Team STEPPS in LongTerm Care LTC Financial and

® Team. STEPPS in Long-Term Care (LTC): Financial and Safety Benefits of Implementing Team. STEPPS in Nursing Homes and LTC Facilities September 11, 2013

Team. STEPPS in Long-Term Care 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 2 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 in Long-Term Care 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 3 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Help Line (312) 422 -2609 Or email: AHRQTeam. STEPPS@aha. org Mod 1 05. 2 Page 4 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Rules of Engagement n Written questions are encouraged throughout the presentation and will be answered during the Q&A session n A Q&A session will be held at the end of the presentation n The lines will open for call-in questions during the Q&A session Mod 1 05. 2 Page 5 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Today’s Webinar Presenters n Michelle M. Pandolfi, MSW, MBA, LNHA n n Qualidigm Director of Consulting Services n Sharon Kostboth Harper, PHR n n Tealwood Senior Living, Bloomington, MN Project Director, Team. STEPPS and Patient Safety Initiative n Erin Howe, DNP n n Mod 1 05. 2 Page 6 DNP at MM Ewing Continuing Care Center Assistant Faculty at University of Rochester School of Nursing TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Webinar Overview n Part 1: Team. STEPPS in Long-Term Care Version n Michelle Pandolfi n Part 2: Developing a Plan to Implement Team. STEPPS in a Long-Term Care Setting n Sharon Kostboth Harper n Part 3: An Example Implementation n Mod 1 05. 2 Page 7 Erin Howe TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Objectives 1. Describe how the Team. STEPPS curriculum has been adapted for the long-term care setting 2. Discuss the financial and patient safety benefits of Team. STEPPS in long-term care 3. Highlight the importance of implementing Team. STEPPS in long-term care facilities and encourage the long-term care community to use Team. STEPPS tools and resources 4. Describe steps taken to reach the planning process and develop an implementation plan 5. Review an example of the implementation and outcomes of Team. STEPPS in a long-term care setting Mod 1 05. 2 Page 8 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Michelle M. Pandolfi, MSW, MBA, LNHA Director of Consulting Services Qualidigm Mod 1 05. 2 Page 9 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Key Principles n Team Structure n Leadership n Situation Monitoring n Mutual Support n Communication Mod 1 05. 2 Page 10 10 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Why Long-Term Care? n Long-term care environment is unique n “Patients” are called “Residents” n Care Teams: multi-disciplinary, include non- clinical staff n Approximately 16, 000 nursing homes and 1. 6 M nursing home residents across the country Mod 1 05. 2 Page 11 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Focus of Long-Term Care Version Text and associated training materials made relevant to the long-term care environment n Language meaningful to long-term care n Exercises, scenarios, tests and videos center around chronic medical or rehabilitation circumstances n Graphics and pictures reflect nursing home staff, care and environment Mod 1 05. 2 Page 12 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Long-Term Care Team Mod 1 05. 2 Page 13 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Implementation n Evidence tested with long-term care leadership and staff n Adjust for audience, including education level and English proficiency n Share experiences and stories n Supplement lectures with exercises n Hold brief yet frequent learning sessions n Focus on communication skills Mod 1 05. 2 Page 14 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Long-Term Care Videos n Two videos created Long-Term Care – subtle decline in a resident over a 24 -hour period n Sub-Acute Care –possible Myocardial Infarction/Pulmonary Embolism in a resident receiving physical therapy n 14 of 15 Team. STEPPS skills were highlighted n Time-Out is not a skill deemed necessary for most nursing homes n Mod 1 05. 2 Page 15 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS New in Long-Term Care Version n Videos and Discussions Discussion questions about videos and use of skills n Exercises, Scenarios n Care planning group exercise n Multi-disciplinary scenarios n Non-clinical examples and scenarios n Non-clinical application of Team. STEPPS skills and techniques n Mod 1 05. 2 Page 16 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Investing in Team. STEPPS n Patients are safer in healthcare delivery systems where teamwork principles are practiced n Communication failures are the leading cause of preventable patient deaths Mod 1 05. 2 Page 17 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS (Cost) Benefits of Team. STEPPS n Decreased malpractice n n claims Decreased insurance premiums Decreased litigation Reduced rate of adverse drug events (from 30 to 18 per 1, 000 patient days) Reductions in staff turnover rates Mod 1 05. 2 Page 18 TEAMSTEPPS 05. 2 n Increased teamwork and communication n Improved medication reconciliation n n 72% to 88% at admission 53% to 89% at discharge n Increase in employee satisfaction rates

Team. STEPPS in Long-Term Care Team. STEPPS Contact Information Michelle M. Pandolfi, MSW, MBA, LNHA Qualidigm Director, Consulting Services mpandolfi@qualidigm. org 860 -632 -3735 Mod 1 05. 2 Page 19 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Sharon Kostboth Harper, PHR Project Director, Team. STEPPS and Patient Safety Initiative Tealwood Senior Living Mod 1 05. 2 Page 20 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Tealwood Senior Living n Headquartered in Bloomington, Minnesota n Facilities located in Minnesota, South Dakota, Iowa and Nebraska n Senior care provider offering independent living, assisted living, long-term skilled nursing, and short -term rehab services n Currently serving over 1, 200 residents/patients throughout four states n The Team. STEPPS initiative includes 14 skilled nursing facilities in Minnesota (12 facilities owned and/or managed and 2 outside facilities invited to participate in collaborative) Mod 1 05. 2 Page 21 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Grant n Performance-Based Incentive Payment Program (PIPP) grant awarded by the state of Minnesota n Our objective: Focus on patient safety through teamwork and technology n Research and resources led us to Team. STEPPS n Mod 1 05. 2 Page 22 Grant implementation to focus on 14 MN skilled nursing facilities TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Resident / Patient Safety “Front & Center” n Multi-faceted approach to improve resident n n Mod 1 05. 2 Page 23 safety in our participating facilities Areas of clinical focus are pressure ulcers, pain management, medication errors, and falls Key to improvement is effective team delivery of care services Develop and implement program to fit the specific needs of each facility, utilizing Team. STEPPS structure and rich content Create a sustainable culture of safety TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Let’s Start At The Very Beginning n Project Director (PD) identified n PD attends “Master Trainer” training, Duke University August 22 nd and 23 rd n Introduction of initiative and PD to key stakeholders n Begin introduction of initiative to participants Mod 1 05. 2 Page 24 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Next Steps…………. n Following the Team. STEPPS model, next steps include: n n n Mod 1 05. 2 Page 25 Kick-off meeting with key personnel – introduction of project & initiate “buy-in” Identify members of the Steering Committee PD familiarization with participating facilities – leadership, culture, metrics – location visits essential! Develop a customized site assessment tool Analyze outcome of site assessments, to be used in the development of the individual facility Action Plan Identify data / metrics to be used in assessing progress TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Next Steps…continued n Develop facility Action Plan based on assessment outcomes and other factors n n n Mod 1 05. 2 Page 26 Initiate Phase II – planning, training & implementation at the facility level Introduce initiative to all staff Identify location champion Train-the-Trainer Develop timelines with activities / deliverables Implement the Action Plan TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Next Steps…continued n Initiate Phase III n Continue to coach and integrate n Continue to monitor the plan n Identify opportunities for continued improvement Keep The Momentum Going!!!! Mod 1 05. 2 Page 27 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Enjoy the positive outcomes of this collaborative effort!! Mod 1 05. 2 Page 28 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS SHIFT TOWARD A CULTURE OF SAFETY Mod 1 05. 2 Page 29 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Erin Howe, DNP MM Ewing Continuing Care Center Assistant Faculty at University of Rochester School of Nursing Mod 1 05. 2 Page 30 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Impact of CNA Turnover in Long-Term Care? Barry, Brannon, & Mor (2005); Dawson (2007); Koren (2010); Piven et al. (2007); Yeatts & Cready (2007 Mod 1 05. 2 Page 31 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Why is CNA Empowerment So Vital in Long-Term Care? Eriksen, 2006 Mod 1 05. 2 Page 32 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS CNA Empowerment Model Eriksen (2006), Kanter (1977), Thomas & Velthouse (1990), Spreitzer (1995) Mod 1 05. 2 Page 33 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS The Program n Regularly scheduled debriefing: <6 minutes at end n n n day shift CNAs develop debriefing logistics Each debriefing will be facilitated by rotating CNAs Facilitation involves asking three questions: n 1) What went well today? n 2) What can we improve on? n 3) What do we need in order to improve? Mid-way point brainstorming session Focus groups/interviews post-program Mod 1 05. 2 Page 34 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Specific Aims n The process of CNAs developing and implementing a communication program on the Jewish Home Transitional Care Unit will lead to: n Improved CNA empowerment n Improved quality of work life n Reduced intent to leave job in following 3 months Mod 1 05. 2 Page 35 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS The QWL Survey n QWL=Quality of Work Life n 45 -items, Likert scale responses n Used in several studies to examine perceived quality of work life of CNAs and nurses n Captures components of empowerment n Competence, meaning, impact, autonomy n Cronbach alpha coefficient (reliability score) for subscales ranged: . 69 -. 94 (>. 7 ideal) Krueger, et al. (2002) Mod 1 05. 2 Page 36 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Intervention n Location: Jewish Home Transitional Care Unit n Two sub-acute rehabilitation wings NE: 35 beds n SW: 33 beds n Participants: CNAs and nurses n Project duration 16 weeks: November-February n Pre-posttest design with built-in replication n NE wing: 8 weeks: training, program, evaluation n SW wing: 8 weeks: replicated n Mod 1 05. 2 Page 37 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS NE Wing Debriefings n Location: Charting room n Attendants: CNAs and nurses only n Issues n n n Challenging to gather staff Would leave immediately to answer bells Numerous interruptions (phones/families) n Process n n Mod 1 05. 2 Page 38 Frequently emotional Felt discussed problems repeatedly without resolution TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS NE Wing Debriefings n Midway point: Brainstorming session n n Asked to invite other disciplines Wanted to change location: dining room n Adjusted sessions n n Mod 1 05. 2 Page 39 Met with unit dietician, recreational therapist, PT/OT Director, Director of Nursing Roundtable discussion Identified issues & possible solutions Requested to continue with monthly meeting after program completed TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS SW Wing Debriefings n Location: Dining room n Attendants: Mostly CNAs, occasional nurses n Process n n n Mod 1 05. 2 Page 40 CNAs would be on time waiting at table Would “round each other up” Did not answer call bells during session Frequently stayed afterwards to talk Laughed & joked during sessions TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS SW Wing Debriefings n Midway point: Brainstorming session Did not want to change format n Did not want to change location n Not interested in inviting other staff n Stated they laughed to deal with stress n Did not feel initially they were safe to share concerns n Second half of program: more open discussion regarding problems n Mod 1 05. 2 Page 41 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Climate Change: Debriefings Mod 1 05. 2 Page 42 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Results Summary SUBSCALE SECTIONS MEAN SCORE CHANGE PRE POSTTEST NE WING COWORKER/SUPERVISOR SUPPORT SW WING Mod 1 05. 2 Page 43 JOB DEMANDS TEAMSTEPPS 05. 2 TEAMWORK/COMMUNICATION

Team. STEPPS in Long-Term Care Team. STEPPS CNA Focus Group Responses n “I have more control over my day and that makes me feel like more a part of a team and less like a little piece of dust!” n “The environment is getting better for me…[I]t feels less stressful. ” n “It’s nice to vent and not worry you’re going to get in trouble for complaining. ” n “It’s easier to talk to each other about issues when they come up during the day because we know we’ll be talking about it at 1: 30 anyway!” Mod 1 05. 2 Page 44 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Implementation Pearls n Incorporate stakeholders in each phase n Update leadership/management, promote! n Anticipate barriers: financial, physical, cultural n Be prepared for unplanned challenges n Try to embrace the process & use challenges to your advantage Be: Present, Proactive & Positive! Mod 1 05. 2 Page 45 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Questions and Answers Mod 1 05. 2 Page 46 TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Upcoming Team. STEPPS Events n Monthly Webinars n n Scheduled through September 2014 Topics, speakers, and registration information will be posted on the portal n Annual Conference n n Mod 1 05. 2 Page 47 June 2014 in Chicago More details to be provided in the coming months TEAMSTEPPS 05. 2

Team. STEPPS in Long-Term Care Team. STEPPS Thank You! For more information, please contact our team at: AHRQTeam. STEPPS@aha. org Mod 1 05. 2 Page 48 TEAMSTEPPS 05. 2