• Improving Nurse-Nurse Communication to Reduce Patient Bounce-Back

      Marchione, Natalie A.; Gourley, Bridgitte (2020-05)
      Problem & Purpose: A deficit in nurse communication was identified, causing 2-5% of patients bounced-back (readmitted) to the emergency department (ED) from the psychiatric emergency services (PES). No report tool was currently used. This suboptimal communication contributed to a lack of rapport, poor workflow, and reduced patient safety, making implementation of a communication tool for the receiving nurse in PES essential. The purpose of this project was to implement and evaluate a psychiatric SBAR tool (PSYCH) utilized by PES nurses when receiving report on patients from the ED. The goal was to reduce the current rate of 2-5% patient bounce-back in PES to 0% through improvements in nurse communication. Methods: The theoretical framework used was Kurt Lewin’s Change Theory, guided by the MAP-IT model. Subjects included were all PES nurses. Data was collected using the AHRQ TeamSTEPPS T-TAQ Communication Scale, Random Observations, and Patient Bounce-Back Audit Form. The T-TAQ communication scale was identified to collect data on nurse perception of communication between PES and the ED, analyzed by Independent samples t-tests. Results: Pre-T-TAQs found the ED perception of communication (M = 24.25) was hypothesized to be lower than PES’s perception (M = 25.75). This difference was found to be significant, t(30) = -1.85, p = 0.04. Post- T-TAQ scores were not found to be significant. Patient bounce-back reduced to 0.8% throughout implementation. Conclusion: This project showed the feasibility of a PSYCH tool used during report between two emergency units to improve communication. It allowed nurses to comprehend information gathered, enhancing efficiency by reducing redundancy. The project reduced patient bounceback and identified security concerns impacting patient and staff safety. The results reinforced the importance of gathering all pertinent data using a standardized tool for furthering effective communication.
    • Improving Teamwork and Communication for Child Psychiatric Staff

      Smith, Ciara M.; Rowe, Gina C. (2020-05)
      Problem & Purpose: There is a critical need for mental health staff to work well as a team, particularly with the increase in high acuity behavioral health patients and shortage of experienced psychiatric nurses in recent years. Staff members on an inpatient pediatric psychiatric unit have recognized elements that underpin effective teams and include efficient, effective communication, transparency and trust. Leadership on the unit have identified team communications skills as an area of opportunity to improve the staff’s perception of teamwork. The purpose of this quality improvement (QI) project is to establish a baseline measure of teamwork, equip staff with evidence-based teamwork tools based on TeamSTEPPS 2.0: Strategies and Tools to Enhance Performance and Patient Outcomes (TeamSTEPPS), evaluate success of the tools, and make recommendations for improvement. Methods: Thirty-four inpatient child psychiatric nurses and mental health technicians received education on strategies from the Mutual Support and Situational Monitoring modules of the TeamSTEPPS® 2.0 fundamental curriculum, such as C-U-S, DESC Script, and cross monitoring. These strategies helped improve the process of communication during therapeutic groups by improving staff’s interactions. Staff used the TeamSTEPPS strategies to communicate when they needed support and to actively seek out opportunities to help their team members. Charge nurses audited staff members’ communication patterns during an evening therapeutic group twice a week to assess the team’s ability to use the new TeamSTEPPS strategies. Results: Data from the domains of Mutual Support and Situation Monitoring of the Teamwork Perceptions Questionnaire (T-TPQ) were collected at baseline and post-implementation. Staff’s perception of Situation Monitoring increased significantly (p=0.01). Staff’s perception of Mutual Support increased; however, this increase was not significant (p=0.11). Although staff did not consistently meet the targeted goal of “Good” (4), the run charts of both outcomes revealed a positive trend, and staff met the goal 32% of the time during the implementation period. Conclusions: TeamSTEPPS offers a standardized approach to teach mental health providers how to support each other during therapeutic groups. Future studies should focus on reinforcement strategies and the long-term relationship between TeamSTEPPS implementation and rates of workplace violence.