Our Journey through the

Implementation of TeamSTEPPS

United Memorial Medical Center

Learning Objectives

Identify ways to integrate TeamSTEPPS tools into simulation sessions1. Practice “CUS”2. Practice Huddle – Brief – Debrief

Reinforce effective hourly rounding techniques3. Review of hourly rounding video

Our Team!Our team consisted of: Educators, Nurse Managers representatives from Laboratory, Radiology, Clinical Care Coordinator - Surgical floorRisk Manager, Director of Cardiology and Pain Centers (outpatient services), ED Staff nurse, andPatient Safety Officer

We all attended TeamSTEPPS Train-the-Trainer classes on 4/11, and 4/12/2013

The Aims . . .• We hoped to improve the hourly rounding in the

clinical departments

• Educate the staff on the tools (CUS – Huddle- Brief – Debrief) and utilize these tools consistently in simulation trainings

• Reinforce use of the tools with real stories when used successfully

CHART Institute – Train the Trainer 5

“CUS” is an acronym to structure

conversation that may be

difficult to have. First, state your concern (or ask

to clarify). Then, state why

you are uncomfortable.

Lastly, if the conflict is not resolved, state that this a safety issue (STOP!)

6

Promoting and Modeling Teamwork

Tools to use:

• Briefs- clarifies roles and responsibilities, opens lies of communication

• Huddles –reinforces plan and reevaluates workloads

• Debrief – brief informal exchange and feedback tool

The Beginning. . . Hourly Rounding and Simulation• We started the process by developing a survey

tool and conducting interviews with inpatients to see if they were being rounded on routinely

CUS, Brief and Debrief • We started with educating staff on the tools by

putting articles in the Monday report, signs in break rooms, on-line education, leadership presentation, and collecting success stories

The Data• What were the results and findings?

Question Patient AnswerDid you receive a card and instructions about hourly rounding when you were admitted?

20 – no or did not remember getting it (52%)18 – yes (48%)

Do you understand what hourly rounding is?

14 – unsure or no (37%)24 – yes (63%)

Have the staff been rounding on you regularly?(Never – sometimes – usually- always)

8 – sometimes (21%)14 – usually (37%)16- always (42%) 

How often have you received hourly rounding?(Never – sometimes – usually- always) 

9 – sometimes (24%)14 – usually (37%)15- always (39%)

Have you been offered help getting to the bathroom?(Never – sometimes – usually- always)

5– sometimes2 - usually31 -Always or not needed 

Is your pain controlled and do you receive pain medication timely?

7 – sometimes31- Always or not needed

On a scale of 1 – 5, how would you rate your care so far? 

3-2 (5%)4-16 (42%)5-20 (53%)

Summary for patient interviews for hourly rounding (Total # of patients 38)5/6/13 rounded on 9 patients, 5/9 rounded on 16 patients, 5/13 rounded on 6 patients, 5/16 rounded on 7 patients

Process. . . • Education was done at staff meetings (poor

attendance was a hurdle)

• We put signs in all the patient rooms

• After these were done we surveyed the patients again ~ results were very similar to the first time

• We met with a group of “champions” from each of the units and the results are as follows

Hurdles. . . Champions Brainstorming Session – Hourly Rounding

WHY DO WE DO HOURLY ROUNDING?• Satisfy patient needs• Safety• We are told to• Empathy, service, importance to the patient

BARRIERS TO HOURLY ROUNDING• Patient load• Patient perception• Staff attitude• Resist new ideas, push back against disciplinary actions• Patient with lots of needs• Time constraint • Need to triage/prioritize duties• Patients don’t recognize what it i• Very busy 7am to 11am (bath time)

Brainstorming Solutions

• Other staff help with rounding • Coaching each other• Different/staggered bath times• Starts from within (champions first, then others)• Ask what they need to do this• Drill down, say the words “Hourly Rounding”, make it a

habit• Lead by example• Develop a contest• Block time (assign certain times for staff)• Make a video

Progress• A rounding video was created by staff and team

members• Rounding competencies were done using the

simulation manikin, staff watched the video and then simulated actual rounding during the month of December

• We are getting other ancillary staff involved in the rounding to assist the clinical staff on the floors (other staff who go to patient rooms – Lab, radiology, social workers, discharge planners – explained at staff meetings)

• Alternate times for rounding (RN’s on the even, CNA’s on the odd)

Success!!U

nsu

re o

r no

Yes

Never

Usu

all

y

Alw

ays 3 4 5

Do you understand what hourly round-

ing is?

Have the staff been round-ing on you regulary?

On a scale of 1-5, how would you rate your

care so far? (1 - worse 5 best care ever)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Patient Scores Based on Patient Interviews

May 2013January/February 2014

Sustain the Gains• We plan on continuing patient interviews

quarterly to monitor progress. If we see a decline we will activate more education

• All new clinical employees will view the hourly rounding video during orientation

• We are doing annual hourly rounding competencies

• Managers continue to review hourly rounding sheets

Integrating TeamSTEPPS Tools

and Simulation• Using simulation in the making of the video

• Mock Codes done in simulation are debriefed consistently

• Competencies done with simulation include scenarios that practice huddle- brief - debrief

RN’sCome One Come All to the Competency

Circus!

Headlining: The Curious Transformation ofSim Man to Bo Bo the ClownAlso featuring:The Sword Swallower (NG tube insertion, Tracheostomy Care)The Ice Man (Fluid Warmer, CBI)The Knife Thrower (chest tubes, pain pump, IV pump)The Amazing Horsewoman (Decubitus Prevention, Wound care and Staging)Electric Man (Defibrillator training and Mock Code)Ventriloquist (Hourly Rounding competency)

Competency Circus 2014 -

Using Simulation

Culture Changes…• Team leaders are now using TeamSTEPPS

terminology on a consistent basis: Huddle – Brief – Debrief - CUS

• The TeamSTEPPS team continues to meet monthly, and the next project is to develop a “debrief” form used by staff after all codes.

• UMMC is now integrating bedside reporting on the medical unit. Staff survey responses were overwhelmingly supportive and positive

Wrapping up

• TeamSTEPPS tools are an excellent resource both with simulation and real life events

• The team hopes to continue to tackle different projects using the tools we have learned

• Make it measurable – this is sometimes a struggle and we still struggle with simulation at times

• When possible make it fun! Healthcare is a very serious business, so if you can lighten up the learning you get better results!