario)
Tools and Outcomes TOOLS and STRATEGIES Brief Huddle Debrief STEP Cross Monitoring Feedback Advocacy and Assertion Two-Challenge Rule CUS DESC Script Collaboration SBAR Call-Out Check-Back Handoff OUTCOMES Shared Mental Model Adaptability Team Orientation Mutual Trust Team Performance Patient Safety!!
WellStar School of Nursing Certificate of Completion is hereby granted to STUDENT NAME for successful completion of TEAMSTEPPS TRAINING Awarded: Date Presenter Name and Title
Summary Importance of STEPPS Importance of repetitive dosing throughout curriculum Ease of integration (embedding within preexisting objectives)
TeamSTEPPS Certified Master Trainer Course: June 26-28th Date: June 26-28, 2012 Location: KSU Contact: Carey Sipp, Health Team Training Conference Coordinator csipp@healthcareteamtraining.com
Bibliography 1. Agency for Healthcare Research and Quality (AHQR). (2011). TeamSTEPPS: Strategies and tools to enhance performance and patient safety. Retrieved July, 2011 from http://teamstepps.ahrq.gov/ 2. Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating Nurses. A Call for Radical Transformation. San Francisco: Josey-Bass. 3. Berwick,D. M., Bisognano,M. (2011). Preparing Nurses for Participation in and Leadership of Continual Improvement. Journal of Nursing Education, 50 (6), 322-327. 4. Bremner. M., Aduddell, K., Bennett, D., & VanGeest, J. (2006). The use of Human Patient Simulators: Best Practices with Novice Nursing students. Nurse Educator, 31, (4). 5. Hall,P., Marshall,D., Weaver,L., Boyle,A., Taniguchi,A. (2011). A method to enhance student teams in palliative care: Piloting the McMaster-Ottawa Team Observed Structured Clinical Encounter. Journal of Palliative Medicine, 14 (6), 744-750. 6. Husebo,S. E., Rystedt,H., Friberg,F. (2011). Educating for teamwork - nursing students' coordination in simulated cardiac arrest situations. Journal of Advanced Nursing 7. Joint Commission on the Accreditation of Healthcare Organizations. 2012 National Patient Safety Goals and Sentinel event data base. Retrieved February, 2012 from, www.jointcommission.org 8. Kesten,K. S. (2011). Role-play using SBAR technique to improve observed communication skills in senior nursing students. The Journal of Nursing Education, 50 (2), 79-87. 9. Pelling,S., Kalen,A., Hammar,M., Wahlstrom,O. (2011). Preparation for becoming members of health care teams: findings from a 5-year evaluation of a student interprofessional training ward. Journal of Interprofessional Care, 25 (5), 328-332. 10. Rosenfield,D., Oandasan,I., Reeves,S. (2011). Perceptions versus reality: A qualitative study of students' expectations and experiences of interprofessional education. Medical Education, 45 (5), 471-477. 11. Thibault,G. E. (2011). Interprofessional education: an essential strategy to accomplish the future of nursing goals. The Journal of Nursing Education, 50 (6), 313-317. 12. Wilhelmsson,M., Ponzer,S., Dahlgren,L. O., Timpka,T., Faresjo,T. (2011). Are female students in general and nursing students more ready for teamwork and interprofessional collaboration in healthcare?. BMC Medical Education, 1115-.
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