san antonio regional hospital - hospital association of ...key individuals core team mario...

San Antonio Regional Hospital

TeamSTEPPS Presentation

November 10, 2016

Key Individuals

Core Team

Mario Lopez-Luna

Christina Mallon

Maureen Battle

Natalie Souza

Michelle Lukaszewicz

Linda Lough

Physician Champion

Dr. Owais Zaidi

Baseline Data

Data was obtained through our Employee Satisfaction survey, Patient Safety Culture survey and through a discussion with active providers and our CNO and Director of Operations for Nursing Administration

Our surveys showed there were deficiencies in communication between departments; only 53% felt there was adequate communication between departments

Baseline Data

Within departments, nurses were more

likely to communicate well amongst each

other but there were communication

issues within other departments

Although receiving higher scores, there

was still room for improvement in having

employees feel that their department or

work group worked well together as a

team

Baseline Data

During our discussion with physicians we

learned that they were unaware of the

SBAR and were unable to locate it easily

in the patient chart

There was a communication barrier

between nursing and physicians

Physicians felt the program might be

another “flavor of the month” and there

would be no follow-through

Focus and Efforts

We decided to focus our efforts hospital

wide and not on one specific unit.

Meetings covered the following topics:

Introduction to program/what our goal was

Communication (SBAR)

Team Structure/Synergistic Decision Making/

Huddles/Briefs

Situational Monitoring/Mutual Support

CUS/2 Rule-Challenge/Next Steps

Barriers & Hospital Challenges

Largest barrier is getting physicians on

board with the program

New hospital patient tower opening in

December

Keeping the program “alive”

Silo mentality among staff

Strategies – What and How

Held five 1.5 hour meetings in the

evening. Staff paid for their time and

dinner was provided.

Started with Charge Nurses and Team

Leads from ancillary departments

An average of 65 participants per meeting

Event Photos

Team Huddle

Event Photos

Tools Started With

The communication tool we emphasized

the most was the SBAR

Although the tool is currently being used

by nursing, it was not always being utilized

properly

SBAR is brief and effective and can be

used to update physicians and oncoming

nurses of any relevant changes to the

patient

SBAR From Cerner (EMR)

SBAR Printout

SBAR Note Entered On: 7/15/2016 6:04 PDT Performed On: 7/15/2016 5:49 PDT by NURSE NAME

Situation: 0420. Patient calling for assistance out of bed to BRP. Patient walked to BRP without any difficulty and upon sitting on commode, patient reporting nausea and dizziness. Patient then became non-verbal upon sitting down on commode. 0422: Blood sugar obtained and BS: 106. 0425 RR team paged to room. Unable to get patient off of commode due to mentation status. Dr XXX (Covering Dr XXX) 0430: RR team in patient room. 0430: Currently updated Dr XXX on patient status. Notified him that RR team was in patient room. 0431: Paged placed on hospitalist at this time to call Dr XXX, 0437: patient with BP: 134/57, HR: 77. Patient remains on commode. RR team remains at bedside. Lab in room. Upon standing-up patient took two steps then reporting that she is getting blurry vision. Patient back in bed and alert and oriented to person and place. 0454: BP: 120/94 and patient 100% on RA. Upon going back into patient room, patient noted with oxygen saturation level of 88%. Patient placed on 5L NC and oxygen saturation up to 90%. Patient with blank stare in the middle of conversing. Patient placed on 6L Mask. Paged placed to Dr XXX, 0515 to update him on patient's current status. Order received. Patient's current BP: 101/87 and remains 93% on 6L mask. Patient alert and notified her friend via text of current status. Patient more alert upon transfer to tele Rm 262B. Background: Patient is POD # 2 RTK Assessment: Patient clammy and diaphoretic. Oxygen saturation dropped to 70%. Patient able to slur out her name. Patient still unable to remain alert. BP: 70/40 with HR 120. 0427: 6L NC placed on patient via portable O2 tank. ). NS bolus started. Patient remains on commode and more alert. Patient no longer slurring words, Patient more alert and assisted back to bed. Please refer to situation Recommendation: To transfer to tele. NURSE NAME - 7/15/2016 6:18 PDT

Tools Started With

Call out and CUS – instrumental in preventing safety issues and providing safe care to patients

Briefs, De-briefs, and Huddles – excellent communication tools to discuss what worked and what could have been done better and to discuss patient care for the day

Mutual Support – letting staff know it’s ok to ask for help and to offer help

Tools Started With

Situational Monitoring

Process Changes

Implement the idea towards eliminating

“Nursing Notes” so that SBAR is the

main means of effective communication

Moving the SBAR from the nursing

domain to the M-Page of physicians for

quick access

Qualitative/Quantitative Data

Performed an evaluation after the

program was completed

Attendees were very supportive of the

program and found it to be very beneficial

They stated they are now more likely to

speak up when they see something that

could affect patient safety and are more

likely to ask for help or offer task

assistance


Many respondents have already began

using the communication tools they

learned about, especially the SBAR

76% of the respondents felt that the

biggest barrier in implementing the

program was resistance from providers


SBAR usage increased

3384 3435 34163234

40224313

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

April May June July August September

SB

AR

Co

un

t

# of Times SBAR was Used


Program was found to be “very beneficial”

among the majority of attendees

Very

beneficial,

89%

Somewhat

beneficial,

7%

Not very

beneficial,

4%

Not at all

beneficial,

0%


Communication tools found to be most

useful

0% 20% 40% 60% 80% 100%

Feedback

Briefs

Check-back

Debrief

Huddle

Call-outs

CUS

SBAR

46%

50%

57%

57%

61%

71%

86%

96%


All of the attendees have already used

some of the tools introduced. The most

used tools were:

SBAR

Huddle

Feedback

CUS


Overall Rating of Meetings (10 = highest),

mean score of 8.6

0%

10%

20%

30%

40%

50%

10 9 8 7 6 5 4 3 2 1

36%

25%29%

7%

0% 0% 0% 0% 0%4%

Feedback About Meetings

“I wish more could participate in this workshop. It is beneficial in everything we do to help each other help others!”

“Group input and participation.”

“Together we make things better.”

“It reminded me to come to work with the idea of making sure we don’t fail any one patient.”

“Powerful videos, clear direction from speakers, good useful content.”

Conclusion/Next Steps

From the feedback received, the primary

barrier to overcome is from providers. To

overcome this barrier we’re going to be

conducting a 3 hour presentation to our

executive management group along with

all medical directors of departments. This

will hopefully strengthen their

commitment to more effective

communication.

Conclusion/Next Steps

Classes will be offered in 2017 to all members of the patient care team

Restructure class format to accommodate larger volume of employees

Continue to award appropriate use of SBAR to individual staff along with awarding leads and charge for effective communication through huddles, briefs, and debriefs

Team will be visible on the floors

Iceberg

Currently we are in

the “Empower

Others” stage

Something BIG is happening in the IE!

And we are glad to be part of it!

Contacts:

Chris - (909) 579-6715

Michelle - (909) 920-6222

Questions?

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