pdpm academy – business solutions for better patient care…• ltc version developed in 2012-...

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PDPM ACADEMY –Business Solutions for Better Patient Care

6/17/2019 IMPROVING LIVES BY DELIVERING SOLUTIONS FOR QUALITY CARE 1

LTC TeamSTEPPs® - In Depth

June 17, 2019

Count Down to PDPM Implementation from June 6 to October 1, 2019

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106 Days from Today, June 17, to October 1,

2019

Transition Work

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Agenda

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LTC TeamSTEPPs® Position in Core Competencies

Agency for Healthcare Research and Quality TeamSTEPPs® Overview

Member LTC TeamSTEPPs® Experience, Tealwood Senior Living

Q&A

Today’s Speakers

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Margie Shofer, Amanda Johnson

Sharon KostbothHarper

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LTC Team STEPPs® -In Context with Core Competencies

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Core Competencies Refresher

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Strengthening Your Care Delivery Under PDPM – Deep

Dive on LTC TeamSTEPPS

Margie ShoferDirector, Patient Safety Program

Center for Quality Improvement and Patient SafetyAgency for Healthcare Research and Quality

AHRQ’s Mission

“To produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.”

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What Is TeamSTEPPS®?

• An evidence-based teamwork system

• Designed to improve:

► Quality

► Safety

► Efficiency of health care

• Practical and adaptable

• Provides ready-to-use materials for training and ongoing teamwork

Why Use TeamSTEPPS?

• Goal: Produce highly effective medical teams that optimize the use of information, people, and resources to achieve the best clinical outcomes.

• Teams of individuals who communicate effectively and back each other up dramatically reduce the consequences of human error.

• Team skills are not innate; they must be trained.

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What Makes TeamSTEPPS Different?

• Evidence based and field tested

• Comprehensive

• Customizable

• Easy to use

• Publicly available

History of TeamSTEPPS

• First developed for the acute care setting in 2006

• Updated over the past 14 years to include multiple settings and revisions to modernize the content

• LTC version developed in 2012- revised to 2.0 in 2018.

• Since that time, TeamSTEPPS has been widely used and proven to help lead to a positive culture of safety.

• Train the trainer model.

• The curriculum is available on the AHRQ website.

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Evidence That TeamSTEPPS Works

■ Thomas & Galla (2013)

■ Systemwide implementation

■ Pre- and post-TeamSTEPPS training results:

■ Significant improvement in HSOPS scores on Feedback and Communication AboutError, Frequency of Events Reported, Hospital Handoffs and Transitions, and Teamwork Across Units

■ Incremental changes evident through reduction of nosocomial infections, falls, birth trauma, and other incidents

■ Howe (2014)

■ Certified nurse aide implementation

■ Pre- and post-TeamSTEPPS training results:

■ Improved scores on several Quality of Life survey subscales

■ Enhanced perceived empowerment of the certified nurse aides

What is Included in the Curriculum?

• Fundamentals includes 7 modules► Introduction

► Team Structure

► Communication

► Leading Teams

► Situation Monitoring

► Mutual Support

► Summary – Pulling it all Together

• An additional 5 modules are for trainers to address issues related to implementation

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TeamSTEPPS Strategies and Tools

BARRIERS

Inconsistency in Team Membership

Lack of Time

Lack of Information Sharing

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

OUTCOMES

Shared Mental

Model

Adaptability

Team Orientation

Mutual Trust

Team

Performance

Resident Safety!!

Challenges in Communication and Teamwork

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SBAR

• Situation—What is happening with the resident?

• Background—What is the clinical background?

• Assessment—What do I think the problem is?

• Recommendation—What would I recommend?

SBAR in Action

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Briefs

• A team briefing is an effective strategy for sharing the plan

• Briefs should help:

► Form the team

► Designate team roles and responsibilities

► Establish climate and goals

► Engage team in short- and long-term planning

Brief in Action

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Handoffs

• Transfer of responsibility and accountability

• Clarity of information

• Verbal communication of information

• Acknowledgment by receiver

• Opportunity to review

I PASS THE BATON

Introduction: Introduce yourself and your role/job (include resident)

Patient/Resident: Identifiers, age, sex, location

Assessment: Present chief complaint, vital signs, symptoms, and diagnosis

Situation: Current status/circumstances, including code status, level of uncertainty, recent changes, and response to treatment

Safety: Critical lab values/reports, socioeconomic factors, allergies, and alerts (falls, isolation, etc.)

THE

Background: Comorbidities, previous episodes, current medications, and family history

Actions: What actions were taken or are required? Provide brief rationale

Timing: Level of urgency and explicit timing and prioritization of actions

Ownership: Who is responsible (nurse/doctor/team)? Include resident/family responsibilities

Next: What will happen next? Anticipated changes? What is the plan? Are there contingency plans?

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I PASS THE BATON in Action

Huddle

Problem Solving

► Hold “touch base” meetings as needed to regain situation awareness

► Discuss critical issues and emerging events

► Anticipate outcomes and likely contingencies

► Assign resources

► Express concerns

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Huddle in Action

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Amanda Johnson,

Vice President Clinical Operations

and

Sharon Kostboth Harper,

TeamSTEPPS & Resident Safety

Project Director

Amanda Johnson,

Vice President Clinical Operations

and

Sharon Kostboth Harper,

TeamSTEPPS & Resident Safety

Project Director

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• Corporate Office: Bloomington, Minnesota

• Locations: Minnesota, Wisconsin, South Dakota, Nebraska and

Iowa

• Services Portfolio: Long-term care, assisted living,

independent living, memory care and rehabilitation services

• 45 Locations

• Employees: 2900

Our TeamSTEPPS Journey

• Began in 2013 with TeamSTEPPS program

implementation at 15 long-term care centers

in Minnesota and South Dakota

• Team & Clinical Focus Areas: Pain, Pressure

Ulcers, Falls, Medication Errors

• Brief, Handoff, Huddle, SBAR

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Tealwood Application: BRIEFPlanning

– Team meets at the start of every shift

– Nurse leads Brief

– Team roles and responsibilities clarified

– Resident & staff updates communicated

– Brief: 5 - 7 minutes

– Identify means of communicating information for team members not

present

– Facilitates information sharing and team engagement

Tealwood Application: HUDDLEProblem Solving

– Nurse facilitates Huddle

– Huddle follows resident fall/Adverse Event

– Team members responding to resident fall attend Huddle

– Conduct root cause analysis (RCA)

– Utilize Adverse Event Investigative report to discuss fall & complete Huddle form

– Facilitates guided discussion regarding event and

interventions to prevent a future event

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Tealwood Application: HANDOFF

• Internal Handoff: Shift Change

Information exchange from outgoing shift nurse to incoming shift nurse

Utilize resident 24-hour report to discuss events: medication changes, change in

condition, falls, admissions, discharges, and doctor appointments as well as staffing

updates or changes in assignments

Facilitates continuity of care

• External Handoff: Transition of care outside the Center Transfer of information (along with authority and responsibility) outside the center, for example, to

the hospital or another facility

I PASS THE BATON

HANDOFF (continued)• External Handoff:

Transition of care outside the Center

(hospital, another facility, home)

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TeamSTEPPS Sustainability

• ED Reports

• Monthly or Quarterly Consultant Reviews

• New Employee Onboarding

• Current Employee Annual Refresher

• Mentor Program

• Track Goals on Internal Dashboard

• Embedded in our Culture

Tealwood Application: SBARA technique for communicating critical information that requires immediate

attention and action concerning a resident’s condition.

• Nurse contact with physician

• Other (?)

SBARSituation

Background

Assessment

Recommendation & request

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Tealwood’s PDPM Journey

• Formed an internal “Task Force”

• AHCA’s PDPM Readiness Toolkit as guide

• Monthly meetings

• Monthly trainings or communications

AHCA Academy, Webinars etc

TEALWOOD PDPM and TeamSTEPPS

Focus on the Four Competencies

#1 Understand New Payment Model’s Impact

#2 Accurate Collection of Clinical Information

#3 Focus on Care Delivery Process

#4 Optimize Resources

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TeamSTEPPS PDPM

Per CMS-

“PDPM focuses on the unique,

individualized needs, characteristics and goals

of each patient/resident.”

and ToolsBARRIERS

Inconsistency in Team

Membership

Lack of Time

Lack of Information Sharing

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

OUTCOMES

Shared Mental

Model

Adaptability

Team Orientation

Mutual Trust

Team Performance

Resident Safety!!

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TeamSTEPPS PDPM

Briefs

Huddles

Handoffs

TeamSTEPPS PDPM

Core Competency #1- Key Components

*Gaps in Care Delivery

*Patient First Culture

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PRIORITY- Attention to First 3 days

• an interdisciplinary team of qualified clinicians

is involved in assessing the resident during

the three-day assessment period.

• A team briefing is an effective strategy for

sharing the plan

• Briefs should help:

– Form the team

– Designate team roles and responsibilities

– Establish climate and goals

– Engage team in short- and long-term planning

Briefs

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• Opportunity for use: BRIEF

– Prior to new admission

– Format for Medicare Meetings- Care Coordination

• Share more detailed information on care

delivery/needs

TeamSTEPPS PDPM

Core Competency #2- Key Components

*Discrepancy between disciplines

*Section GG

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• Transfer of responsibility and accountability

• Clarity of information

• Verbal communication of information

• Acknowledgment by receiver

• Opportunity to review

Handoffs

Opportunity for use: HANDOFF

– Shift change/Caregiver change

– Prior to Therapy Session

– Make Section GG areas of focus of Handoff• Bed mobility (2 items)

• Transfers (3 items)

• Eating

• Toileting

• Oral Hygiene

• Walking (2 items)

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TeamSTEPPS PDPM

Core Competency #3- Key Components

*Who is involved in Care Planning

*Communications focused on key PDPM

components

Problem Solving– Hold “touch base” meetings as needed to regain situation awareness

– Discuss critical issues and emerging events

– Anticipate outcomes and likely contingencies

– Assign resources

– Express concerns

Huddle

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Opportunity for use: HUDDLE

Adverse Events-

fall, bruise, behavior

New or Change of Condition

transfers, pain, special requests

TeamSTEPPS PDPM

Core Competency #4- Key Components

*Utilize Resources

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• TeamSTEPPS

• AHRQ

• AHCA

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LTC TeamSTEPPs® Resources

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AHRQ Webpage

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Recommended Tools

Communication• SBAR

• Call-Out

• Check-Back

• Handoff

Leading Teams• Brief

• Huddle

• Debrief

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Review the Detailed Core Competencies Resources

Download the Readiness Tools Here at ahcancalED

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Upcoming Events and Resources

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June PDPM Academy Webinar

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June 25, 3:00 – 4:30PM

Role of Restorative

Nursing in PDPM

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Have We Addressed Questions & Concerns?

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PDPM ACADEMY –Business Solutions for

Better Patient Care

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