Developing the Next Generation of Champions - PowerPoint Presentation

1. Developing the Next Generation of Champions: TeamSTEPPS Nurse Education Curriculum DevelopmentBrigetta D. Craft, RN, DNPLibba Reed McMillan, RN, PhDMary Beth Maguire MSN, RN, CNESharon Wengier, MS, APRN, CNS, RNC-OB

2. Translating TeamSTEPPS® Concepts into the Current CurriculumBrigetta D. Craft, RN, DNPPatient Safety Program ManagerTeamSTEPPS2

3. METCMedical Education and Training CenterLocated in San Antonio, TXUnited States Department of Defense (DoD) integrated campus under a single university-style administrationAir Force, Army and Navy enlisted medical trainingOfficer supplemental training3

4. The ProcessGetting our foot in the door…Cadre of instructors attended Train the TrainerStarted with Surgical Technologists programFocused discussion/development of action plan for implementation into curriculum without adding hours to the course training standardPatient Safety and TeamSTEPPS added to Career Field Education and Training Plan Blueprint for all training required during enlistment Allows introduction at entry level of all surgical technician career fields 4

5. Class ObjectivesDiscuss types of communication relationshipsDiscuss goals of communicationDescribe the significance of content and tone in communicationDistinguish between assertive and aggressive behaviorDescribe concepts of conflict resolutionDemonstrate principles of communication in the surgical settingDemonstrate principles of teamwork in the surgical environment5

6. Crosswalk: TeamSTEPPS and Current ContentCommunicationTypes of relationshipsGoalsPrinciplesComponentsQualitiesTeamwork PrinciplesConflict ManagementConflict ResolutionTeamSTEPPS ToolsBrief/ Debrief/HuddlesFeedbackHandoffs - SBARSpeak UpCheckbackCall Outs2 ChallengeDESCCross Monitoring6

7. Tips for SuccessInstructor cadre to model the desired behaviorsDemonstration and SimulationEvaluation of both clinical proficiency and team behaviorsUse of team behavior checklistUse of forcing functions during practicumDebrief as feedback and learning mechanismVisualize – use of TS posters in classroom and OR lab7

8. Tips for SuccessPut the patient first!Educate about the benefits of team.Get support from the senior leadership.Be truthful with the team about additional work to start incorporating concepts into the curriculum.8

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10. Hearing, “Peering” and SteeringPeer Reviewers to Improve Patient SafetyLibba Reed McMillan, RN PhDAssociate ProfessorAuburn UniversityAuburn, Alabama

11. Learning ObjectivesAt the completion of this presentation, the learner will be able to:1. Demonstrate appropriate use of SBAR technique to communicate effectively with a physician/ health care provider.2. Evaluate performance of peer(s) in communicating utilizing the SBAR technique.3. Appreciate the importance of self- assessment of communication skills to ensuring quality and safety in nursing practice.

12. Description of LearnersFirst semester of baccalaureate nursing school at Auburn UniversityAge Demographics: 20-21 years oldSimulation experience following faculty delivery of theory content “Communicating with Members of the Health Care Team "using TEAMSTEPPS material on SBAR Most students do not have experience communicating with health care professionalsStudents given pocket-sized cards with SBAR information for reference to keep during exercise and beyond.

13. ExerciseMcMillan, L.R. (2010). Utilizing SBARR: Using Peer Reviewers in a Low-Fidelity Lab Exercise. QSEN Website: Teaching Exercises

14. Instructions/Pre-brief15-20 minutesStudent Instructions: They will be given a simple “problem” with their patient, in which they will need to call the attending physician and/ or the health care provider (HCP). The students given peer- review evaluation forms. These will be used to evaluate their peers as to effective use of the SBAR technique in communicating with the physician/ HCP. The students are told that they have been called into the different patient rooms with the patient requesting to see them as soon as possible due to a complaint or concern. Each concern will necessitate contacting the HCP. It is NOT the role of the student to “diagnose” the problem. The primary objective is to communicate effectively with the HCP.

15. Scenario1 hourStudents will arrive to lab/ simulation setting in 4 groups consisting of 4 students in each group. Students will randomly decide the order they will be in the primary role and communicate using SBAR. The other three students are to use the peer evaluation tool to evaluate the primary student’s performance. The “patient” will be in bed. The student will talk with the patient and the patient will communicate their concern regarding a particular problem to the HCP (role played by faulty/staff member). After approximately 6 minutes, the groups will rotate to the next bed; where there will be a different student in the group serving in the primary role, and the other three students will peer evaluate their performance. This process continues through the 4 groups.

16. Scenario AMs. Kim McIntyre, 40 years old, is complaining of extreme nausea. Has just vomited twice prior to the nurse arriving. Vomit has bright red blood in it. Stomach hurts very badly. Is allergic to aspirin and Sulfa drugs. History of liver disease. Vital signs are 120/80, 60 Pulse, 20 Respirations, and temperature of 102.5 orally.

17. Scenario BMargaret Miles, 88 year old patient, is complaining of severe ear pain in both ears. Is extremely hard of hearing. A week ago, she was placed on an antibiotic. She has been taking Motrin for pain in the right ear. She has a history of gout, and high blood pressure. Vitals: blood pressure 110/64, Pulse 65, Respirations 16, Temp 100.2 orally. 

18. Scenario CJudy Riley, 60 year old patient, is complaining of severe chest pain. Has hurt the past 3 hours. Has a history of heart disease, and stroke. Is allergic to no medications. Has been taking Aspirin and vitamins for the past 2 months. Vitals: blood pressure 180/88, Pulse 80, Respirations, 20, Temperature 99.1 orally.

19. Scenario DKathy Fairling, a 25 year old patient is complaining of a severe lower back pain, which is making it difficult to stay in bed. She has no pain medications ordered. She has a history of gall stones, and is 5 months pregnant with her third baby. Vital signs are blood pressure 190/84, 98 pulse, Respirations 22, Temperature 103.5 orally. 

20. Debrief45 minutesThe SBAR exercise leader will conduct a debrief session consisting of the students completing the “SELF ASSESSMENT EVALUATION OF SBAR COMMUNICATION” tool.

21. Student FeedbackStudent’s stated they:Overestimated their ability to communicate with HCP prior to exerciseUnderestimated the difficulty to both organize information and listen to HCPFound it difficult to know what foreign orders meant, but have to ask for clarificationWrite orders while listening carefullyThought they DID communicate effectively prior to exerciseSee radical difference in speaking with HCP and personal conversations.

22. Variations to Increase DifficultyTo adapt to more advanced target audiences:Have the HCP give an order of which the patient is allergicHave the HCP be difficult to understand (bad connection, distracted, different accent/language barrier)Have the HCP be unprofessional (requiring student to navigate through remaining professional)Add complex patient medications and procedures

23. Examples of Peer Review ToolsSBAR pocket cardsPeer Review Evaluation toolSelf Assessment Evaluation of SBAR Communication tool

24. Where to Go From Here With Exercise?Video tape for student self-feedbackCollection of data (pre- and post)Add to Exercises and difficulty of scenarios

25. Harnessing the Power of Technology to Improve Team Training in Nursing Education Mary Beth Maguire MSN, RN, CNEMarie Bremner DSN, RNKennesaw State UniversityKennesaw, Georgia

26. Please identify your experience with audience response technologyI have never used an audience response device I have used audience response technology as a participantI have used audience response technology as a presenterI have used audience response technology as BOTH a participant and presenter

27. ObjectivesIdentify the importance of TeamSTEPPS training in undergraduate nursing education.2. Describe a high fidelity clinical obstetric simulation in undergraduate nursing education.3. Demonstrate the value of video capturing simulation participants and observers to identify TeamSTEPPS activities and improve engagement.

28. Please describe your practice environmentHospital settingOutpatient settingEducation settingOther

29. Kennesaw State UniversityNorthwest metro Atlanta25,000 students500 nursing studentsBaccalaureateMastersDoctoralTraditional, Accelerated, RN-BSN, International MSN

30. TeamSTEPPS & Nursing EducationAccrediting organizations value teamworkNovember 2005 RWJ grant awarded to enhance nursing school curricula related to quality and safety (QSEN Institute, 2013)6 core QSEN competencies:Patient-centered careTeamwork and collaborationEvidence-based practiceQuality improvementSafetyInformatics

31. TeamSTEPPS & KSUSummer 2011 Master Trainer courseSpring 2012 TeamSTEPPS curriculum integration initiativeRepetitive “dosing” throughout the curriculumAugmented current simulation experiencesCreated new simulation experiences

32. A New Simulation Activity3rd semester studentsLaerdal SimMomi>clicker technologyPostpartum Hemorrhage scenario4 TeamSTEPPS Ambassadors25 observers

33. Pre-SimulationPowerPoint review slides posted before scenarioSession immediately followed test reviewBrief recap of previous TeamSTEPPS sessionsDiscussion of TeamSTEPPS in actionOrientation of day10 minutes review20 minute scenario run40 minute debrief

34. Let’s watch a clip:OB Sim Video

35. Identify the TeamSTEPPS strategies observedSBARCall outCheck-backCUSHuddle

36. The ParticipantsStudents viewed the simulation scenario via live stream into the classroomResponded via i>clicker to TeamSTEPPS strategies observed

37. The DebriefImmediately observed video together while still actively processing the experience (Cantrell, 2008)Playback allowed review of actual performance instead of reviewing the memory of it (Megel et al., 2012)Allowed for critical appraisal

38. The Debrief+/-/Δ strategyArranged by roleRN 1RN 2Student NurseFamily MemberRecognition of TeamSTEPPS strategies observed and suggestions for improvement

39. Engagement & SupportAmbassadorsEngagementSupportParticipantsEngagementSupportInstructorsEngagementSupport

40. Student FeedbackAppreciated the learning activityAsked for more TeamSTEPPS activitiesActivities help with predictor examImproved team skills among graduates aids in employment search after graduation

41. SummaryNursing education is an ideal setting to prepare high functioning team members via the TeamSTEPPS curriculumClinical simulation provides nursing students exposure to high-risk OB situations and opportunity to critically analyze the eventTechnology can improve engagement among all participants

42. Last Question:AgreeDisagree

43. Thank you!Acknowledgements:Mr. Roger PfeifferSimulation Support SpecialistMr. Matt LaStarBroadcast Specialist

44. Oklahoma City is Alive and Well Women’s & Newborn ServicesNurse ResidencyOB Simulation + TeamSTEPPS Sharon Wengier, MS, APRN, CNS, RNC-OB

45. Oklahoma City is Alive and WellObjectivesDescribe the incorporation ofTeamSTEPPS communication skills into an obstetrical simulation for nurse residentsIdentify the benefits of using TeamSTEPPS and simulation for nurse residents as part of the training

46. Oklahoma City is Alive and WellBackground TeamSTEPPS Essential Course Team-based Learning Simulation

47. Oklahoma City is Alive and WellSetting Scenario150120Analyze the strip…Variability: UCs:Baseline Rate: Interpretation:Episodic Pattern: Actions taken: Periodic Pattern:You are told to “pit thru it”Do you need to CUS?Two – challenge?Chain of Command?

48. Oklahoma City is Alive and WellFindings StripVariability: Moderate Baseline Rate: 140Episodic Pattern: None Periodic Pattern: NoneUCs: Tachysystole B/P 130 / 76 92 18 37.8Interpretation: I I SVE 7 / C / +1 Pitocin @ 18 mu / minDid you do the following ACTIONS? Document Pitocin Checklist IV bolus On side If you adjusted the Pitocin –did you call? Palpate UCs - Strong Pain - 5/10 Pitocin rate  to @ 9 mu / min Temperature - 37.8 C I / O – voided 400 cc What TeamSTEPP skills might you want to use? The strip on the next slide is 2 ½  later

49. Oklahoma City is Alive and WellKirkpatrick  Level 1 – Reaction  Level 2 – Learning Pre/Post Test  Level 3 – Transfer TENTS

50. Oklahoma City is Alive and WellChallenges & Opportunities

51. OKLAHOMA CITY ISALIVE AND WELLand OU Medicine is at its heart