Team STEPPS

Status of the Patient

-Patient history -Vital signs -Medications -Physical exam -Plan of care -Psychosocial condition

Team STEEPs is comprised of?

-communication -mutual support -leadership -situational monitoring

Cross Monitoring

An error reduction strategy that involves: •Monitoring actions of other team members •Providing a safety net within the team •Ensuring mistakes or oversights are caught quickly and easily •"Watching each others backs"

Debrief

What went well, what can we change, was communication clear, did we share the workload evenly

Mutual Support

Core skill •Supporting teams: •Backup and fill in for each other •Are self correcting •Compensate for each other •Reallocate functions •Distribute and assign work thoughtfully •Regularly provide feedback to each other •Task assistance

**I PASS the BATON

I-introduction P-patient A-assessment S-situation S-safety concerns the B-background A-actions T-timing O-ownership N-next

Huddle

Problem solving •Hold ad hoc, "touch-base" meetings to regain situation awareness •Discuss critical issues and emerging events •Anticipate outcomes and likely contingencies •Assign resources •Express concerns

**STEP represents?

Status of the patient Team members Environment Progress toward goal

Institute of Medicine (IOM) (now National Academy of Medicine)

Students and working professionals should develop and maintain proficiency in five core areas: •Delivering patient-centered care •Working as part of interdisciplinary teams •Practicing evidence-based nursing •Focusing on quality improvement •Using information technology

Debrief Checklist

The team should address the following questions during a debrief: •Communication was clear? •Role & responsibilities understood? •Situation awareness maintained? •Workload distribution equal? •Task assistance requested or offered? •Were errors made or avoided? Availability of resources? What went well, what should change, what should improve?

Team Steps promotes safety and safe patient care how?

communication and teamwork

Leaders/Leadership

effective team leaders: •Are responsible for ensuring that team members are sharing information, monitoring situational cues, resolving conflicts, and helping each other PRN •Manage resources •Facilitate team actions by communicating •Develop norms for information sharing •Ensure team members are aware of situational changes to plan

ultimate goal of team STEPPS?

optimize team performance across healthcare system

situation monitoring

process of actively scanning and assessing situational elements to gain information, understanding, or maintain awareness to support functioning of the team

Team work

team members ability to: •Anticipate needs of others •Adjust to each other's actions and the changing environment •Have a shared understanding of how a procedure or plan of care should happen

**CUS? ((Mutual Support)

• I am (C)ONCERENED! • I am (U)NCOMFORTABLE! • This is a (S)AFETY ISSUE! CUS

**Team STEPPS provides higher quality, safer patient care by:

•"Producing highly effective medical care teams that optimize the use of information, people, and resources to achieve the best clinical outcomes for patients. •Increasing team awareness and clarifying team roles and responsibilities. •Resolving conflicts and improving information sharing. •Eliminating barriers to quality and safety."

Collaboration: (Mutual Support)

•Addressing conflict •Win-Win situation •Team members, team, and patient •Commitment to a common mission •Involved full and open communication •Meet objectives/goals without compromising •Maintain relationships

3 activities that promote teamwork:

•Briefs •Huddles •Debriefs (team events; Activities of planning, problem solving, & process improvement)

Check-back

•Closed loop communication to ensure information was conveyed by sender and receiver understood •Steps include •Sender initiates the message •Receiver accepts the message and provides feedback •Sender double-checks to ensure that the message was received •Example: •HCP: "Give 1 mg Morphine IV push now" •Nurse: "1 mg Morphine IV push now" •HCP: "That is correct"

2 steps that involve situation monitoring

•Cross Monitoring •STEP •I'M SAFE checklist

Brief Checklist

•During the brief, the team should address the following questions: •Who is on the team? •All members understand and agree upon goals? •Roles & responsibilities are understood? •What is our plan of care? •Staff and provider's availability throughout the shift? •Workload among team members? •Availability of resources?

environment

•Facility information •Administrative information •Human resources •Triage acuity (triage the patients, prioritize who is seen first/last and their needs) •Equipment (is it working properly?)

Team members

•Fatigue •Workload (are hcp over worked) •Task performance (ratio of pt to PRN) •Skill (some LVN cant administer ivs) Stress (having multiple patients plus helping a new graduate)

4 aspects of Mutual Support

•Feedback •Two challenge rule •CUS Collaboration

**I'M SAFE Checklist

•I = Illness (too sick to come to work) •M = Medication (does it impair ability to work) •S= Stress (life or work event effecting you) •A= Alcohol and Drugs •F= Fatigue •E= Eating & Elimination

Call-Out

•Informs all teams members simultaneously during emergent situation •Helps team members anticipate next step •Direct responsibility to a specific person for carrying out the task •Example: •Leader: "Airway status?" •Resident: "Airway clear" •Leader: "Breath sounds?" •Resident: "Breath sounds decreased RLL." •Leader: "BP?" Resident: "BP is 90/62"

Adverse Events (AEs)

•Institute for Healthcare Improvement (IHI) •Adverse events •10-20% of errors reported •Of those, 90-95% cause no harm •Trigger tools •Triggers or clues to identify adverse drug events

Two Challenge Rule: (Mutual Support)

•It is your responsibility to assertively (not aggressively) voice concerns at least two (2) times •Team member being challenged must acknowledge •IF the outcome is still not acceptable: •Take a stronger course of action •Utilize supervisor or chain of command •Empower all team members to "stop the line" if they sense/discover an essential safety breach

Why Teamwork?

•Reduce clinical errors •Improve patient outcomes •Improve process outcomes •Increase patient satisfaction •Increase staff satisfaction •Reduce malpractice claims

5 types of Communication

•SBAR •Call-Out •Check-back •Handoff "I PASS the BATON"

Progress toward goal

•Status of team's patient(s)? •Established goals of team? •Tasks/Actions of team? •Plan still appropriate?

Briefs

•Talking about what youre planning to do for the day; or in one particular situation what is going on

Task assistance

•Team members protect each other from work overload situations •Effective teams place all offers & supports in terms of patient safety •Team members foster a climate that assistance is actively sought & offered

Feedback should be: (Mutual Support)

•Timely: Given soon after behavior has occurred •Respectful: Focus on behaviors & Not personal attributes •Specific: About what behaviors need correcting •Directed toward improvement: Provide directions for future improvement •Considerate: Consider team member's feelings & Deliver negative information with fairness & respect

Handoff

•Transfer of information during transition of care •Change of shift •Patient transfer •Opportunity to ask questions, clarify, & confirm