Team STEPPS for Code Blue Teams Piloting SBAR

Team. STEPPS for Code Blue Teams: Piloting SBAR & CUS for Interprofessional Team Education April 8, 2015

Team. STEPPS for Code Blue Teams Team. STEPPS® Rules of Engagement n Audio for the webinar can be accessed in two ways: 1. Through the phone (*Please mute your computer speakers) 2. Through your computer n A Q&A session will be held at the end of the presentation n Written questions are encouraged throughout the presentation and will be answered during the Q&A session n To submit a question, type it into the Chat Area and send it at any time during the presentation n The lines may open for call-in questions during the Q&A session Mod 1 05. 2 Page Slide 2 2 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Acknowledgements n Project Sponsors n n Jim Battles, Ph. D (AHRQ) Heidi King, MS (Do. D) n Project Team n n Mod 1 05. 2 Page Slide 3 3 Health Research & Educational Trust (HRET) n Barb Edson (Project Director) n Chris Hund (Project Manager) IMPAQ International n David Baker (Team Lead) TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Team. STEPPS Master Training n Two-day training course n Train-the-trainer approach n Prepares you to serve as a Team. STEPPS Master Trainer by n n Providing instruction on Team. STEPPS tools and strategies Providing an opportunity to develop and plan your Team. STEPPS implementation n Prepares you to serve as a leader for implementing Team. STEPPS within your organization Mod 1 05. 2 Page Slide 4 4 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Upcoming Team. STEPPS Events n Monthly Webinars n Scheduled through September 2015 n Topics, speakers, and registration information will be posted on the portal n Register now for the May webinar: I-PASS: Integrating High Quality Handoffs into Team. STEPPS and Hospital Care n Master Training Courses n Registration available for courses through August 2015 n Online Course Availability n Not able to travel? Team. STEPPS 2. 0 Online Master Trainer Course now available n Mod 1 05. 2 Page Slide 5 5 Register and enroll at: https: //tslms. org TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Upcoming Team. STEPPS Events (Cont’d) n Annual Conference n June 16 -18, 2015 n Denver, Colorado at the Westin Downtown Denver n Learn more and register for all events at www. Team. STEPPSportal. org Mod 1 05. 2 Page Slide 6 6 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Help Line (312) 422 -2609 Or email: AHRQTeam. STEPPS@aha. org Mod 1 05. 2 Page Slide 7 7 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Today’s Presenters n Ken Miller, RN, MSN, CCRN n n Simulation Education Program Coordinator Department of Nursing Practice, Research, and Education n Edward Lee, MD n n n Mod 1 05. 2 Page Slide 8 8 Assistant Clinical Professor, Hospitalist Section UCLA Department of Internal Medicine Chair, Code Blue QI Committee TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Objectives n Provide an overview of Code Blue teams and interprofessional team education at UCLA n Describe the identification of the need for Team. STEPPS tools among code blue team members n Describe how interprofessional code team training and Team. STEPPS tools are being implemented n Present data measuring the effectiveness of the intervention Mod 1 05. 2 Page Slide 9 9 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Code Blue Team Overview n Ronald Reagan UCLA Medical Center n Level I Trauma Center n 520 Acute inpatient beds n 6 different intensive care units (ICU) n Teaching hospital with 76 ACGME accredited programs and over 1000 physician trainees n Tertiary/quaternary referral center n High volume transplant center Mod 1 Slide 10 05. 2 Page 10 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Code Blue Team Overview n Code Blue Team Composition n Medical ICU Resident and Intern n Coronary Care Unit Resident and Intern n Anesthesia Senior Resident n Critical Care Transport RN n Pharmacist n Respiratory Therapist n EMT/Escort n Security, Chaplain, Bed Control n *Nurses from the affected unit Mod 1 Slide 11 05. 2 Page 11 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® In-Situ Education n 3 -Minute Mock Codes n Emphasis on the first three minutes of a code n Objectives include the development of: n n Mod 1 Slide 12 05. 2 Page 12 Leadership Skills Role Designation SBAR Communication Early and High Quality Compressions TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Interprofessional Education (IPE) n August 2012 – Begin advanced simulation training for internal medicine junior and senior residents. Sessions scheduled “just in time” prior to residents being on the code pager. n January 2013 – Sessions become interprofessional with med/surg nurses, ICU nurses, and critical care transport nurses. n July 2014 – Department of Anesthesia commits residents to the IPE sessions. Mod 1 Slide 13 05. 2 Page 13 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Interprofessional Education (IPE) n 2013 -2014 – 13 sessions n 2014 -2015 – 20 sessions n 2015 -2016 – Anticipated 25 sessions Mod 1 Slide 14 05. 2 Page 14 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Interprofessional Education (IPE) n 3 Cases per Session (1/2 day) n n n n Intracranial hemorrhage Cardiogenic shock Advanced arrhythmia GI Bleed Status Asthmaticus Sepsis Dual patient triage scenario n Debriefing after each case n n Mod 1 Slide 15 05. 2 Page 15 Teamwork and communication Medical decision making TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Identifying Areas for Improvement n Sources of information n Personal experience in codes at UCLA n Informal survey of healthcare providers about issues related to teamwork and communication n Quality improvement committee reviews n Data from event reports n Observation of teams during IPE sessions Mod 1 Slide 16 05. 2 Page 16 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Identifying Areas for Improvement n Four Items Identified Issue Intervention Key information not effectively shared Team members not speaking up when problems are noticed Orders not heard/completed Team not “on the same page” Mod 1 Slide 17 05. 2 Page 17 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Identifying Areas for Improvement n UCLA became a Team. STEPPS training center in early 2013, practically coinciding with the start of IP Code Team training n Team. STEPPS provided the mental framework and vocabulary to better understand teamwork, helping us to more effectively train our providers Mod 1 Slide 18 05. 2 Page 18 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Identifying Areas for Improvement n Four Items Identified Issue Intervention Effective Communication SBAR Advocacy and Assertion CUS, Assertive Statement Verify and Validate Information Closed-Loop Communication Exchange Shared Mental Model Mod 1 Slide 19 05. 2 Page 19 Using the Huddle TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® SBAR n Examples of the Problem n Code Team did not hear from primary MD that a patient with an intracranial bleed was taking Coumadin. n Mod 1 Slide 20 05. 2 Page 20 Primary MD did not feel comfortable with information relayed by nurse, leading to a delay in management of septic patient. TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® SBAR n Poor communication noted during nurse-to- primary MD communication and during primary MD-to-Code Blue Team communication n Intervention – SBAR n Situation―What is going on with the patient? n Background―What is the clinical background or context? n Assessment―What do I think the problem is? n Recommendation―What would I recommend? Mod 1 Slide 21 05. 2 Page 21 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Assertive Statement, CUS n Examples of the Problem n While waiting for norepinephrine drip to be prepared, the anesthesia resident fails to suggest bolusing pressors despite having drugs available. n Mod 1 Slide 22 05. 2 Page 22 Team leader reads EKG as non-STEMI. Another team member clearly sees that the EKG shows a STEMI, but fails to speak up. TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Assertive Statement, CUS n Failure to “speak up” when mistakes or delays in care were noticed by a team member n CUS n n Creating a culture of collaboration n Mod 1 Slide 23 05. 2 Page 23 Concern Uncomfortable Safety issue Team training facilitates the notion that all team members are important and have contributions to make TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Closed Loop Communication n Examples of the Problem n Vitamin K is ordered by MD, but is not clearly communicated to anyone, resulting in the drug not being given to the patient. n Mod 1 Slide 24 05. 2 Page 24 Arterial blood gas ordered by MD, but nobody took responsibility thus the blood was not sent. This was only realized when results were later requested, only to discover that the ABG was never done. TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Closed-Loop Communication n Communication, particularly orders, often not clearly directed n Closed-Loop Communication Mod 1 Slide 25 05. 2 Page 25 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Huddle – Shared Mental Model n Examples of the Problem n Providers physically segregate based on specialty Mod 1 Slide 26 05. 2 Page 26 n Providers cognitively segregate based on tasks (Ex – airway team only communicating with each other) n Anesthesia resident nearly gives succinylcholine for induction because he was not aware that the team was considering increased intracranial pressure TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Huddle – Shared Mental Model n Teams tend to self-segregate into groups (silos) resulting in poor communication between providers n Huddle n n n Mod 1 Slide 27 05. 2 Page 27 Brief, ad-hoc “meeting” to regain situation awareness and bring everyone back to a shared mental model Effective for discussing critical events/actions Breaks down silos by encouraging cross communication TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Implementation n Team training works, but only if you do it!! n Get institutional buy-in n Identify champions from each provider group n Train the trainers n Motivate providers to participate n A simulation center is helpful, but not required! Mod 1 Slide 28 05. 2 Page 28 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Implementation n Get institutional buy-in n Patient outcomes n Financial considerations (risk management) n Reportable data n Educational needs of training programs Mod 1 Slide 29 05. 2 Page 29 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Implementation n Identify champions from each provider group n Understanding of politics/motivations n Understanding of schedules, practical barriers n Understanding of areas for improvement n Important for curriculum design to ensure that key competencies are being addressed Mod 1 Slide 30 05. 2 Page 30 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Implementation n Train the trainers n All instructors take a 2 -day simulation instructor course n Most instructors have participated in a Team. STEPPS course n Structured debriefing is used by all instructors and addresses teamwork/communication first n Model behaviors – describe and demonstrate the skills Mod 1 Slide 31 05. 2 Page 31 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Implementation n Motivate providers to participate n Mandatory n Offer CME or CE credits n Show outside data – Everyone wants to improve n Pilot in certain areas then show gains to more resistant areas to get buy-in n Peer pressure/Word of mouth Mod 1 Slide 32 05. 2 Page 32 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Barriers Encountered n Time (participants and instructors) n Support from institution n Participation from some groups n Scaling to the entire health system Mod 1 Slide 33 05. 2 Page 33 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Measuring Progress n 2012 – Began collecting data on teamwork and communication using 5 questions included on our event reporting system n n n Mod 1 Slide 34 05. 2 Page 34 Was a code leader clearly evident throughout the code? Was information consistently shared among team members? Were the workload and tasks appropriately distributed between team members? Did team members communicate effectively with one another? Rate the overall teamwork during the code. TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Measuring Progress n Limitations n Not a validated questionnaire n Event reports on codes are completed by nurses n Subjective rating scale n Bias – nurse who completes the report was also present during the resuscitation n Positive response – defined as an answer of 4 or 5 on 1 -5 scale or “Yes” to Yes/No questions Mod 1 Slide 35 05. 2 Page 35 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Measuring Progress Mod 1 Slide 36 05. 2 Page 36 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Measuring Progress n What about patient outcomes? n Caveat - Many quality improvement projects related to resuscitation were initiated between 2012 to current Mod 1 Slide 37 05. 2 Page 37 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Measuring Progress Mod 1 Slide 38 05. 2 Page 38 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Summary n Interprofessional team training is an important part of Code Blue Team performance n Team. STEPPS concepts are effective at teaching teamwork skills and creating a culture of mutual support n Pick specific skills to emphasize that are relevant to your Code Blue Teams – We emphasize SBAR, CUS, Closed-Loop Communication, and Huddles n Barriers to progress exist, but can be overcome! Mod 1 Slide 39 05. 2 Page 39 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Summary n In hospital cardiac arrest outcomes can be improved!!!! Mod 1 Slide 40 05. 2 Page 40 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Questions and Answers Mod 1 Slide 41 05. 2 Page 41 TEAMSTEPPS 05. 2

Team. STEPPS for Code Blue Teams Team. STEPPS® Thank You! For more information, please contact our team at: AHRQTeam. STEPPS@aha. org Mod 1 Slide 42 05. 2 Page 42 TEAMSTEPPS 05. 2