Pocket Guide: TeamSTEPPS: Strategies & Tools To Enhance .

Pocket GuideTeam Strategies & Toolsto Enhance Performanceand Patient Safety

Table of ContentsTeamSTEPPS Framework and Competencies.4 Key Principles.5Team Structure Multi-Team System For PatientCare.7Communication SBAR.9 Call-Out.10 Check-Back.11 Handoff.12 “I PASS THE BATON”.13Leadership Effective Team Leaders.15 Team Events.16 Brief Checklist.17 Debrief Checklist.182

Table of ContentsSituation Monitoring Situation Monitoring Process.20 STEP.21 Cross-Monitoring.23 I’M SAFE Checklist.24Mutual Support Task Assistance. 26 Feedback.27 Advocacy and Assertion. 28 Two-Challenge Rule.29 CUS.30 DESC Script.31Team Performance ObservationTool.32Barriers, Tools and Strategies,and Outcomes.33Contact Information .353

Framework and CompetenciesTeam Competency OutcomesKnowledge Shared Mental ModelAttitudes Mutual Trust Team OrientationPerformance Adaptability Accuracy Productivity Efficiency SafetyTeamSTEPPS has five key principles. It is based onteam structure and four teachable-learnable skills:Communication, Leadership, Situation Monitoring, andMutual Support. The arrows depict a two-way dynamicinterplay between the four skills and the team-relatedoutcomes. Interaction between the outcomes and skillsis the basis of a team striving to deliver safe, quality careand support quality improvement. Encircling the fourskills is the team structure of the patient care team, whichrepresents not only the patient and direct caregivers, butalso those who play a supportive role within the health caredelivery system.TeamSTEPPS is an evidence-based framework tooptimize team performance across the health caredelivery system.4

Key PrinciplesTeam StructureIdentification of the components of a multi-teamsystem that must work together effectively to ensurepatient safetyCommunicationStructured process by which information is clearlyand accurately exchanged among team membersLeadershipAbility to maximize the activities of team members byensuring that team actions are understood, changesin information are shared, and team members havethe necessary resourcesSituation MonitoringProcess of actively scanning and assessingsituational elements to gain information orunderstanding, or to maintain awareness to supportteam functioningMutual SupportAbility to anticipate and support team members’needs through accurate knowledge about theirresponsibilities and workload5

Team Structure

Multi-Team SystemFor Patient CareSafe and efficient care involvesthe coordinated activities of amulti-team system.MTSPATIENTCONTINGENCYTEAMSCORE TEAMCOORDINATINGTEAMANCILLARY& SUPPORTSERVICESADMINISTRATION7Team Structure

Communication

SBARA technique for communicating criticalinformation that requires immediate attentionand action concerning a patient’s conditionSituation – What is going on with thepatient?“I am calling about Mrs. Josephin room 251. Chief complaint isshortness of breath of new onset.”Background – What is the clinicalbackground or context?“Patient is a 62-year-old female postop day one from abdominal surgery.No prior history of cardiac or lungdisease.”Assessment – What do I think theproblem is?“Breath sounds are decreased onthe right side with acknowledgmentof pain. Would like to rule outpneumothorax.”Recommendation and Request – Whatwould I do to correct it?“I feel strongly the patient should beassessed now. Can you come to room251 now?”9Communication

CommunicationCall-OutStrategy used to communicate important orcritical information Informs all team memberssimultaneously during emergentsituations Helps team members anticipate nextsteps Important to direct responsibility toa specific individual responsible forcarrying out the taskExample during an incoming trauma:Leader:“Airway status?”Resident: “Airway clear”Leader:“Breath sounds?”Resident: “Breath sounds decreasedon right”Leader:“Blood pressure?”Nurse:“BP is 96/62”10

Check-BackUsing closed-loop communication to ensurethat information conveyed by the sender isunderstood by the receiver as intendedThe steps include the following:1. Sender initiates the message2. Receiver accepts the message andprovides feedback3. Sender double-checks to ensure thatthe message was receivedExample:Doctor: “Give 25 mg Benadryl IV push”Nurse:“25 mg Benadryl IV push”Doctor:“That’s correct”11Communication

CommunicationHandoffThe transfer of information (along withauthority and responsibility) duringtransitions in care across the continuum.It includes an opportunity to ask questions,clarify, and confirm.Examples of transitions in care includeshift changes; transfer of responsibilitybetween and among nursing assistants,nurses, nurse practitioners, physicianassistants, and physicians; and patienttransfers.12

HandoffStrategy designed to enhance information exchangeduring transitions in care“I PASS THE BATON”IIntroductionIntroduce yourself and yourrole/job (include patient)PPatientName, identifiers, age, sex,locationAAssessmentPresent chief complaint, vitalsigns, symptoms, and diagnosesSSituationCurrent status/circumstances,including code status, level of(un)certainty, recent changes,and response to treatmentSSafetyConcernsCritical lab values/reports,socioeconomic factors,allergies, and alerts (falls,isolation, etc.)BBackgroundComorbidities, previousepisodes, current medications,and family historyAActionsExplain what actions weretaken or are required. Providerationale.TTimingLevel of urgency and explicittiming and prioritization ofactionsOOwnershipIdentify who is responsible(person/team), includingpatient/family membersNNextWhat will happen next?Anticipated changes? What isthe plan? Are there contingencyplans?THE13Communication

Leadership

Effective Team LeadersThe following are responsibilities of effectiveteam leaders: Organize the team Identify and articulate clear goals (i.e., theplan) Assign tasks and responsibilities Monitor and modify the plan;communicate changes Review the team’s performance; providefeedback when needed Manage and allocate resources Facilitate information sharing Encourage team members to assist oneanother Facilitate conflict resolution in a learningenvironment Model effective teamwork15Leadership

LeadershipTeam EventsSharing the Plan Brief - Short session prior to start toshare the plan, discuss team formation,assign roles and responsibilities, establishexpectations and climate, anticipateoutcomes and likely contingenciesMonitoring and Modifying the Plan Huddle - Ad hoc meeting to re-establishsituational awareness, reinforce plansalready in place, and assess the need toadjust the planReviewing the Team’s Performance Debrief - Informal information exchangesession designed to improve teamperformance and effectiveness throughlessons learned and reinforcement ofpositive behaviors16

Brief ChecklistDuring the brief, the team should addressthe following questions: Who is on the team? Do all members understand andagree upon goals? Are roles and responsibilitiesunderstood? What is our plan of care? What is staff and provider’savailability throughout the shift? How is workload shared amongteam members? What resources are available?17Leadership

LeadershipDebrief ChecklistThe team should address the followingquestions during a debrief: Was communication clear? Were roles and responsibilitiesunderstood? Was situation awarenessmaintained? Was workload distributionequitable? Was task assistance requested oroffered? Were errors made or avoided? Were resources available? What went well? What should improve?18

SituationMonitoring

Situation MonitoringSituation Monitoring ProcessSituation monitoring is the process ofcontinually scanning and assessing a situationto gain and maintain an understanding ofwhat’s going on around you.Situation awareness is the state of “knowingwhat’s going on around you.”A shared mental model results from eachteam member maintaining situation awarenessand ensures that all team members are “on thesame page.”20

STEPA tool for monitoring situations in the delivery ofhealth careComponents of Situation Monitoring:21Situation Monitoring

Situation MonitoringSTEPTool to help assess health care situationsStatus of PatientPatient HistoryVital SignsMedicationsPhysical ExamPlan of CarePsychosocial IssuesTeam MembersFatigueWorkloadTask PerformanceSkillStressEnvironmentFacility InformationAdministrative InformationHuman ResourcesTriage AcuityEquipmentProgress Toward GoalStatus of Team’s Patient(s)?Established Goals of Team?Tasks/Actions of Team?Plan Still Appropriate?22

Cross-MonitoringA harm error reduction strategy that involves: Monitoring actions of other teammembers Providing a safety net within theteam Ensuring that mistakes oroversights are caught quickly andeasily “Watching each other’s back”23Situation Monitoring

Situation MonitoringEach team member is responsible forassessing his or her own safety statusI’M SAFE Checklist I Illness M Medication S Stress A Alcohol and Drugs F Fatigue E Eating and Elimination24

Mutual Support

Mutual SupportTask AssistanceHelping others with tasks builds a strongteam. Key strategies include: Team members protect each otherfrom work overload situations Effective teams place all offersand requests for assistance in thecontext of patient safety Team members foster a climatewhere it is expected thatassistance will be actively soughtand offered26

FeedbackInformation provided to team members for thepurpose of improving team performanceFeedback should be: Timely – given soon after the targetbehavior has occurred Respectful – focuses on behaviors, notpersonal attributes Specific – relates to a specific task orbehavior that requires correction orimprovement Directed toward improvement – providesdirections for future improvement Considerate – considers a teammember’s feelings and delivers negativeinformation with fairness and respect27Mutual Support

Mutual SupportAdvocacy and AssertionAdvocate for the patient Invoked when team members’viewpoints don’t coincide with that of thedecisionmakerAssert a corrective action in a firm andrespectful manner Make an opening State the concern State the problem (real or perceived) Offer a solution Reach agreement on next steps28

Two-Challenge RuleEmpowers all team members to “stop the line”if they sense or discover an essential safetybreachWhen an initial assertive statement isignored: It is your responsibility to assertivelyvoice concern at least two times toensure that it has been heard The team member being challengedmust acknowledge that concern hasbeen heard If the safety issue still hasn’t beenaddressed:–– Take a stronger course of action–– Utilize supervisor or chain ofcommand29Mutual Support

Mutual SupportCUSAssertive statements:“Stop the Line”30

DESC ScriptA constructive approach for managing andresolving conflictD Describe the specific situation orbehavior; provide concrete dataE Express how the situation makesyou feel/what your concerns areS Suggest other alternatives andseek agreementC Consequences should be stated interms of impact on establishedteam goals; strive for consensus31Mutual Support