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San Antonio Regional Hospital
TeamSTEPPS Presentation
November 10, 2016
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Key Individuals
Core Team
Mario Lopez-Luna
Christina Mallon
Maureen Battle
Natalie Souza
Michelle Lukaszewicz
Linda Lough
Physician Champion
Dr. Owais Zaidi
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Baseline Data
Data was obtained through our Employee Satisfaction survey, Patient Safety Culture survey and through a discussion with active providers and our CNO and Director of Operations for Nursing Administration
Our surveys showed there were deficiencies in communication between departments; only 53% felt there was adequate communication between departments
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Baseline Data
Within departments, nurses were more
likely to communicate well amongst each
other but there were communication
issues within other departments
Although receiving higher scores, there
was still room for improvement in having
employees feel that their department or
work group worked well together as a
team
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Baseline Data
During our discussion with physicians we
learned that they were unaware of the
SBAR and were unable to locate it easily
in the patient chart
There was a communication barrier
between nursing and physicians
Physicians felt the program might be
another “flavor of the month” and there
would be no follow-through
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Focus and Efforts
We decided to focus our efforts hospital
wide and not on one specific unit.
Meetings covered the following topics:
Introduction to program/what our goal was
Communication (SBAR)
Team Structure/Synergistic Decision Making/
Huddles/Briefs
Situational Monitoring/Mutual Support
CUS/2 Rule-Challenge/Next Steps
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Barriers & Hospital Challenges
Largest barrier is getting physicians on
board with the program
New hospital patient tower opening in
December
Keeping the program “alive”
Silo mentality among staff
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Strategies – What and How
Held five 1.5 hour meetings in the
evening. Staff paid for their time and
dinner was provided.
Started with Charge Nurses and Team
Leads from ancillary departments
An average of 65 participants per meeting
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Event Photos
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Event Photos
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Team Huddle
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Event Photos
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Tools Started With
The communication tool we emphasized
the most was the SBAR
Although the tool is currently being used
by nursing, it was not always being utilized
properly
SBAR is brief and effective and can be
used to update physicians and oncoming
nurses of any relevant changes to the
patient
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SBAR From Cerner (EMR)
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SBAR Printout
SBAR Note Entered On: 7/15/2016 6:04 PDT Performed On: 7/15/2016 5:49 PDT by NURSE NAME
Situation: 0420. Patient calling for assistance out of bed to BRP. Patient walked to BRP without any difficulty and upon sitting on commode, patient reporting nausea and dizziness. Patient then became non-verbal upon sitting down on commode. 0422: Blood sugar obtained and BS: 106. 0425 RR team paged to room. Unable to get patient off of commode due to mentation status. Dr XXX (Covering Dr XXX) 0430: RR team in patient room. 0430: Currently updated Dr XXX on patient status. Notified him that RR team was in patient room. 0431: Paged placed on hospitalist at this time to call Dr XXX, 0437: patient with BP: 134/57, HR: 77. Patient remains on commode. RR team remains at bedside. Lab in room. Upon standing-up patient took two steps then reporting that she is getting blurry vision. Patient back in bed and alert and oriented to person and place. 0454: BP: 120/94 and patient 100% on RA. Upon going back into patient room, patient noted with oxygen saturation level of 88%. Patient placed on 5L NC and oxygen saturation up to 90%. Patient with blank stare in the middle of conversing. Patient placed on 6L Mask. Paged placed to Dr XXX, 0515 to update him on patient's current status. Order received. Patient's current BP: 101/87 and remains 93% on 6L mask. Patient alert and notified her friend via text of current status. Patient more alert upon transfer to tele Rm 262B. Background: Patient is POD # 2 RTK Assessment: Patient clammy and diaphoretic. Oxygen saturation dropped to 70%. Patient able to slur out her name. Patient still unable to remain alert. BP: 70/40 with HR 120. 0427: 6L NC placed on patient via portable O2 tank. ). NS bolus started. Patient remains on commode and more alert. Patient no longer slurring words, Patient more alert and assisted back to bed. Please refer to situation Recommendation: To transfer to tele. NURSE NAME - 7/15/2016 6:18 PDT
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Tools Started With
Call out and CUS – instrumental in preventing safety issues and providing safe care to patients
Briefs, De-briefs, and Huddles – excellent communication tools to discuss what worked and what could have been done better and to discuss patient care for the day
Mutual Support – letting staff know it’s ok to ask for help and to offer help
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Tools Started With
Situational Monitoring
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Process Changes
Implement the idea towards eliminating
“Nursing Notes” so that SBAR is the
main means of effective communication
Moving the SBAR from the nursing
domain to the M-Page of physicians for
quick access
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Qualitative/Quantitative Data
Performed an evaluation after the
program was completed
Attendees were very supportive of the
program and found it to be very beneficial
They stated they are now more likely to
speak up when they see something that
could affect patient safety and are more
likely to ask for help or offer task
assistance
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Qualitative/Quantitative Data
Many respondents have already began
using the communication tools they
learned about, especially the SBAR
76% of the respondents felt that the
biggest barrier in implementing the
program was resistance from providers
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Qualitative/Quantitative Data
SBAR usage increased
3384 3435 34163234
40224313
0
500
1000
1500
2000
2500
3000
3500
4000
4500
5000
April May June July August September
SB
AR
Co
un
t
# of Times SBAR was Used
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Qualitative/Quantitative Data
Program was found to be “very beneficial”
among the majority of attendees
Very
beneficial,
89%
Somewhat
beneficial,
7%
Not very
beneficial,
4%
Not at all
beneficial,
0%
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Qualitative/Quantitative Data
Communication tools found to be most
useful
0% 20% 40% 60% 80% 100%
Feedback
Briefs
Check-back
Debrief
Huddle
Call-outs
CUS
SBAR
46%
50%
57%
57%
61%
71%
86%
96%
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Qualitative/Quantitative Data
All of the attendees have already used
some of the tools introduced. The most
used tools were:
SBAR
Huddle
Feedback
CUS
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Qualitative/Quantitative Data
Overall Rating of Meetings (10 = highest),
mean score of 8.6
0%
10%
20%
30%
40%
50%
10 9 8 7 6 5 4 3 2 1
36%
25%29%
7%
0% 0% 0% 0% 0%4%
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Feedback About Meetings
“I wish more could participate in this workshop. It is beneficial in everything we do to help each other help others!”
“Group input and participation.”
“Together we make things better.”
“It reminded me to come to work with the idea of making sure we don’t fail any one patient.”
“Powerful videos, clear direction from speakers, good useful content.”
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Conclusion/Next Steps
From the feedback received, the primary
barrier to overcome is from providers. To
overcome this barrier we’re going to be
conducting a 3 hour presentation to our
executive management group along with
all medical directors of departments. This
will hopefully strengthen their
commitment to more effective
communication.
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Conclusion/Next Steps
Classes will be offered in 2017 to all members of the patient care team
Restructure class format to accommodate larger volume of employees
Continue to award appropriate use of SBAR to individual staff along with awarding leads and charge for effective communication through huddles, briefs, and debriefs
Team will be visible on the floors
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Iceberg
Currently we are in
the “Empower
Others” stage
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Something BIG is happening in the IE!
And we are glad to be part of it!
Contacts:
Chris - (909) 579-6715
Michelle - (909) 920-6222
Questions?