TeamSTEPPS Essentials Course

Contents

Slide 1: Essentials Course
Slide 2: Framework and Competencies
Slide 3: Key Principles
Slide 4: Multi-Team System For Patient Care
Slide 5: SBAR
Slide 6: Call-Out
Slide 7: Check-Back
Slide 8: Handoff
Slide 9: Handoff (continued)
Slide 10: Effective Team Leaders
Slide 11: Team Events
Slide 12: Brief Checklist
Slide 13: Debrief Checklist
Slide 14: Situation Monitoring Process
Slide 15: STEP
Slide 16: STEP (continued)
Slide 17: Cross-Monitoring
Slide 18: I'M SAFE Checklist
Slide 19: Task Assistance
Slide 20: Feedback
Slide 21: Advocacy and Assertion
Slide 22: Two-Challenge Rule
Slide 23: CUS
Slide 24: DESC Script
Slide 25: Team Performance Observation Tool
Slide 26: Barriers, Tools and Strategies, and Outcomes
Slide 27: Effective Use of TeamSTEPPS Tools and Strategies
 

Slide 1: Essentials Course

Pocket Guide: TeamSTEPPS 2.0

Team Strategies & Tools to Enhance Performance and Patient Safety.

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Slide 2: Framework and Competencies

Team Competency Outcomes

Knowledge:

• Shared Mental Model.

Attitudes:

• Mutual Trust.
• Team Orientation.

Performance:

• Adaptability.
• Accuracy.
• Productivity.
• Efficiency.
• Safety.

Image: The TeamSTEPPS logo.

TeamSTEPPS has five key principles. It is based on team structure and four teachable-learnable skills: Communication, Leadership, Situation Monitoring, Mutual Support. The arrows depict a two-way dynamic interplay between the four skills and the team-related outcomes. Interaction between the outcomes and skills is the basis of a team striving to deliver safe, quality care and support quality improvement. Encircling the four skills is the team structure of the patient care team, which represents not only the patient and direct caregivers, but also those who play a supportive role within the healthcare delivery system.

...TeamSTEPPS is an evidence-based framework to optimize team performance across the healthcare delivery system.

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Slide 3: Key Principles

Team Structure

Identification of the components of a multi-team system that must work together effectively to ensure patient safety.

Communication

Structured process by which information is clearly and accurately exchanged among team members.

Leadership

Ability to maximize the activities of team members by ensuring that team actions are understood, changes in information are shared, and team members have the necessary resources.

Situation Monitoring

Process of actively scanning and assessing situational elements to gain information or understanding, or to maintain awareness to support team functioning.

Mutual Support

Ability to anticipate and support team members' needs through accurate knowledge about their responsibilities and workload.

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Slide 4: Multi-Team System for Patient Care

Safe and effective care involves the coordinated activities of a multi-team system.

Image: A triangle shows the following teams in the multi-team system from top to bottom: Patient → Core Team / Contingency Teams → Coordination Team and Ancillary & Support Services → Administration.

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Slide 5: SBAR

A technique for communicating critical information that requires immediate attention and action concerning a patient's condition.

Situation—What is going on with the patient?

"I am calling about Mrs. Joseph in room 251. Chief complaint is shortness of breath of new onset."

Background—What is the clinical background or context?

"Patient is a 62-year-old female post-op day one from abdominal surgery. No prior history of cardiac or lung disease."

Assessment—What do I think the problem is?

"Breath sounds are decreased on the right side with acknowledgment of pain. Would like to rule out pneumothorax."

Recommendation and Request—What would I do to correct it?

"I feel strongly the patient should be assessed now. Can you come to room 251 now?"

Image: A photograph shows a member of the medical team talking on the telephone.

Select the link below to access the video.

SBAR (1 min., 35 sec.)

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Slide 6: Call-Out

Strategy used to communicate important or critical information.

• Informs all team members simultaneously during emergent situations.
• Helps team members anticipate next steps.
• Important to direct responsibility to a specific individual responsible for carrying out the task.

Example during an incoming trauma:

Leader: "Airway status?"
Resident: "Airway clear."
Leader: "Breath sounds?"
Resident: "Breath sounds decreased on right."
Leader: "Blood pressure?"
Nurse:  "BP is 96/62."

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Slide 7: Check-Back

Using closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended. 

The steps include the following:

1. Sender initiates the message.
2. Receiver accepts the message and provides feedback.
3. Sender double-checks to ensure that the message was received.

Example:

Doctor: "Give 25 mg Benadryl IV push."
Nurse: "25 mg Benadryl IV push."
Doctor: "That's correct."

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Slide 8: Handoff

The transfer of information (along with authority and responsibility) during transitions in care across the continuum. It includes an opportunity to ask questions, clarify, and confirm.

Examples of transitions in care include shift changes; transfer of responsibility between and among nursing assistants, nurses, nurse practitioners, physician assistants, and  physicians; and patient transfers.

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Slide 9: Handoff (continued)

Strategy designed to enhance information exchange during transitions in care.

I PASS the BATON

Initial	Stands for...
I	Introduction	Introduce yourself and your role/job (include patient).
P	Patient	Name, identifiers, age, sex, location.
A	Assessment	Present chief complaint, vital signs, symptoms, and diagnoses.
S	Situation	Current status/circumstances, including code status, level of (un)certainty, recent changes, and response treatment.
S	Safety Concerns	Critical lab values/reports, socioeconomic factors, allergies, and alerts (falls, isolation, etc.).
THE
B	Background	Comorbidities, previous episodes, current medications, and family history.
A	Actions	Explain what actions were taken or are required. Provide rationale.
T	Timing	Level of urgency and explicit timing and prioritization of actions.
O	Ownership	Identify who is responsible (person/team), including patient/family members.
N	Next	What will happen next? Anticipated changes? What is the plan? Are there contingency plans?

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Slide 10: Effective Team Leaders

The following are responsibilities of effective team leaders:

• Organize the team.
• Identify and articulate clear goals (i.e., the plan).
• Assign tasks and responsibilities.
• Monitor and modify the plan; communication changes.
• Review the team's performance; provide feedback when needed.
• Manage and allocate resources.
• Facilitate information sharing.
• Encourage team members to assist one another.
• Facilitate conflict resolution in a learning environment.
• Model effective teamwork.

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Slide 11: Team Events

Sharing the Plan

• Brief—Short session prior to start to share the plan, discuss team formation; assign roles and responsibilities, establish expectations and climate; anticipate outcomes and likely contingencies.

Monitoring and Modifying the Plan

• Huddle—Ad hoc meeting to re-establish situation awareness; reinforce plans already in place, and assess the need to adjust the plan.

Reviewing the Team's Performance

• Debrief—Informal information exchange session designed to improve team performance and effectiveness through lessons learned and reinforcement of positive behaviors.

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Slide 12: Brief Checklist

During the brief, the team should address the following questions:

• Who is on the team?
• Do all members understand and agree upon goals?
• Are roles and responsibilities understood?
• What is our plan of care?
• What is staff and provider's availability throughout the shift?
• How is workload among team members?
• What resources are available?

Image: Teams members are shown conferring in a hospital corridor.

Select the link below to access the video.

Brief (36 sec.)

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Slide 13: Debrief Checklist

The team should address the following questions during a debrief:

___ Was communication clear?

___ Were roles and responsibilities understood?

___ Was situation awareness maintained?

___ Was workload distribution equitable?

___ Was task assistance requested or offered?

___ Were errors made or avoided?

___ Were resources available?

___ What went well?

___ What should improve?

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Slide 14: Situation Monitoring Process

Image: A circular process moves from Situation Monitoring (Individual Skill) to Situation Awareness (Individual Outcome), to Shared Mental Model (Team Outcome), and back to Situation Monitoring (Individual Skill).

Situation monitoring is the process of continually scanning and assessing a situation to gain and maintain an understanding of what's going on around you.

Situation awareness is the state of "knowing what is going on around you."

A shared mental model results from each team member maintaining situation awareness and ensures that all team members are "on the same page."

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Slide 15: STEP

A tool for monitoring situations in the delivery of health care.

Components of Situation Monitoring:

Image: A series of steps are shown, captioned from top to bottom:

• Status of the patient.
• Team Members.
• Enviroment.
• Progress Toward Goal.

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Slide 16: STEP (continued)

Tools to help assess health care situations.

• Status of Patient:
  • Patient History.
  • Vital Signs.
  • Medications.
  • Physical Exam.
  • Plan of Care.
  • Psychosocial Issues.
• Team Members:
  • Fatigue.
  • Workload.
  • Task Performance.
  • Skill.
  • Stress.
• Environment:
  • Facility Information.
  • Administrative Information.
  • Human Resources.
  • Triage Acuity.
  • Equipment.
• Progress Toward Goal:
  • Status of Team's Patient(s)?
  • Established Goals of Team?
  • Tasks/Actions of Team?
  • Plan Still Appropriate?

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Slide 17: Cross-Monitoring

A harm error reduction strategy that involves:

• Monitoring actions of other team members.
• Providing a safety net within the team.
• Ensuring that mistakes or oversights are caught quickly and easily.
• "Watching each other's back."

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Slide 18: I'M SAFE Checklist

Each member of the team is responsible for assessing his or her own safety status.

___ I = Illness
___ M = Medication
___ S = Stress
___ A = Alcohol and Drugs
___ F = Fatigue
___ E = Eating and Elimination

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Slide 19: Task Assistance

Helping others with tasks builds a strong team. Key strategies include:

• Team members protect each other from work overload situations.
• Effective teams place all offers and requests for assistance in the context of patient safety.
• Team members foster a climate where it is expected that assistance will be actively sought and offered.

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Slide 20: Feedback

Information provided to team members for the purpose of improving team performance.

Feedback should be:

• Timely—given soon after the target behavior has occurred.
• Respectful—focuses on behaviors, not personal attributes.
• Specific—relates to a specific task or behavior that requires correction or improvement.
• Directed toward improvement—provides directions for future improvement.
• Considerate—considers a team member's feelings and delivers negative information with fairness and respect.

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Slide 21: Advocacy and Assertion

Advocate for the patient:

• Invoked when team members' viewpoints don't coincide with that of the decisionmaker.

Assert a corrective action in a firm and respectful manner.

• Make an opening.
• State the concern.
• State the problem.
• Offer a solution.
• Reach agreement on next steps.

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Slide 22: Two-Challenge Rule

Empowers all team members to "stop the line" if they sense or discover an essential safety breach.

When an initial assertive statement is ignored:

• It is your responsibility to assertively voice concern at least two times to ensure it has been heard.
• The team member being challenged must acknowledge that concern has been heard.
• If the safety issues still hasn't been addressed:
  • Take a stronger course of action.
  • Utilize supervisor or chain of command.

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Slide 23: CUS

Assertive statements:

• I am Concerned!
• I am Uncomfortable!
• This is a Safety Issue!

"Stop the Line."

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Slide 24: DESC Script

A constructive approach for managing and resolving conflict.

D = Describe the specific situation or behavior; provide concrete data.

E = Express how the situation makes you feel/what your concerns are.

S = Suggest other alternatives and seek agreement.

C = Consequences should be stated in terms of impact on established team goals; strive for consensus.

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Slide 25: Team Performance Observation Tool

Team Structure

Assembles team.
Assigns or identifies team members' roles and responsibilities.
Holds team members accountable.
Includes patients and families as part of the team.

Communication

Provides brief, clear, specific, and timely information.
Seeks information from all available sources.
Uses check-backs to verify information that is communicated.
Uses SBAR, call-outs, check-backs, and handoff techniques to communicate effectively with team members.

Leadership

Identifies team goals and vision.
Utilizes resources efficiently to maximize team performance.
Balances workload within the team.
Delegates tasks or assignments, as appropriate.
Conducts briefs, huddles, and debriefs.
Role models teamwork behaviors.

Situation Monitoring

Monitors the state of the patient.
Monitors fellow team members to ensure safety and prevent errors.
Monitors the environment for safety and availability of resources (e.g., equipment).
Monitors progress toward the goal and identifies changes that could alter the care plan.
Fosters communication to ensure a shared mental model.

Mutual Support

Provides task-related support and assistance.
Provides timely and constructive feedback to team members.
Effectively advocates for the patient using the Assertive Statement, Two-Challenge Rule, or CUS.
Uses the Two-Challenge Rule or DESC script to resolve conflict.

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Slide 26: Barriers, Tools and Strategies, and Outcomes

Barriers	Tools & Strategies	Outcomes
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	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	Shared Mental Model Adaptability Team Orientation Mutual Trust Team Performance Patient Safety!!

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Slide 27: Effective Use of TeamSTEPPS Tools and Strategies

Image: A nurse and the patient's daughter are shown standing in a hospital room.

Select the link below to access the video.

Effective Use (6 min, 59 sec.)

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