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
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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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THANK YOU FOR YOUR TIME & PLEASE PROVIDE FEEDBACK TO HELP AHCA IMPROVE
OUR MEMBER SUPPORTS