Assignment: Implementing the Bedside Shift Project Protocol

Assignment: Implementing the Bedside Shift Project Protocol ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Assignment: Implementing the Bedside Shift Project Protocol Leaders seek out change opportunities regularly. Innovation, critical thinking, and decision making are key to making an impact on an organization. This assignment is designed to help you look at aspects of your own clinical practice and become a change agent in your organization. Use your current or past experience to identify a change project to implement. Assignment: Implementing the Bedside Shift Project Protocol Step 1: Select a topic for a change project. Review the following resources for potential change topic or process ideas: Institute for Healthcare Improvement: Transforming Care at the Bedside http://www.ihi.org/engage/initiatives/completed/TCAB/Pages/default.aspx Institute for Healthcare Improvement: Hospital Inpatient Waste Identification Tool SEE ATTACHMENT FILE For process change resources: TeamSTEPPS® Pocket Guide SEE ATTACHMENT FILE Step 2: Identify the context for your change. Describe the setting where the change will take place. For example, clinical, insurance, home health, or public and community. Explain who is affected: patients, nurses, leadership, and other stakeholders in the organization. Step 3: Review the literature to find possible solutions and evidence to address your topic. Research sources that guide evidence-based practice to improve outcomes related to your selected topic. Find a minimum of three peer-reviewed articles directly related to addressing your change topic. Step 4: Create a draft implementation plan. Summarize each article to explain how the evidence you gathered will help address your change topic. Explain how you could use the information in the research to carry out the change in your identified setting. Format your assignment as a 700- to 1,050-word APA formatted paper, Including Paper has to meet 5 goals: 1.1 Apply leadership and other organizational theories to behaviors of the roles and functions of professional nursing. 1.2 Correlate the role of managing resources and delivering quality, cost-effective care. 1.3 Examine interpersonal and personal skills and strategies useful for addressing patient, staff, and organizational problems. 1.4 Analyze opportunities for nurses to serve as change agents. 1.5 Demonstrate ways to incorporate leadership activities into daily activities. Assignment: Implementing the Bedside Shift Project Protocol teamstepps_pocketguide.pdf ihi_hospital_inpatient_waste_identification_tool_white_paper_2011.pdf Pocket Guide Team Strategies & Tools to Enhance Performance and Patient Safety Table of Contents TeamSTEPPS® • Framework and Competencies…..4 • Key Principles…………………………..5 Team Structure • Multi-Team System For Patient Care………………………………………..7 Communication • SBAR………………………………………9 • Call-Out…………………………………10 • Check-Back……………………………11 • Handoff………………………………….12 • “I PASS THE BATON”……………..13 Leadership • Effective Team Leaders……………15 • Team Events…………………………..16 • Brief Checklist………………………..17 • Debrief Checklist…………………….18 2 Table of Contents Situation Monitoring • Situation Monitoring Process……20 • STEP…………………………………….21 • Cross-Monitoring…………………….23 • I’M SAFE Checklist………………….24 Mutual Support • Task Assistance…………………… 26 • Feedback……………………………….27 • Advocacy and Assertion………… 28 • Two-Challenge Rule………………..29 • CUS………………………………………30 • DESC Script…………………………31 Team Performance Observation Tool………………………………………………32 Barriers, Tools and Strategies, and Outcomes……………………………….33 Contact Information ……………………….35 3 Framework and Competencies Team Competency Outcomes Knowledge • Shared Mental Model Attitudes • Mutual Trust • Team Orientation Performance • Adaptability • Accuracy • Productivity • Efficiency • Safety TeamSTEPPS has five key principles. It is based on team structure and four teachable-learnable skills: Communication, Leadership, Situation Monitoring, and Mutual Support. The arrows depict a two-way dynamic interplay between the four skills and the team-related outcomes. Interaction between the outcomes and skills is the basis of a team striving to deliver safe, quality care and support quality improvement. Encircling the four skills is the team structure of the patient care team, which represents not only the patient and direct caregivers, but also those who play a supportive role within the health care delivery system. …TeamSTEPPS is an evidence-based framework to optimize team performance across the health care delivery system. Assignment: Implementing the Bedside Shift Project Protocol 4 Key Principles Team Structure Identification of the components of a multi-team system that must work together effectively to ensure patient safety Communication Structured process by which information is clearly and accurately exchanged among team members Leadership Ability to maximize the activities of team members by ensuring that team actions are understood, changes in information are shared, and team members have the necessary resources Situation Monitoring Process of actively scanning and assessing situational elements to gain information or understanding, or to maintain awareness to support team functioning Mutual Support Ability to anticipate and support team members’ needs through accurate knowledge about their responsibilities and workload 5 Team Structure Multi-Team System For Patient Care Safe and efficient care involves the coordinated activities of a multi-team system. MTS PATIENT CONTINGENCY TEAMS CORE TEAM COORDINATING TEAM ANCILLARY & SUPPORT SERVICES ADMINISTRATION 7 Team Structure Communication SBAR A technique for communicating critical information that requires immediate attention and action concerning a patient’s condition Situation – What is going on with the patient? “I am calling about Mrs. Joseph in room 251. Chief complaint is shortness of breath of new onset.” Background – What is the clinical background or context? “Patient is a 62-year-old female postop day one from abdominal surgery. No prior history of cardiac or lung disease.” Assessment – What do I think the problem is? “Breath sounds are decreased on the right side with acknowledgment of pain. Would like to rule out pneumothorax.” Recommendation and Request – What would I do to correct it? “I feel strongly the patient should be assessed now. Can you come to room 251 now?” 9 Communication Communication Call-Out Strategy used to communicate important or critical information • Informs all team members simultaneously during emergent situations • Helps team members anticipate next steps • Important to direct responsibility to a specific individual responsible for carrying out the task Example during an incoming trauma: Leader: “Airway status?” Resident: “Airway clear” Leader: “Breath sounds?” Resident: “Breath sounds decreased on right” Leader: “Blood pressure?” Nurse: “BP is 96/62” 10 Check-Back Using closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended The steps include the following: 1. Sender initiates the message 2. Assignment: Implementing the Bedside Shift Project Protocol Receiver accepts the message and provides feedback 3. Sender double-checks to ensure that the message was received Example: Doctor: “Give 25 mg Benadryl IV push” Nurse: “25 mg Benadryl IV push” Doctor: “That’s correct” 11 Communication Communication Handoff The transfer of information (along with authority and responsibility) during transitions in care across the continuum. It includes an opportunity to ask questions, clarify, and confirm. Examples of transitions in care include shift changes; transfer of responsibility between and among nursing assistants, nurses, nurse practitioners, physician assistants, and physicians; and patient transfers. 12 Handoff Strategy designed to enhance information exchange during transitions in care “I PASS THE BATON” I Introduction Introduce yourself and your role/job (include patient) P Patient Name, identifiers, age, sex, location A Assessment Present chief complaint, vital signs, symptoms, and diagnoses S Situation Current status/circumstances, including code status, level of (un)certainty, recent changes, and response to treatment S Safety Concerns Critical lab values/reports, socioeconomic factors, allergies, and alerts (falls, isolation, etc.) B Background Comorbidities, previous episodes, current medications, and family history A Actions Explain what actions were taken or are required. Provide rationale. T Timing Level of urgency and explicit timing and prioritization of actions O Ownership Identify who is responsible (person/team), including patient/family members N Next What will happen next? Anticipated changes? What is the plan? Are there contingency plans? THE 13 Communication Leadership Effective Team Leaders The following are responsibilities of effective team leaders: • Organize the team • Identify and articulate clear goals (i.e., the plan) •Assignment: Implementing the Bedside Shift Project Protocol Assign tasks and responsibilities • Monitor and modify the plan; communicate changes • Review the team’s performance; provide feedback when needed • Manage and allocate resources • Facilitate information sharing • Encourage team members to assist one another • Facilitate conflict resolution in a learning environment • Model effective teamwork 15 Leadership Leadership Team Events Sharing the Plan • Brief – Short session prior to start to share the plan, discuss team formation, assign roles and responsibilities, establish expectations and climate, anticipate outcomes and likely contingencies Monitoring and Modifying the Plan • Huddle – Ad hoc meeting to re-establish situational awareness, reinforce plans already in place, and assess the need to adjust the plan Reviewing the Team’s Performance • Debrief – Informal information exchange session designed to improve team performance and effectiveness through lessons learned and reinforcement of positive behaviors 16 Brief Checklist During the brief, the team should address the following questions: †† Who is on the team? †† Do all members understand and agree upon goals? †† Are roles and responsibilities understood? †† What is our plan of care? †† What is staff and provider’s availability throughout the shift? †† How is workload shared among team members? †† What resources are available? 17 Leadership Leadership Debrief Checklist The team should address the following questions during a debrief: †† Was communication clear? †† Were roles and responsibilities understood? †† Was situation awareness maintained? †† Was workload distribution equitable? †† Was task assistance requested or offered? †† Were errors made or avoided? †† Were resources available? †† What went well? †† What should improve? 18 Situation Monitoring Situation Monitoring Situation Monitoring Process Situation monitoring is the process of continually scanning and assessing a situation to gain and maintain an understanding of what’s going on around you. Situation awareness is the state of “knowing what’s going on around you.” Assignment: Implementing the Bedside Shift Project Protocol A shared mental model results from each team member maintaining situation awareness and ensures that all team members are “on the same page.” 20 STEP A tool for monitoring situations in the delivery of health care Components of Situation Monitoring: 21 Situation Monitoring Situation Monitoring STEP Tool to help assess health care situations Status of Patient Patient History Vital Signs Medications Physical Exam Plan of Care Psychosocial Issues Team Members Fatigue Workload Task Performance Skill Stress Environment Facility Information Administrative Information Human Resources Triage Acuity Equipment Progress Toward Goal Status of Team’s Patient(s)? Established Goals of Team? Tasks/Actions of Team? Plan Still Appropriate? 22 Cross-Monitoring A harm error reduction strategy that involves: • Monitoring actions of other team members • Providing a safety net within the team • Ensuring that mistakes or oversights are caught quickly and easily • “Watching each other’s back” 23 Situation Monitoring Situation Monitoring Each team member is responsible for assessing his or her own safety status I’M SAFE Checklist †† I = Illness †† M = Medication †† S = Stress †† A = Alcohol and Drugs †† F = Fatigue †† E = Eating and Elimination 24 Mutual Support Mutual Support Task Assistance Helping others with tasks builds a strong team. Key strategies include: • Team members protect each other from work overload situations • Effective teams place all offers and requests for assistance in the context of patient safety • Team members foster a climate where it is expected that assistance will be actively sought and offered 26 Feedback Information provided to team members for the purpose of improving team performance Feedback should be: • Timely – given soon after the target behavior has occurred • Respectful – focuses on behaviors, not personal attributes • Specific – relates to a specific task or behavior that requires correction or improvement • Directed toward improvement – provides directions for future improvement • Considerate – considers a team member’s feelings and delivers negative information with fairness and respect 27 Mutual Support Mutual Support Advocacy and Assertion Advocate for the patient • Invoked when team members’ viewpoints don’t coincide with that of the decisionmaker Assert a corrective action in a firm and respectful manner • Make an opening • State the concern • State the problem (real or perceived) • Assignment: Implementing the Bedside Shift Project Protocol Offer a solution • Reach agreement on next steps 28 Two-Challenge Rule Empowers all team members to “stop the line” if they sense or discover an essential safety breach When an initial assertive statement is ignored: • It is your responsibility to assertively voice concern at least two times to ensure that it has been heard • The team member being challenged must acknowledge that concern has been heard • If the safety issue still hasn’t been addressed: –– Take a stronger course of action –– Utilize supervisor or chain of command 29 Mutual Support Mutual Support CUS Assertive statements: “Stop the Line” 30 DESC Script A constructive approach for managing and resolving conflict D = Describe the specific situation or behavior; provide concrete data E = Express how the situation makes you feel/what your concerns are S = Suggest other alternatives and seek agreement C = Consequences should be stated in terms of impact on established team goals; strive for consensus 31 Mutual Support Mutual Support Team Performance Observation Tool Team Structure Assembles team Assigns or identifies team members’ roles and responsibilities Holds team members accountable Includes patients and families as part of the team Communication Provides brief, clear, specific, and timely information Seeks information from all available sources Uses check-backs to verify information that is communicated Uses SBAR, call-outs, check-backs, and handoff techniques to communicate effectively with team members Leadership Identifies team goals and vision Utilizes resources efficiently to maximize team performance Balances workload within the team Delegates tasks or assignments, as appropriate Conducts briefs, huddles, and debriefs Role models teamwork behaviors Situation Monitoring Monitors the state of the patient Monitors fellow team members to ensure safety and prevent errors Monitors the environment for safety and availability of resources (e.g., equipment) Monitors progress toward the goal and identifies changes that could alter the care plan Fosters communication to ensure a shared mental model Mutual Support Provides task-related support and assistance Provides timely and constructive feedback to team members Effectively advocates for the patient using the Assertive Statement, Two-Challenge Rule, or CUS Uses the Two-Challenge Rule or DESC script to resolve conflict 32 33 BARRIERS • Inconsistency in Team Membership • Lack of Time • Lack of Information Sharing •Assignment: Implementing the Bedside Shift Project Protocol Hierarchy • Defensiveness • Conventional Thinking • Complacency • Varying Communication Styles • Conflict • Lack of Coordination and Followup With Coworkers • Distractions • Fatigue • Workload • Misinterpretation of Cues • Lack of Role Clarity TOOLS and STRATEGIES Communication • SBAR • Call-Out • Check-Back • Handoff Leading Teams • Brief • Huddle • Debrief Situation Monitoring • STEP • I’M SAFE Mutual Support • Task Assistance • Feedback • Assertive Statement • Two-Challenge Rule • CUS • DESC Script • Patient Safety • Team Performance • Mutual Trust • Team Orientation • Adaptability OUTCOMES • Shared Mental Model Contact Information To learn more about TeamSTEPPS®, refer to the Agency for Healthcare Research and Quality (AHRQ) Web site: http://teamstepps.ahrq.gov/ and the Department of Defense Patient Safety Program Web site: http://www.health.mil/dodpatientsafety/ ProductsandServices/TeamSTEPPS Developed for the Department of Defense Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality TeamSTEPPS® 2.0 Pocket Guide 35 AHRQ Pub. No. 14-0001-2 Replaces AHRQ Pub. No. 06-0020-2 Revised December 2013 Innovation Series 2011 Hospital Inpatient Waste Identification Tool The Institute for Healthcare Improvement thanks the Health Foundation (Registered Charity Number: 286967) for its support in the development of this tool. 24 The Institute for Healthcare Improvement (IHI) is an independent not-for-profit organization that works with health care providers and leaders throughout the world to achieve safe and effective health care. IHI focuses on motivating and building the will for change, identifying and testing new models of care in partnership with both patients and health care professionals, and ensuring the broadest possible adoption of best practices and effective innovations. Based in Cambridge, Massachusetts, IHI mobilizes teams, organizations, and increasingly nations, through its staff of more than 100 people and partnerships with hundreds of faculty around the world. We have developed IHI’s Innovation Series white papers as one means for advancing our mission. The ideas and findings in these white papers represent innovative work by IHI and organizations with whom we collaborate. Our white papers are designed to share the problems IHI is working to address, the ideas we are developing and testing to help organizations make breakthrough improvements, and early results where they exist. Copyright © 2011 Institute for Healthcare Improvement All rights reserved. Individuals may photocopy these materials for educational, not-for-profit uses, provided that the contents are not altered in any way and that proper attribution is given to IHI as the source of the content. These materials may not be reproduced for commercial, for-profit use in any form or by any means, or republished under any circumstances, without the written permission of the Institute for Healthcare Improvement. How to cite this paper: Resar RK, Griffin FA, Kabcenell A, Bones C. Hospital Inpatient Waste Identification Tool. Assignment: Implementing the Bedside Shift Project Protocol IHI Innovation Series white paper. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2011. (Available on www.IHI.org) Acknowledgements: IHI would like to thank the following individuals for their contribution to this work: Marian Bihrle Johnson, Research Associate, IHI; Elizabeth Bradbury, RN, Health Foundation/IHI Fellow, 2009-2010; and Gareth Parry, PhD, Research Scientist, IHI. The authors thank Don Goldmann, Jane Roessner, and Val Weber of IHI for their critical review of and editorial assistance with this paper. IHI is also thankful to the following hospitals that contributed to testing the Hospital Inpatient Waste Identification Tool: Great Ormond Street Hospital for Children, NHS Trust; Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust; Ninewells Hospital, NHS Tayside Board; Royal Bolton Hospital, NHS Foundation Trust; Royal Free Hospital, Hampstead NHS Trust; Salford Royal Hospital, NHS Foundation Trust; Blessing Hospital; and Memorial Hermann—Texas Medical Center. In particular, we thank Blessing Hospital, Memorial Hermann—Texas Medical Center, LifeBridge Health, and St. Anthony’s Home Care for contributing their stories and examples for this white paper. We would also like to acknowledge the following individuals who consulted with IHI in this work: Khalid Almoosa, MD, Medical Director, Transplant/Surgical ICU, University of Texas Health Science Center, Memorial Hermann—Assignment: Implementing the Bedside Shift Project Protocol Texas Medical Center; Evan Benjamin, MD, Vice President, Healthcare Quality, Baystate Medical Center; Eric Dickson, MD, Senior Medical Director, University of Massachusetts Memorial Medical Group; Katharine Luther, RN, MPM, Director, Healthcare Improvement, Memorial Hermann—Texas Medical Center; Robert Merrick, MD, Medical Director of Quality Management, Blessing Hospital; Bela Patel, MD, Chief, Critical Care Medicine, University of Texas Health Science Center, Memorial Hermann—Texas Medical Center; Anna Roth, Chief Executive Officer, Contra Costa Regional Medical Center; and Sean Townsend, MD, Vice President of Quality and Safety, California Pacific Medical Center. Institute for Healthcare Improvement, 20 University Road, 7th Floor, Cambridge, MA 02138 Telephone (617) 301-4800, or visit our website at www.IHI.org. Innovation Series 2011 Hospital Inpatient Waste Identification Tool Authors: Senior Fellow, IHI Frances A. Griffin, RRT, MPA: Director, IHI Andrea Kabcenell, RN, MPH: Vice President, IHI Catherine Bones, MSW: Project Director, IHI Roger K. Resar, MD: 1 Innovation Series: Hospit … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10