Nurses Find TeamSTEPPS Improves Communication and Outcomes

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By Debra Wood, RN, contributor

“To err is human” may be a true statement, but studies have shown that humans err less frequently when they learn to communicate clearly and work well with their colleagues.  This concept is especially important in health care, where patients’ health and providers’ reputations are on the line.

A group of employees at UNC Health attend TeamSTEPPS training. Photo courtesy UNC.

Thus, improving health care professionals’ communication and teamwork skills through an initiative like TeamSTEPPS training leads to fewer adverse events and better outcomes for patients.

“TeamSTEPPS has been very rewarding, personally, and lots of staff had an opportunity to embrace a new way of communicating, which they said they needed,” said Celeste Mayer, RN, Ph.D., patient safety officer at University of North Carolina (UNC) Health Care System in Chapel Hill, which participated in a pilot training program. The program was first implemented in UNC Health Care’s pediatric and surgical intensive care units.

Celeste Mayer, RN, Ph.D.
Celeste Mayer, RN, Ph.D., reports TeamSTEPPS has been well received by staff while improving teamwork, leadership, communication and other skills. Photo courtesy UNC.

The U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense Patient Safety Program developed TeamSTEPPS, an evidence-based, multimedia, training program in response to the Institute of Medicine’s call for “interdisciplinary team training programs that incorporate proven methods for team management” to prevent medical errors.

More than 135 military units and clinics have received some TeamSTEPPS training and are in various stages of implementing the program’s tools and strategies. In addition, more than 1,000 military medical personnel serving in Iraq have been trained in TeamSTEPPS.

“This is a total culture change within an organization,” said Deborah A. Milne, RN, MPA, senior research scientist at the American Institutes for Research in Washington, D.C., the prime contractor for AHRQ and the Department of Defense in training health care professionals in TeamSTEPPS methods. “It’s been a very successful program.”

TeamSTEPPS’ four components are leadership, communication, mutual support and situational monitoring. Communication tools include SBAR (situation, background, assessment and recommendation) and check-backs. For example, if the physician orders give 25 mg of Benadryl IV push, the nurse repeats 25 mg of Benadryl IV push, and the physician must confirm.

Sue Wendell, RN, BS, CPHQ
Sue Wendell, RN, BS, CPHQ, has found TeamSTEPPS beneficial in creating a common language and promoting better communication. Photo courtesy Abington.

“It feels a little awkward, but the staff thought it made perfect sense,” Mayer said.
Twenty UNC Health Care clinicians received the initial training. They in turn educated their co-workers. In all four components, Mayer reported statistically significant improvement as measured by observations and speed in delivering certain procedures. UNC Health Care has since trained more than 600 staff and faculty in nine units, including the operating room, air transport, bone marrow transplant, labor and delivery and the neonatal intensive care unit.
The government offered free two-day training sessions to 1,200 people. All slots are assigned, but the American Institutes for Research keeps a waiting list.
“The training is intense,” said Amanda Reynolds, RNC, BSN, adjunct clinical faculty at the University of Missouri St. Louis and a clinical educator in women’s services at SSM DePaul Health Center in St. Louis. “There are great video vignettes. It gives people taking the course [an opportunity] to learn and interact with their team workers.”
Mayer added that training together encouraged teamwork between the physicians, nurses and other members of the health care team. They role-played and gave each other feedback.
AHRQ and the Department of Defense will continue to offer the materials at no charge via their Web site, http://teamstepps.ahrq.gov/.
Abington Memorial Hospital in Abington, Pennsylvania, obtained the program’s toolkit from AHRQ in 2007, tailored it to the hospital’s needs including shortening it to four hours, and implemented it initially in nursing. The facility has since taught TeamSTEPPS to 2,850 staff members, residents and attending physicians.
“It creates a common language,” said Sue Wendell, RN, BS, CPHQ, safety and quality specialist at Abington Memorial. “We’re communicating in a common way across the organization.”
Although each professional comes to the situation with different views, communication and situational monitoring help clinicians respect each other’s contributions and work more collegially with members of the team. It teaches people how to bring up concerns without making it seem like a personal attack.
“You have the ability to speak up and stop the line if you need to,” Wendell said.
Abington has improved compliance with handwashing guidelines since team members began applying TeamSTEPPS and implementing other strategies. Observational studies now show 75 percent of staff wash their hands when indicated, up from 35 percent before TeamSTEPPS.
The hospital also has noted a 27 percent decline in inpatient adverse events per 1,000 days, as measured by the Global Trigger Tool, and a 30 percent decrease in the crude hospital mortality rate.
TeamSTEPPS encourages clinicians who notice a patient at risk for an adverse outcome to call a “huddle” with everyone involved in the patient’s care to talk about what has happened and work together toward a better outcome.
“It was an opportunity for our staff to compliment each other about things we did well and give a forum to acknowledge things we could do better the next time,” Reynolds said. “You are not punished for a mistake, but [we] use that opportunity to improve on our care.”
Situational awareness is as a valuable component of TeamSTEPPS. Every nurse on the SSM DePaul maternal health unit not only assumes responsibility for his or her patients but also makes sure they know what is going on around them.
“If I’m more in tune with what is going on in the unit, I can watch out for the next person’s patient,” Reynolds said. “You watch out for your team member’s back. People appreciate it, and it makes a better working environment.”

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