implementation from 0 to 60 - metrohealth's story of ... 1 implementation from 0 to 60:...
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6/10/2015
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Implementation from 0 to 60: MetroHealth’s Story of SuccessJackelyn Csank, EMT-P Joseph Golob, MD Julia Gorecki, BSN, RN, MBA Victoria Jenkins, BSN, RN, CNOR Jay Koren, RN, BSN Ken Salisbury, RN, BSN, CNOR Robert Smith, PhD
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Implementation from 0 to 60: MetroHealth’s Story of
Success
Robert L. Smith, PhD
Director, Medical Staff Assistance Program
Director, TeamSTEPPS Regional Training Center
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Who is MetroHealth?
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
• Serving Cuyahoga Countyin Cleveland since 1837
• One of the largest healthcare organizations in Northeast Ohio
• 700-bed medical center
• 17 community health centers
MetroHealth
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Staffing
• Over 476 Primary Care/ Specialty Physicians
• 1,230 Registered Nurses
• 145 Advanced Practice Nurses
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Training Programs• Twenty-four Residency Programs
• Fifteen Fellowship Programs
• 1st and 2nd Year Medical Students, etc.
– 1035 “students”
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Patient Care at MetroHealth
• Care provided in 2014
– 28,000 inpatients
– 2,900 newborns delivered
– Over 1,000,000 visits in outpatient centers
– Over 107,000 visits to the Emergency Department
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
TeamSTEPPS and MetroHealth2013 Implementation
• Identified TeamSTEPPS Champion
• Established TeamSTEPPS Change Team
• Prepared Master Trainers
• Developed Steering Committee
• Agreed to Implement System-wide
• Developed Instructor Training Course
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Organizational Change Team
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
• Quality Department
• OB/GYN
• Emergency Medicine
• Surgery
• Trauma / Burn Units
• Medicine
• Pediatrics
• Geriatrics
• PM&R
• Ambulatory Care
• Medical ICU
• Organizational Develop
• Simulation Center
• Communication
• Diversity and Inclusion
• Marketing
• MetroHealth Union
Organizational Change Team
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Target Administration for Buy‐In
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Examples of MetroHealth’s
Administrative Buy-In
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth’s Mission
“Leading the way to a healthier you
and a healthier community
through service, teaching, discovery
and
teamwork.”
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth’s Values
• Service to Others
• Teamwork
• Accountability
• Respect
• Inclusion and Diversity
• Quest for Excellence
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
TeamSTEPPS and MetroHealth2014 Implementation
• Emergency Department
• Critical Care/ Trauma/ Burn Units
• Operating Room and PACU
• Labor & Delivery, NICU and Post-Partum
• Administration, Strategic Planning, Foundation
• Physical Medicine and Rehabilitation
• Middleburg Hts. Ambulatory Care
• Ambulatory Surgery on Main Campus
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
TeamSTEPPS and MetroHealth2014
Establishment of Action Councils
• Part of Sustainability
• Clinical and Non-Clinical Areas
• Goals:– Improve Patient Safety/ customer services
– Improve patient/customer satisfaction
– Improve Employee Satisfaction
– Improve Processes and Efficiencies
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
TeamSTEPPS and MetroHealth2015
• Approximately 1/3 of staff trained
• On Deck:– Cardiology
– Pulmonology
– Internal Medicine
– Pediatrics
– Finance / Information Systems
– Ambulatory Network
– Environmental Services / Dietary / TextilesMetroHealth and Case Western Reserve University, affiliated since 1914,
partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
“TeamSTEPPS Implementation: It's more than just training. It's a
culture change.”
Joe Golob, MDTrauma Surgeon and Surgical Intensivist
Medical Director of Hospital Patient SafetyMedical Director of the Surgical Intensive Care Unit.
andJay Koren, RN, BSN
Nurse Manager, Surgical Intensive Care Unit
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Physicians Nurses
Respiratory
PT/OTPharmacy
Social workCase Manager
Nutrition
Patient and Family
ICU Care: The Pieces
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Patient and Family
Physician
Nurse
Respiratory
PT/OTPharmacy
Social workCase Manager
Nutrition
Pre-TeamSTEPPS Culture
Care is given by “teams of experts”MetroHealth and Case Western Reserve University, affiliated since 1914,
partners in advancing patient care through research and teaching.
Patient and FamilyPhysician
Nurse
Respiratory
PT/OT Pharmacy
Social workCase Manager
Nutrition
Patient andFamily
Post-TeamSTEPPS Culture
Care given by “an expert team”/not “teams of experts”
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
The Process of Change
1. TeamSTEPPS Organizational Readiness Assessment• Evaluates need, readiness for change, time, resources, personnel and sustainment of change
2. Surveyed the entire unit staff on their perception of patient safety, communication and job satisfaction• Modified version of the AHRQ’s Patient Safety Culture Survey
SHARED RESULTS WITH STAFF!
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
The Process of Change3. Created a TeamSTEPPS Intervention – TeamSTEPPS Rounding Improvement Project (TRIP)
4. Five‐hour TeamSTEPPS training for the entire unit
5. Implemented TRIP
6. Re‐surveyed the entire unit staff on their perception of patient safety, communication and job satisfaction
SHARED RESULTS WITH STAFF!
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Pre-TeamSTEPPS Patient Safety Grade
Positive (Grade A or B) = 73%
Negative (Grade C, D, F) = 27%
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Pre-TeamSTEPPS Communication Grade
Positive (Grade A or B) = 70%
Negative (Grade C, D, F) = 30%
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Handoff to Jay Koren
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
TeamSTEPPS Rounding Improvement Project (TRIP)
1. Nurse initiates rounds, reviewing and presenting overnight events, concerns, and current clinical data
2. Physicians examines patient and discusses daily plan
3. Nurse summarizes the daily plan
4. Attending closes by asking the team if they have any unanswered questions, concerns and creates a follow up list for the remainder of the day.
Major TeamSTEPPS Tools Used: briefs, call outs, checks backs, check lists, debriefs
Sterile Cockpit!
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Patient Introduction and Nurse Report Video
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Physician Forming Treatment Plan Video
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Nurse Summary Video
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Physician Summary Video
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
TeamSTEPPS Rounding Sheet
• Overnight issues and nursing concerns• Vital signs / Drips / Labs• Additional information: activity, lines/tubes, skin issues
• Plan summary
• Review the rounding process• Attending debrief check list• Follow up items
BACK
FRONT
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Problems Encountered with TRIP Implementation
• Angry night nurses– “Filling out the TRIP sheet is busy work”
• Angry day nurses– “Reporting vitals and labs is a resident’s job”
• Impatient attending intensivists– “I have to wait for the nurse to round?”
• Implementation of the sterile cockpit– “No interruptions?”
• Increased time on rounds – Not really!
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Post-TeamSTEPPS Patient Safety Grade
Positive (Grade A or B)
Pre‐TeamSTEPPS = 73%
Post‐ TeamSTEPPS = 91%
Negative (Grade C, D, F)
Pre‐TeamSTEPPS = 27%
Post –TeamSTEPPS = 9%
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Post-TeamSTEPPS Communication Grade
Positive (Grade A or B)
Pre‐TeamSTEPPS = 70%
Post‐ TeamSTEPPS = 81%
Negative (Grade C, D, F)
Pre‐TeamSTEPPS = 30%
Post –TeamSTEPPS = 19%
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Continued TRIP Improvement• Trained observers, blinded to the rounding team audited TRIP rounds– 262 TRIP rounding observations– Entire Team present during rounds: 81%– All four parts of the rounding process used: 71%
• Identified issues:– Nurse not always available for rounds– TRIP sheet not always complete and legible– Attending forgets to conduct the end of rounds debrief and summary
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Conclusions• Utilize the TeamSTEPPS Implementation Guide
• Collect data and show the staff so they know personally what TeamSTEPPS is trying to improve in their unit
• Utilize frontline staff to create a project to be started during or immediately after training to show staff they are using TeamSTEPPS
• Continue to modify the process and make improvements
• Show the staff success!
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
“Us,” “Them,” and “CUS”ing in the Operating Room:
Moving toward safer surgery through TeamSTEPPS
Vicki Jenkins, BSN, Manager of Central Sterile Processing
andKen Salisbury, B.S.N., R.N.,CNOR OR Nurse / Quality
Improvement Facilitator
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Surgery at MetroHealth
• Only Level I Adult Trauma Center in the Cleveland, Ohio area
• 20 Operating Rooms
• Surgery Teams wear “two hats:” – Trauma surgeries
– Elective Surgeries (i.e., hip and knee replacements)
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
These surgeons can replace an arthritic hip and restore a patient’s independence and quality of life. In a trauma, they can save lives. They need instruments that are functional and sterile.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
How Do You Sterilize a Tray?• Ultrasonic washer (five minutes) - preliminary cleaning
• Commercial instrument washer (20-35 minutes) thorough cleaning
• Assemble tray - manually check cleanliness and functionality.
• Every instrument must be totally free of any bio-burden
• Tray placed in the sterilizer (60 minutes) 270 degrees F°and then time to dry.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
How Do You Sterilize a Tray?• Sterilizer door is opened to allow the instruments to cool.
• If tray is pulled too quickly, water vapor condenses and causes a “wet tray,” negating the sterilization process.
• Entire sterilization process takes approx. four hours.
• If instruments are not cleaned effectively, the process is repeated or the tray is “flashed” in the Operating Room.
• If instruments are missing, OR staff must find substitutes.
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
What Happens If the Instruments are Not Right?
• Infections
• Injuries to patients and staff
• Delays in patient care
• Increased healthcare costs
• Staff turnover
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
A Long Cleveland Winter • OR and Central Sterilization were physically separated in
2005. They had been connected for decades.
• By winter of 2013-2014, conditions deteriorated.
• OR Staff encountered missing / contaminated instruments.
• OR staff felt they could not “trust their instruments” and began “flashing” instruments or using other trays.
• Stress level was high, morale was low, and staff dreaded coming to work.
• It became “Us” (Surgeons and OR Staff) versus “Them” (Central Sterilization).
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Learn to CUSAssertive Communication
If an error is about to occur
“Stop the line!”
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Spring 2014- Day OneCulture Change
• March of 2014, MetroHealth was under new leadership, and our CUSing was heard by the new administration.
• Staff members from the OR, Anesthesia, PACU and Surgeons were selected to serve as TeamSTEPPS coaches/instructors.
• 22 instructors were trained- multidisciplinary group
• The instructors designed a four hour TeamSTEPPS training module specific to the Perioperative Area.
• 24 four-hour classes were conducted.
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Spring 2014- Day OneCulture Change
• Keys to Success:
• Leadership support
• Surgeon support
• Quality instructors with passion and resilience
• Relevant curriculum
• Brief/Huddle/Debrief - use your strengths
• Safe environment for open/honest discussion
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Spring 2014- Day OneCulture Change
What did we learn:• There are hardworking, caring, and dedicated staff
members in every department
• Everyone wanted to keep patients safe.
• Staff in Central Sterilization knew what needed to change but were afraid to speak up.
• We knew less than we thought about each other’s jobs and needed TeamSTEPPS tools and techniques to work better together.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Spring 2014- Day TwoCulture Change
• It took almost a decade to create a culture of distrust.
• Changing this will be a long-term process.
• We are now talking, creating policies, and implementing the tools we learned in TeamSTEPPS.
• TeamSTEPPS is the framework and the toolkit to build a culture of trust to provide safer care.
• So, what happened in Central Sterilization?
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Summer 2014- Day TwoCulture Change
• Perioperative TeamSTEPPS Action Council
• Consists of representatives from 15 disciplines/ job categories in Perioperative Services
• Issues are identified and interdisciplinary project teams are formed to find and implement solutions
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Handoffto Vicki Jenkins
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
July 2014
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
TeamSTEPPS “Wrong Fit” Leader
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.56
Please Use CUS Wordswhen appropriate!
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.57
Conflict ResolutionDESC Script
D—Describe the specific situation
E—Express your concerns about theaction
S—Suggest other alternatives
C—Consequences should be stated
Ultimately, consensus needs to be reached.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
DESC
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
TeamSTEPPS Tools
Brief
Huddle
DebriefMetroHealth and Case Western Reserve University, affiliated since 1914,
partners in advancing patient care through research and teaching.
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
TeamSTEPPS Tools
Handoff
Checklists
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
January February March
Quarter 1
2015
100%
99.5%99.5%
100%
99.2%
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
100%
2015
January February March April May
Quarter 1 Quarter 2
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
April 2015
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
TeamSTEPPS and CSPD Video
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Fast Track to Ebola PreparednessUsing TeamSTEPPS Concepts
Julia Gorecki, BSN, RN, MBA
Director of Nursing, Emergency Department and Life Flight Operations
and
Joe Tagliaferro, DO
Chief Resident, Emergency Department
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Objectives
• Discuss value of TeamSTEPPS in Ebola/Emerging Infectious Disease Preparedness Planning
• Identify components of TeamSTEPPS used in the Ebola/Emerging Infectious Disease Protocols
• Discuss power of simulation in preparing teams for managing the Ebola/Emerging Infectious Disease Patients
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Ebola Virus
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Ebola Virus Disease (EVD) Preparedness Planning
• MetroHealth began planning for EVD in July, 2014
• Increased urgency due to Texas case– MetroHealth RNs on flight with nurse from
Texas
– Public Concern – furloughed nurses
– Prepared to care for patient under investigation (PUI)
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Multi-Team System (MTS)
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Team Structure
• Core Team– Situation Leader assembles care team
• Tools and Strategies– Brief
• Role assignment, equipment checklist, shared mental model
– Checklist for safe donning/doffing
– Situation Monitoring
• Leader and team membersMetroHealth and Case Western Reserve University, affiliated since 1914,
partners in advancing patient care through research and teaching.
Team Observation ToolED Ebola Response
1. Team Structure
o Situation Leader (SL) established
o SL assembles care team
o Nurse
o Physician
o PPE checklist reader
o PPE helper
o Relief nurse rotation
o SL verifies that all equipment is available for patient care
o SL holds team members accountable
o SL actively shares information among team members
Emergency DepartmentTeam Process• Team Structure• Leadership• Situation Monitoring
• Mutual Support• Communication
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Team Observation ToolTeam Process
o Care team follows PPE protocolso Care team renders care to patient as
dictated by situationo Care team communicates findings and
needs2. Leadership
o SL conducts brief before any patient contact to review process, protocol, goals
o SL conducts huddle as necessary to review progress toward the goal
o SL empowers team members to speak freely, ask questions, and “stop the line” if a breach in protocol occurs
o SL conducts debrief to review adherence to process and achievement of goals
Emergency DepartmentTeam Process• Team Structure• Leadership• Situation Monitoring
• Mutual Support• Communication
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Coordinating Team
• Infection control – team support– Content experts
– Communication with CDC, local health departments
• Training– Reinforce shared mental model
– Goals of preparedness
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Donning / Doffing ChecklistPerformance Activity: PAPR ‐ Inpatient Donning
**BUDDY MUST BE PRESENT TO OBSERVE DONNING PROCESS
□ Complete Vital Signs & PPE Checklist
□ Ensure all parts of PAPR belt are in working order:
□ Complete airflow test of machine
□ Visually inspect the integrity of the tubing
□ Check the expiration date of the filters
□ Ensure battery pack is fully charged
□ Change into blue surgical scrubs & impermeable work shoes
□ Remove all jewelry, pagers, cell phones etc.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Donning / Doffing Checklist□ Remove hospital ID badge
□ Pull hair into a tie back if needed
□ Wash hands
□ Tape bottom of scrubs at ankle so they do not ride up
□ Don white Tyvek suit – except hood
□ Buddy is to roll hood of Tyvek suit, tucking it into the back of the suit
□ Step into the Tyvek trauma booties
□ Put first layer of surgical gloves on over the Tyvek sleeves
□ Tape circumference of each wrist
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Team Process
• Contingency Team
– Support Core Team – Environmental Services, Lab, Radiology
– Planning Protocols – team meetings Include in Briefs – Huddles – Debriefs
– Shared Mental Model – reduce fear
• Simulation training
• Communication
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
PPE Inspection ChecklistPAPR FILTER DATE CHECKED VISUAL TUBING INSPECTIONBATTERY CHARGED AIRFLOW TEST INNER SHROUD TUCKEDTYVEK SUIT GLOVES TAPED OUTER GLOVES TRAUMA BOOTIES ISSUES OR BREACHES:
CHECKED BY: _____________
TIME IN SUIT: ____________
TIME OUT SUIT: __________
PAPR Buddy Checklist
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Role of Leadership
• Support from Senior Leadership– Communicate vision – community
support
– Support policies and procedures
• Team sent to Emory for training
– Equipment, supplies, training
• Financial Support
– Leadership Team Meetings with Coordinating Team
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Tools and Strategies
• Special Disease Containment Unit– Team Structure – Selection and Training
– Briefs – Huddles – Debriefs
• Daily Family Meeting
– Mutual Support and Situational Monitoring
– Stop the line and CUS
– Checklists - Equipment, Supplies, Processes, Safety with PPE, Caregiver
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Caregiver ChecklistBLOOD PRESSURE* Diastolic >105* Systolic < 100 > 150
HEART RATE:* > [70% (220‐Age)]* Any irregular rate/rhythm
RESPIRATIONS:* >24 / minTEMPERATURE:* < 99.5 FWEIGHT:SKIN:* Open Sores, large rash, Or sunburn
HYDRATION:
Situational Monitoring
• Performed for all direct caregivers
• Baseline data
• Safe to don suit
• Monitored daily by employee health
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Handoff Communication
• Checklists for handoff
• SBAR – patient handoff
• Team handoff at shift change
Handoff to Jackie Csank
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
The Team The Space…..
• 635 hours of Simulation
• 2,700 + Sim North + Morgue +
Creepy Room + Soon to be Sim West
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Simulation Power• Apply knowledge
• Realistic appraisal of systems, processes and personnel
• Deliberate practice
• Direct Observation
• Recording
• Debriefing / Feedback
• Train to Mastery
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Simulation• SDCU Design
– Team roles / structure – Communication – Mutual Support
• Doffing– Checklist – Situational Leader– Team roles / structure– Situational monitoring– Communication– Mutual support
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TeamSTEPPS and Doffing Video
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Results of Debriefing
• Insights / observations
• Improvements – protocol revision
• Repetition / Video
• Applying lessons learned
– SDCU and Care Team
– Transport Team
– Lab
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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Staff Response
Impact of TeamSTEPPS Tools
and Simulation
– Shift from Individual Caregivers to a Strong Team
– Shift from “Raw” to “Well Done”
– Shift from Uncomfortable to Comfortable
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Regional Treatment Center
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Questions
MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching.
Contact Information
Robert L. Smith, Ph.D.Director, TeamSTEPPS Regional
Training CenterMetroHealth System, Cleveland,
Ohio
Office: (216) 778-3399
Email: [email protected]