TeamSTEPPS for Patients: A Pilot Test in Labor and Delivery

TeamSTEPPS for Patients: A Pilot Test in Labor and Delivery December 17, 2014 TeamSTEPPS for Patients TeamSTEPPS Acknowledgements Project Sponsors Jim Battles, PhD (AHRQ) Heidi King, MS (DoD) Project Team Mod 1Slide 05.2 2 Page 2

Health Research & Educational Trust (HRET) Barb Edson (Project Director) Chris Hund (Project Manager) IMPAQ International David Baker (Team Lead) TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS TeamSTEPPS Master Training Two-day training course Train-the-trainer approach Prepares you to serve as a TeamSTEPPS Master Trainer by Providing instruction on TeamSTEPPS tools and strategies Providing an opportunity to develop and plan your

TeamSTEPPS implementation Prepares you to serve as a leader for implementing TeamSTEPPS within your organization Mod 1Slide 05.2 3 Page 3 TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Help Line (312) 422-2609 Or email: [email protected] Mod 1Slide 05.2 4 Page 4

TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Rules of Engagement A Q&A session will be held at the end of the presentation Written questions are encouraged throughout the presentation and will be answered during the Q&A session To submit a written question, type it into the Discussion Area at the top left of your screen and send it at any time during the presentation The lines may open for call-in questions during the Q&A session Mod 1Slide

05.2 5 Page 5 TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Todays Presenter David P. Baker, PhD IMPAQ International Chief Program Officer Involved with TeamSTEPPS since the beginning Director, Health Services Research Institute, Carilion Clinic (2007-2010) Associate Professor, Virginia Tech Carilion School of Medicine, IPE Block Design Team Mod 1Slide 05.2 6 Page 6 TEAMSTEPPS 05.2

TeamSTEPPS for Patients TeamSTEPPS Objectives Describe the development of a TeamSTEPPS curriculum for patients and their family members Provide an overview of methods used to pilot test the curriculum Present the results and implications of the pilot test Mod 1Slide 05.2 7 Page 7 TEAMSTEPPS 05.2 TeamSTEPPS for Patients

TeamSTEPPS Project Background Work funded under an AHRQ Demonstration Grant (R21) Grant program focused on Risk and Litigation Work done at Carilion Clinic Research Team David P. Baker, PhD (Principal Investigator) Patrice Weiss, MD (Co-Investigator) Laurie Spotswood, MSEd, CLS (Research Specialist) Anthony Slonim, MD, DPH (Co-Investigator) Mod 1Slide 05.2 8 Page 8 TEAMSTEPPS 05.2

TeamSTEPPS for Patients TeamSTEPPS Research Background Patients and family members are core members of the care team Studies have shown increases in patient satisfaction and self-efficacy when patients/families are included in the care team (Dunst et al., 2007) Including patients and their family members in the care team should: Yield better communication between providers and patients/families (As a result) Mitigate risk and reduce liability claims Could patients and family members benefit from TeamSTEPPS training?

Mod 1Slide 05.2 9 Page 9 TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Research Background (Contd) Little research to-date on how to: Mod Slide 1 05.2 10 Page 10 Include patients and their family members as part of the care team Train patients and their family members to be effective team members (including what training should consist

of, when it should occur, and its results) TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Project Purpose To understand patient and family responsibilities within the care team To develop and pilot test a shortened version of the TeamSTEPPS curriculum that: Mod Slide 1 05.2 11 Page 11 Teaches patients/families how to be members of the care team

Enhances communication between patients/families and providers TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Research Aims 1. Identify L&D events that vary in terms of risk and liability and require teamwork 2. Identify the root causes of each event 3. Conduct patient/family focus groups team member responsibilities and useful TeamSTEPPS tools 4. Develop and test a module for teaching TeamSTEPPS tools to patients/family members Mod Slide 1 05.2 12 Page 12

TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Patient/Family Focus Groups 47 total patients/family members 18 pregnant 28 had experienced a medical error 9 healthcare workers Focus groups were two hours long Mod Slide 1 05.2 13

Page 13 Discussed patient/family responsibilities Discussed patient/family-provider communication Discussed disclosure Reviewed TeamSTEPPS tools TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Focus Group Approach Introductions, Informed Consent, and Housekeeping Purpose of this Research Review Outcome and Discuss Patient and Family

Responsibilities Review and Discuss Possible Breakdowns in Care Short Survey Doctor and Patient Communication Mod Slide 1 05.2 14 Page 14 TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Focus Group Approach Presented information on SBAR, Check-Back, Two-Challenge Rule, CUS, and Briefs, Huddles and Debriefs For each tool, participants were asked:

Mod Slide 1 05.2 15 Page 15 Do you think the tool is clear and would be easy to use? Would you feel comfortable using the tool with doctors and nurses providing you care? Do you think it would be a good idea to provide training to patient/family members on the tool? TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Training Objectives Describe how the patient and family fits into the

clinical team Describe the patient and family responsibilities as team members Describe the clinical team member roles and responsibilities Describe the core components of team leadership, assertion, and communication Describe TeamSTEPPS tools that can be used by patients Mod Slide 1 05.2 16 Page 16 Briefs, Huddles, and Debriefs Assertive Statement and Two-Challenge Rule SBAR and Check-Back TEAMSTEPPS 05.2

TeamSTEPPS for Patients TeamSTEPPS Mod Slide 1 05.2 17 Page 17 TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Pilot Test Included 28 participants Patients and family members who were receiving or had recently received L&D care Participants trained across three classes

Collected data on participant reactions and learning Mod Slide 1 05.2 18 Page 18 TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Reactions Measure Assessed participant reactions to training at two levels: Did participants like the training (i.e., affective reactions)?

Did the participants find the training useful (i.e., instrumentality)? Participants completed the reaction questionnaire post-training only Mod Slide 1 05.2 19 Page 19 TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Reactions Measure Mod Slide 1 05.2 20 Page 20 TEAMSTEPPS 05.2

TeamSTEPPS for Patients TeamSTEPPS Participant Learning Learning is defined as changes in knowledge, skills, or attitudes Assessed participant learning in terms of: Participant attitudes toward teamwork TeamSTEPPS Teamwork Attitudes Questionnaire (TTAQ) Knowledge of teamwork TeamSTEPPS Learning Benchmarks

Both measures administered pre- and post- training Mod Slide 1 05.2 21 Page 21 TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS T-TAQ Sample Items: It is important to ask patients and their families for feedback regarding patient care. (Team Structure) It is important for leaders to take time to discuss with their team members plans for each patient. (Leading Teams) Even individuals who are not part of the direct care team should be encouraged to scan for and report changes in patient status. (Situation Monitoring)

It is appropriate to continue to assert a patient safety concern until you are certain that it has been heard. (Mutual Support) Adverse events may be reduced by maintaining an information exchange with patients and their families. (Communication) Participants indicate agreement on a Likert scale ranging from Strongly Disagree to Strongly Agree Mod Slide 1 05.2 22 Page 22 TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Sample TeamSTEPPS Learning Benchmarks Item 1. A nurse is called to the phone to receive a telephone order from the doctor about a patient she is taking care of today. After clearly establishing the patient and physician identities, the BEST procedure for the nurse would be

A. Listening to the order, calling the pharmacist, writing the details on the order sheet, and bringing the drug to the bedside. B. Refusing to take this telephone order and indicating that she can't be sure of the physician's thought process C. Listening to the order, repeating back what the doctor said, and then writing it down in the patient's medical record. D. Listening to the order, asking the charge nurse how to spell the drug's name, asking the family member if that was in the plan for today and carrying out the order. E. Listening to the order, writing it on the order page, reading the order back to the physician and seeking his verification of the order's accuracy. Mod Slide 1 05.2 23 Page 23 TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Results: Reactions Overall mean rating was 4.18, on a 5-point scale

This training would be appropriate for patients in all care settings This training should be offered by . in the future Highest Rated Items This training would be appropriate for patients in all care settings This training should be offered by Carilion in the future Lowest Rated Item The tools appear easy to use Mod Slide 1 05.2 24 Page 24 TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS

Results: Learning Attitudes (T-TAQ) Pre-training Mean (4.51) Post-training Mean (4.55) Learning (Learning Benchmarks) Pre-training Mean (10.86 items correct) Post-training Mean (12.28 items correct) Mod Slide 1 05.2 25 Page 25 TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Discussion The results found that participants: Thought the training was useful Had very positive reactions to the curriculum and its potential future implementation and use

Future research should consider: Mod Slide 1 05.2 26 Page 26 Larger demonstration and implementation of the training Measuring transfer of trained skills (Level III) Measure impact on quality of care and safety outcomes (Level IV) TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Conclusions Teaching patients/family members some core

TeamSTEPPS tools has promise Labor and Delivery Chronic care A short curriculum enhanced patient/family member knowledge Curious if learning would transfer Mod Slide 1 05.2 27 Page 27 GBS positive Management of family members in the delivery room TEAMSTEPPS 05.2 TeamSTEPPS for

Patients TeamSTEPPS Questions and Answers Mod Slide 1 05.2 28 Page 28 TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Upcoming TeamSTEPPS Events Monthly Teleconferences Scheduled through September 2015 Topics, speakers, and registration information will be posted on the portal

Annual Conference Mod Slide 1 05.2 29 Page 29 June 16-18, 2015 Denver, Colorado at the Westin Downtown Denver TEAMSTEPPS 05.2 TeamSTEPPS for Patients TeamSTEPPS Thank You! For more information, please contact our team at: [email protected] Mod Slide 1 05.2 30

Page 30 TEAMSTEPPS 05.2

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