TEAMWORK AND COMMUNICATION TRAINING

1. TEAMWORK AND COMMUNICATION TRAINING

2. WHY WE CARE: IMPACT OF PATIENT ERROR • 98,000 Americans die each year as a result of preventable medical errors* • Costs associated with all medical errors is $29 billion annually* “NATIONAL PROBLEM OF EPIDEMIC PROPORTIONS”** * To Err Is Human: Building a Safer Health System ** Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors and Their Impact

3. To Err Is HumanInstitute of Medicine 1999 • Medical errors hurt people • Medical errors cost billions • Medical errors erode trust • Medical errors reduce satisfaction of patients and healthcare providers

4. DISTRACTION FATIGUE WHY DO ERRORS HAPPEN? HIERARCHY POOR COMMUNICATION/MULTIPLE HANDOFFS

5. WHY DO ERRORS HAPPEN? In 2004, a Sentinel Alert issued by JACHO revealed that most cases of perinatal death and injury are caused by problems with an organization’s culture and communicationfailures between providers.

6. Joint Commission Sentinel Alert 2004 • Recommendation “Conduct team training in perinatal areas to teach staff to work together and communicate more effectively” “…conduct clinical drills ….and conduct debriefings to evaluate team performance and identify areas for improvement.”

7. VALIDATION OF TEAM TRAINING/SIMULATION • Reduction in clinical errors (31%  4%) • Improved clinical management decisions with simulation drills • Hospital or unit based training/simulation is just as effective as Simulation Center • Process Improvements • “decision to incision” time reduced by twelve minutes (33 mins  21mins)

8. Teamwork behaviors can be transferred to clinical environments • Decreased frequency and severity of adverse events • Fewer malpractice claims • Improved staff scores on patient safety attitude questionnaires

9. CRICO OB Patient Safety Program • Launched in 2003 • Team Training • Simulation Drills • Online Courses on fetal monitoring and shoulder dystocia • OB Practice Guidelines Test

10. TEAM CONCEPTS APPLIED TO HEALTHCARE In the Labor and Delivery setting, every delivery is, by necessity, a multidisciplinary event involving nursing, obstetrics (OB/CNM), anesthesiology, pediatrics, and unit support staff (scrub tech/unit coordinator). “Individual competence in clinical skills is not enough; team coordination, communication, and cooperative skills are essential to effective and safe performance.”

11. WHAT ARE TEAMS AND WHY HAVE THEM? • A team is two or more people who achieve a mutual goal through interdependent and adaptiveactions • Effective teams are more likely to notice mistakes early and address them before they lead to harmful outcomes.

12. TYPES OF TEAMS • Core Team – direct patient care • Coordinating Team – Charge Nurse and Coordinating Physician • Support Team – those providing temporary resources (PP staff, Nursing Supervisor) • Administrative Team – OB Admin on call; Nursing Leadership • Contingency Team – help in emergencies (OB Stat, OB Hemorrhage) Administrative Staff Team Support Staff Coordinating Team Core Team Contingency Team

13. ESSENTIAL ELEMENTS OF TEAMS • Common purpose and shared goals • Interdependent actions • Accountability • Collective effort Teamwork is a safety net that catches errors before they can do harm

14. COMMON PURPOSE AND SHARED GOALS • “Situational Awareness” – each individual must communicate and share information and observations with other members of the team • “Shared Mental Models” – the shared understanding or knowledge about a situation among team members • Achieved through team meetings – active participation is the EXPECTATION

15. TEAM MEETINGS Held at 8AM & 8PM Called anytime, by anyone for concerns about clinical developments, management plans or conflict resolution Used for resource management and planning

16. TEAM MEETINGS • Twice daily, every day • Interdisciplinary • Nonhierarchical • Resource Management • Educational

17. INTERDEPENDENT ACTIONS • All members of the team must look out for one another to ensure the best care is provided and that patient safety is achieved • Accomplished through mutual support and good communication • Cross monitoring • SBAR • Check backs • Call outs

18. COMMUNICATION TOOLS • Cross Monitoring – active awareness of the actions of other team members for the purpose of sharing workload and error prevention This can only occur in a climate where it is expected that assistance will be actively offered, accepted and sought as a method of avoiding mistakes.

19. COMMUNICATION TOOLS • SBAR – a standardized method for presentation of patient information • Describe the Situation • Provide the Background • Make an Assessment • Communicate your Recommendations For communication to be effective it needs to be complete, clear, brief, and timely

20. COMMUNICATION TOOLS • Closed Loop Communication • Check Backs: repeating back information that was given • for example verbally repeating medication dose and route when a verbal order is given • Confirming an action has been completed (“Pedi is on their way.”) • Call Outs: verbalizing information that is important to the team, especially during emergencies • “It’s been 2 minutes” during a shoulder dystocia

21. ACCOUNTABILITY AND COLLECTIVE EFFORT • Advocacy and Assertion – all team members are encouraged and expected to voice concerns and assure their questions are adequately addressed • Suggest alternatives • Review consequences of each option • Obtain consensus • Always be respectful

22. High Patient Risk Zone Patient Risk Zone Performance Mod BOREDOM COMFORT ZONE WORK OVERLOAD Low Low Moderate High Very High Workload ACCOUNTABILITY AND COLLECTIVE EFFORT • To help manage resources and mitigate risk teams need to: • Voluntarily adjust workload and set priorities • Allocate resources on the basis of acuity, volume and team member skills • Equitably distribute the workload • Appropriately utilize resources within the team, the department, and outside the department

23. COLLECTIVE EFFORT Debriefing allows for evaluation of the effectiveness of the team following an “event”. Facilitated reflection has been shown to be a critical element for improving future performance of individuals and teams. Allows identification of systems issues and opportunities for improvement

24. Components of Debriefing • Timely • Leader/Facilitator • Sets the tone • Fosters dialogue • Follows a consistent format • Includes those involved in the event • Identifies opportunities for improvement • Acknowledges good actions/behaviors • Follow up plan • Feedback to participants

25. Sample Team Debriefing Form

26. BENEFITS OF TEAM TRAINING • Reduce clinical errors • Improve maternal and neonatal outcomes • Improve process measures • Increase patient satisfaction • Improve staff satisfaction • Reduce malpractice claims

27. “The nice thing about teamwork is you always have others on your side”