• Improving Ineffective Communication in Long Term Care Settings

      Rucker, Airelle P.; Windemuth, Brenda (2019-05)
      Background Ineffective communication contributes to medical errors and sentinel events in healthcare, leading to fatalities and billions in malpractice cost. Nurses have a leading role in communicating patient information. In long-term care, ineffective communication and poor teamwork contributes to adverse events. Adverse events in our older adults can lead to hospitalizations, injuries, and death. Effective communication and teamwork are key components to providing safe patient care. Implementing a standardized handoff tool and team building curriculum can improve communication and teamwork. Local Problem Ineffective communication was a verbalized, observable practice problem at a long-term care facility in a suburban location in the Mid-Atlantic region. The purpose of this Doctor of Nursing Practice quality improvement project was to implement and evaluate the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) curriculum with a standardized handoff tool to improve communication and teamwork between nurses at this long- term care facility. Interventions During this quality improvement project, six nurses at a suburban long-term care facility learned two TeamSTEPPS modules: communication and team structure. Modules included strategies such as use of the Situation-Background-Assessment-Recommendation communication framework and used a validated handoff tool, Safer Sign Out. This quality improvement project occurred over 14 weeks. During week one, the nurses were informed about the practice change. During week two, the DNP project leader administered pre-surveys and educated the nurses on the TeamSTEPPS’s curriculum and handoff tool. During weeks three through thirteen, the nurses utilized the Safer Sign Out handoff tool to give report. Nurses were observed during each shift change during the first week on implementation. The project leader reviewed the handoff log for compliance and gave feedback. During week fourteen, nurses completed post- surveys. Lippitt’s Change Theory was used to guide this practice change. Results (Impact of change) The post- TeamSTEPPS Teamwork Attitudes Questionnaire revealed an increase in overall scores on the team structure and communication category but these changes were not significant, thus indicating only a limited overall improvement in the nurse’s attitudes about teamwork and communication. The post- TeamSTEPPS Teamwork Perceptions Questionnaire, revealed an overall slight increase in the scores from the team structure category and a slight decrease within the communication category; however, neither were found to be statistically significant. The data revealed that use of TeamSTEPPS did not result in significant improvements in the staff’s attitudes and perceptions on teamwork and communication. Conclusion Ineffective communication and poor teamwork in long-term care continues to lead to adverse events. Information is often lost during shift handoff. In this quality improvement project, several limitations may have impacted the results: a small sample size, a lack of involvement of an organizational champion or internal change agent, limited space to free text information on the handoff tool, and many internal organizational changes. Barriers must be addressed before implementing a communication and team-building curriculum. If barriers are addressed, then utilizing the TeamSTEPPS curriculum with nurses to teach teamwork and communication strategies, along with a validated handoff tool, may help to improve communication during shift hand-off.
    • Improving Staff Communication and Teamwork As a Psychiatric Day Program

      Aitken, Molly K.; Michael, Kathleen (2019-05)
      Background: The Institute for Healthcare Improvement has identified four foundational principals for making health care systems and processes safer and more reliable: Standardized processes and care, Simplified processes, Reduced autonomy, and Highlighting deviations from practice. They recommend use of the TeamSTEPPS Situation, Background, Assessment, Recommendation/Request (SBAR) technique to maximize communication between members of healthcare teams. TeamSTEPPS is a training program that was developed by the Agency for Healthcare Research and Quality (AHRQ) and the Department of Defense (DoD), with the most recent version being TeamSTEPPS 2.0. It consists of five key principals: Team Structure, Communication, Leadership, Situation Monitoring, and Mutual Support. Local Problem: A behavioral health provider in Baltimore City recognized the need to improve teamwork, communication, and efficiency during shift-change report among staff members at their psychiatric day program. Interventions: Fall of 2017, training was done with staff members at this psychiatric day program on TeamSTEPPS 2.0’s key principals of Communication and Leadership. October 3, 2018, training was done on the key principal of Situation Monitoring, implementation of the mnemonic “I PASS THE BATON” – the new evidence based standard for handoffs, and refresher training on Communication and Leadership. Participants completed the Teamwork Attitudes Questionnaire (T-TAQ) prior to training and again after a seven-week implementation period. Results: Eleven staff members (n=11) were trained on October 3, 2018. Comparison of the pretraining and post-training T-TAQ questionnaires yielded evidence of improved staff attitudes toward team structure (38%), leadership (9%), situation monitoring (23%), and communication (38%), as evidenced by a greater number of Strongly Agree responses on the post-training questionnaires. Although there was a 14% improvement in the number of Strongly Agree responses for the category of mutual support, the overall percentage of Strongly Agree responses remained fairly low at only 33%. This agency continues to encourage its staff members to utilize the “I PASS THE BATON” mnemonic during shift reports. Conclusions: TeamSTEPPS 2.0 is a good fit for improving teamwork, communication, and efficiency of shift-change reports for this psychiatric day program. Continued training and refresher training, as well as inclusion of this training as competencies for new-hires, will be essential for maintaining these skills and improving patient outcomes.