1. Our Journey through the Implementation of TeamSTEPPS United Memorial Medical Center

2. Learning Objectives Identify ways to integrate TeamSTEPPS tools into simulation sessions 1.Practice “CUS” 2.Practice Huddle – Brief – Debrief Reinforce effective hourly rounding techniques 1.Review of hourly rounding video

3. Our Team! Our team consisted of: Educators, Nurse Managers representatives from Laboratory, Radiology, Clinical Care Coordinator - Surgical floor Risk Manager, Director of Cardiology and Pain Centers (outpatient services), ED Staff nurse, and Patient Safety Officer We all attended TeamSTEPPS Train-the-Trainer classes on 4/11, and 4/12/2013

4. The Aims... We hoped to improve the hourly rounding in the clinical departments Educate the staff on the tools ( CUS – Huddle- Brief – Debrief ) and utilize these tools consistently in simulation trainings Reinforce use of the tools with real stories when used successfully

5. “CUS” is an acronym to structure conversation that may be difficult to have. First, state your concern (or ask to clarify). Then, state why you are uncomfortable. Lastly, if the conflict is not resolved, state that this a safety issue (STOP!) CHART Institute – Train the Trainer5

6. Promoting and Modeling Teamwork Tools to use: Briefs - clarifies roles and responsibilities, opens lies of communication Huddles –reinforces plan and reevaluates workloads Debrief – brief informal exchange and feedback tool 6

7. The Beginning... Hourly Rounding and Simulation We started the process by developing a survey tool and conducting interviews with inpatients to see if they were being rounded on routinely CUS, Brief and Debrief We started with educating staff on the tools by putting articles in the Monday report, signs in break rooms, on-line education, leadership presentation, and collecting success stories

8. The Data What were the results and findings?

9. QuestionPatient Answer Did you receive a card and instructions about hourly rounding when you were admitted? 20 – no or did not remember getting it (52%) 18 – yes (48%) Do you understand what hourly rounding is? 14 – unsure or no (37%) 24 – yes (63%) Have the staff been rounding on you regularly? (Never – sometimes – usually- always) 8 – sometimes (21%) 14 – usually (37%) 16- always (42%) How often have you received hourly rounding? (Never – sometimes – usually- always) 9 – sometimes (24%) 14 – usually (37%) 15- always (39%) Have you been offered help getting to the bathroom? (Never – sometimes – usually- always) 5– sometimes 2 - usually 31 -Always or not needed Is your pain controlled and do you receive pain medication timely? 7 – sometimes 31- Always or not needed On a scale of 1 – 5, how would you rate your care so far? 3-2 (5%) 4-16 (42%) 5-20 (53%) Summary for patient interviews for hourly rounding (Total # of patients 38) 5/6/13 rounded on 9 patients, 5/9 rounded on 16 patients, 5/13 rounded on 6 patients, 5/16 rounded on 7 patients

10. Process... Education was done at staff meetings (poor attendance was a hurdle) We put signs in all the patient rooms After these were done we surveyed the patients again ~ results were very similar to the first time We met with a group of “champions” from each of the units and the results are as follows

11. Hurdles... Champions Brainstorming Session – Hourly Rounding WHY DO WE DO HOURLY ROUNDING? Satisfy patient needs Safety We are told to Empathy, service, importance to the patient BARRIERS TO HOURLY ROUNDING Patient load Patient perception Staff attitude Resist new ideas, push back against disciplinary actions Patient with lots of needs Time constraint Need to triage/prioritize duties Patients don’t recognize what it i Very busy 7am to 11am (bath time)

12. Brainstorming Solutions Other staff help with rounding Coaching each other Different/staggered bath times Starts from within (champions first, then others) Ask what they need to do this Drill down, say the words “Hourly Rounding”, make it a habit Lead by example Develop a contest Block time (assign certain times for staff) Make a video

13. Progress A rounding video was created by staff and team members Rounding competencies were done using the simulation manikin, staff watched the video and then simulated actual rounding during the month of December We are getting other ancillary staff involved in the rounding to assist the clinical staff on the floors (other staff who go to patient rooms – Lab, radiology, social workers, discharge planners – explained at staff meetings) Alternate times for rounding (RN’s on the even, CNA’s on the odd)

14. Success!!

15. Sustain the Gains We plan on continuing patient interviews quarterly to monitor progress. If we see a decline we will activate more education All new clinical employees will view the hourly rounding video during orientation We are doing annual hourly rounding competencies Managers continue to review hourly rounding sheets

16. Integrating TeamSTEPPS Tools and Simulation Using simulation in the making of the video Mock Codes done in simulation are debriefed consistently Competencies done with simulation include scenarios that practice huddle- brief - debrief

17. RN ’ s Come One Come All to the Competency Circus! Headlining: The Curious Transformation of Sim Man to Bo Bo the Clown Also featuring: The Sword Swallower (NG tube insertion, Tracheostomy Care) The Ice Man (Fluid Warmer, CBI) The Knife Thrower (chest tubes, pain pump, IV pump) The Amazing Horsewoman (Decubitus Prevention, Wound care and Staging) Electric Man (Defibrillator training and Mock Code) Ventriloquist (Hourly Rounding competency)

18. Competency Circus 2014 - Using Simulation

21. Culture Changes… Team leaders are now using TeamSTEPPS terminology on a consistent basis: Huddle – Brief – Debrief - CUS The TeamSTEPPS team continues to meet monthly, and the next project is to develop a “debrief” form used by staff after all codes. UMMC is now integrating bedside reporting on the medical unit. Staff survey responses were overwhelmingly supportive and positive

22. Wrapping up TeamSTEPPS tools are an excellent resource both with simulation and real life events The team hopes to continue to tackle different projects using the tools we have learned Make it measurable – this is sometimes a struggle and we still struggle with simulation at times When possible make it fun! Healthcare is a very serious business, so if you can lighten up the learning you get better results!