It's all about the team
Future nurses get trained on EBP and communication techniques
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By Heather Stringer
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EDITOR'S NOTE: Heather Stringer is a freelance writer.
At a time when medical errors have been cited as a leading cause of death in the U.S., strategies that can improve patient safety are in high demand. One method of reducing errors in healthcare is TeamSTEPPS, an evidence-based model that is changing how caregivers communicate with one another.
Using the TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) program, nurses, pharmacists, physicians, physician’s assistants and other healthcare providers are learning simple techniques that may help them be more adaptable, accurate, productive, efficient and safe.
While many hospitals have trained employees to use the TeamSTEPPS approach, few nursing schools have incorporated the full curriculum into education, due to so many other requirements that have to be fulfilled, according to Karen Parker, DNP, RN, FNP-C, an assistant professor at Wegmans School of Nursing, St. John Fisher College in Rochester, N.Y. Despite this challenge, nurse educators at St. John Fisher College were convinced their students would significantly benefit from formal TeamSTEPPS training. In the fall of 2014, the school started offering a six-hour course covering these communication techniques, and students are required to complete the class in order to graduate. “We knew students were going to be the future in healthcare and they needed to know how to communicate with other health professionals,” said Kylene Abraham, DNP, RN, an assistant professor at St. John Fisher College. “They have to be able to advocate for patients, and we wanted them to learn how important these skills are from the ground up.” Char Smith, DNS, RN-BC, ANEF, was familiar with TeamSTEPPS when she joined the nursing faculty at St. John Fisher College in 2007. She had been working as the director of professional practice and development at a New York hospital that was beginning to implement the techniques, and she wanted students to be equipped with the same strategies before they entered the workforce.
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How it works
The TeamSTEPPS curriculum was developed by the Department of Defense and the Agency for Healthcare Research and Quality. Released in 2005, it includes modules on communication, leadership, situation monitoring and mutual support. One aspect of the training teaches healthcare professionals about “SBAR,” an acronym for situation, background, assessment and recommendation. During change of shift or when approaching a physician about a concern, nurses start by explaining the patient’s situation and background, then give an assessment and recommendation. For example, a physician could order medication to lower a patient’s blood pressure, but a nurse may notice that a patient’s blood pressure reading was already low, Parker said. The nurse could use SBAR to clearly communicate a concern about the medication ordered. “If someone has two seconds for you, then this is a way to pull out the relevant information in a way that makes sense,” Parker said. “The techniques help to reduce the level of intimidation in an interaction. It’s not about personalities or who may or may not like whom. It’s about conveying the facts and keeping the patients central in interactions.” Another element of the curriculum teaches caregivers to use techniques such as a huddle, a brief meeting with a caregiving team to assess a situation and possibly adjust the plan. “If a patient’s situation is deteriorating, just take a few minutes to huddle and decide what to do,” Parker said. “This may be useful during a code.”
Steps in process
Before approaching other nursing faculty at St. John Fisher College about the idea of integrating the TeamSTEPPS program into the curriculum, Smith reviewed the literature to find out if other nursing schools in the U.S. had done the same. She was surprised to discover only a few schools throughout the country had published anything about incorporating TeamSTEPPS into their program. When she suggested the idea to the nursing faculty, they were supportive. They met with pharmacy school faculty to see if they were interested in teaching the curriculum collaboratively to students from both disciplines. Ideally TeamSTEPPS is taught in an interprofessional learning environment to allow students from different fields to learn and practice the strategies together, Smith said. The nursing and pharmacy schools created an interprofessional education committee, which decided to send several nursing and pharmacy faculty to a two-day course to learn how to become TeamSTEPPS trainers. The next hurdle was carving out time to teach the class to students. The only viable time was a Friday evening or Saturday. While the students were not happy about using weekend time, their evaluations of the program have been overwhelmingly positive, Smith said. The feedback from partner hospitals has also been encouraging.

“For example, we had one student who noticed something was abnormal with a patient during a clinical rotation, and she used TeamSTEPPS communication skills when she reported her findings to someone on staff,” Abraham said. “They were impressed with her ability to articulate what had happened and ultimately it helped the patient get the necessary care.” The TeamSTEPPS strategies are incorporated into the didactic coursework as well as clinical and simulation training at the school, which gives students more opportunities to practice the strategies.
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Influencing hospital culture
While Smith hopes all nursing students will eventually be equipped with the TeamSTEPPS tools before graduating, seasoned nurses are also learning the strategies and seeing an impact.

“It has created an entire culture change at our hospital,” said Heather Sisk, RN, a nurse in the cardiac step down unit at Rochester General Hospital in New York. “I’ve been in nursing for 27 years, and when I started nurses did what they were told by doctors. TeamSTEPPS has taught us how to advocate for patients and not be afraid to ask questions.” She recently used SBAR when she was concerned about changes in a patient’s mental status after a procedure. The physician had already seen the patient after the procedure and attributed the changes to medication, but Sisk and the family were still concerned.

“Normally I would have been second-guessing myself because I knew the doctor had aleady seen the patient, but I felt comfortable calling the doctor to express my concern,” Sisk said. As a result, the physician ordered a CT scan, which confirmed the changes were not the result of something more serious. The TeamSTEPPS acronyms were also helpful when the hospital implemented an initiative that required nurses to do handoff reporting in front of patients, rather than at the nursing station. The handoff tools helped nurses organize their thinking, which improved communication and understanding during these interactions, Sisk said. The huddle technique also is frequently used, Sisk said. Recently a nurse manager called a huddle to share with staff on the unit about a change in the concentration of heparin delivered to the unit. During the meeting, caregivers learned the change would affect the drip rate for IVs, and the intravenous pumps needed to be set correctly to reflect the change. Whether new graduates from St. John Fisher’s College join hospitals that are using TeamSTEPPS or not, the nursing faculty from the school hopes their students will be role models. Smith, Parker and Abraham recently shared at a New York Organization of Nurse Executives conference about how they incorporated TeamSTEPPS into the curriculum.

“I wanted to make other people aware of what we were doing and incite others to do the same,” Smith said. “This isn’t something we need to keep to ourselves because we are all focused on better patient care and patient safety.”
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The techniques help to reduce the level of intimidation in an interaction. It’s not about personalities ... It’s about conveying the facts and keeping the patients central in interactions.”
— Karen Parker, RN
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