TeamSTEPPS is a teamwork system developed jointly by the Department of Defense (DoD)and the Agency for Healthcare Research and Quality (AHRQ) to improve institutional collaboration and communication relating to patient safety. Show
Instructor Outline: CommunicationInstructor Note: In this module, you will present information about communication. It is important to convey the importance of communication and how effective information exchange strategies can improve patient safety.The Communication module includes the content provided in the outline below. More content is available than can be covered in the time provided; therefore, optional content and activities are noted. It is strongly recommended that instruction not focus solely on lecture, but also include exercises, videos, and other activities. As such, instructors should use the information below to plan how the module will be taught within the time available.
* Although all instructional content and activities are recommended to ensure that participants achieve the learning objectives, these activities may be considered "optional" if time is constrained. Additional Resources: Below are sources of additional information and videos you may want to use to customize this module to your participants.
Contents
ObjectivesSay: Following this module, you will be able to:
Return to Contents TeamSTEPPS Teamwork SkillsSay: So far, we have covered the following in the TeamSTEPPS framework:
In this module, we will cover Communication. Communication is the lifeline of a well-functioning team and serves as a coordinating mechanism for teamwork. Effective communication skills are vital for patient safety and interplay directly with the other components of the TeamSTEPPS framework. Further, communication is the mode by which most of the TeamSTEPPS tools and strategies are executed. Therefore, this module serves as the basis for the leading teams, situation monitoring, and mutual support modules that will follow. This module will discuss the standards of effective communication and will present information exchange strategies and specific tools to enhance communication among team members. Return to Contents Importance of CommunicationSay: The continued importance of effective communication in care teams cannot be understated. According to sentinel event data compiled by the Joint Commission between 1995 and 2005, ineffective communication was identified as the root cause of 66 percent of reported errors. More recent Joint Commission data from 2010 to 2013 show that ineffective communication has remained among the top three root causes of sentinel events. As these data illustrate, failure to communicate effectively as a team significantly increases the risk of error. Additional information about sentinel events and root causes can be found on the Joint Commission Web site. Return to Contents (Optional) Communication FailuresInstructor Note: Create a slide showing your organizational data related to the top causal factors for inadequate information sharing using local, state, regional, or other benchmark data as appropriate. Discuss findings with the group regarding root cause analyses from events that occur in your organization or are noted on your slide.Examples of contributing factors can be found on the Web site. Ask:
Example 1:
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Example 2:
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Say: Lack of communication among department staff can lead to failure to:
Examples of missed communication opportunities include:
In this module, we will discuss approaches to promote effective communication. Return to Contents Communication is...Say: Communication is defined as the transfer or exchange of information from a sender to a receiver. More specifically, communication is a process whereby information is clearly and accurately conveyed to another person using a method that is known and recognized by all involved. It includes the ability to ask questions, seek clarification, and acknowledge the message was received and understood. One critical result of effective communication is a shared understanding, between the sender and receiver(s) of the information conveyed. Two considerations in communication are whom you are communicating with and how you are communicating information.
We will cover standards of effective communication shortly. These relate primarily to verbal communication. Nonverbal communication can take several forms. Written communication is common in health care. This form of nonverbal communication should adhere to many of the same standards we will discuss shortly. In addition, one should be mindful of standards associated with written communication, such as the Joint Commission's "Do Not Use" list of abbreviations. More information about the "Do Not Use" List of Abbreviations can be found on the Joint Commission Web site. Say: Another form of nonverbal communication is body language. The way you make eye contact and the way you hold your body during a conversation are signals that can be picked up by the person with whom you are communicating. Body language plays a significant role in communication. In a face-to-face communication, words account for 7 percent of the meaning, tone of voice accounts for 38 percent of the meaning, and body language accounts for the remaining 55 percent. Although powerful, this mode of communication does not provide an acceptable mode to verify or validate (acknowledge) information. A third form of nonverbal communication is visual cues. For example, the use of color coding for assignments, charts, scrubs, orders, and so on can help team members identify the information they need quickly. To avoid making assumptions that can lead to error, you should verify in writing or orally any nonverbal communication, such as body language or visual cues, to ensure patient safety. The simple rule is, "When in doubt, check it out, offer information, or ask a question." Ask:
Examples:
Return to Contents Standards of Effective CommunicationSay: When sharing information with the team, which can include other providers, patients, or family members, communication must meet four standards to be effective. Effective communication is:
Examples: A well-written discharge prescription is:
Return to Contents Brief, Clear, and TimelySay: Provide information that is brief, yet as complete as possible. Do not overexplain the situation; be concise. Be clear—Plainly understood. Timely—Looks like it may be a little too late for these penguins! Instructor Note: (Time Permitting) Ask the question below before proceeding to the next slide, which will list communication challenges. You may wish to create a list of answers to the question on a flip chart and then compare those to the challenges listed on the next slide.Ask:
Return to Contents Communication ChallengesSay: Challenges may include:
Ask:
* A TeamSTEPPS Limited English Proficiency Module is available on the AHRQ Web site. Return to Contents (Optional) Communication Challenges ExamplesInstructor Note: The following examples can be read aloud to the class and used to facilitate discussion about communication challenges.Say: Let's spend a few minutes reviewing an example or two of scenarios in which communication challenges are present. Example 1: A physical therapist sees a patient with carpal tunnel syndrome. The physical therapist discusses the case with the physician and recommends ice treatment to decrease inflammation. The physician agrees with the recommended treatment. Discussion:
Example 2: An 89-year-old female presents to the hospital and has a history of chest pain. Many tests are being run to determine the cause of the chest pain. The patient and her family decide they no longer want aggressive measures taken and request that the patient's code status be changed to DNR. The night shift documents in the progress note that the patient requested not to be resuscitated. The night shift does not flag the patient's chart, relay the information during shift change, or notify the attending physician. The morning shift does not read the night shift's notes because of several immediate emergencies. Discussion:
Return to Contents Information Exchange StrategiesSay: A number of tools and strategies to potentially reduce errors associated with miscommunication or lack of information are listed. The following four strategies are simple to integrate into daily practice and have been shown to improve team performance:
Of these strategies, handoffs in particular can take many forms. In this course, we will describe the I PASS the BATON handoff tool in the most detail; however, it is only one tool among many that have been created to standardize the handoff process. Examples of additional handoff resources will also be presented. Return to Contents SBAR Provides...Say: The SBAR technique provides a standardized framework for members of the health care team to communicate about a patient's condition. You may also refer to this as the ISBAR, where "I" stands for "Introductions." In phrasing a conversation with another member of the team, consider the following:
Ask:
Say: Although SBAR is typically used as a communication tool between clinical staff, it can also be modified for use by the patient to communicate with the care team. For example, your facility could provide patients with a version of SBAR to enable them to share information about their own situation, background, assessment, and recommendations, or to ask the care team about their care. Additional information about partnering with patients and families can be found at the Department of Defense (DoD) Web site. Return to Contents SBAR Video ExampleSay: Let's review how to properly use the SBAR technique. In this video, the patient's condition has worsened, resulting in a call to the physician on call. Watch the video to see the transfer of information using the SBAR technique. Do: Play the video by clicking the director icon on the slide.Discussion:
Return to Contents Exercise: SBARSay: Take the next few minutes to create an SBAR example based on your specific role. Instructor Note: You may want to write the following on a flipchart to remind participants of the SBAR acronym:
Do: After a few minutes, ask for a few volunteers to share their examples. You may want to write out some of the examples shared by participants.
Return to Contents Call-Out is...Say: A call-out is a tactic used to communicate critical information during an emergent event. Critical information called out in these situations helps the team anticipate and prepare for vital next steps in patient care. It also benefits a recorder when present during a code or emergent event. One important aspect of a call- out is directing the information to a specific individual. Ask:
Do: Play the video by clicking the director icon on the slide.Discussion:
Return to Contents Check-Back is...Say: A check-back is a closed-loop communication strategy used to verify and validate information exchanged. This strategy involves the sender initiating a message, the receiver accepting the message and confirming what was communicated, and the sender verifying that the message was received. Here is an example of the use of a check-back:
A check-back is an effective tool for all members of the team, including patients and their family members. For example, patients and families can use the check-back to verify the receipt of care instructions or confirm understanding of symptoms to monitor. Now let's watch a short example. Do: Play the video by clicking the director icon on the slide.Discussion:
Return to Contents Handoff Is…Say: When a team member is temporarily or permanently relieved of duty, there is a risk that necessary information about the patient might not be communicated. The handoff strategy is designed to enhance information exchange at critical times such as transitions in care. More important, it maintains continuity of care despite changing caregivers. According to the Joint Commission: "The primary objective of a handoff is to provide accurate information about a patient's/client's/resident's care, treatment and services, current condition, and any recent or anticipated changes. The information communicated during a handoff must be accurate to meet patient safety goals." The Joint Commission National Patient Safety Goals (NPSG 2E) mandate implementing the use of handoffs within each institution. In addition, a standardized approach to handoff communications, including an opportunity to ask and respond to questions, is required. For more information about Joint Commission handoff solutions, visit their Web site. Ask:
Return to Contents Handoff Consists Of...Say: A proper handoff includes the following:
In addition, handoffs include the transfer of knowledge and information about:
It is important to highlight that both authority and responsibility are transferred in a handoff. As identified in root cause analyses of sentinel events and poor outcomes, lack of clarity about who is responsible for care and decisionmaking has often been a major contributor to medical error. Let's watch an example of a handoff. Do: Play the video by clicking the director icon on the slide.Discussion:
Return to Contents I Pass the BatonSay: Your facility should determine a standard protocol for delivering handoffs and make it known to everyone. "I PASS the BATON" is a TeamSTEPPS tool that provides one option for conducting a structured handoff. I Introduction-Introduce yourself and your role/job (include patient). P Patient—Name, identifiers, age, sex, location. A Assessment—Presenting chief complaint, vital signs, symptoms, and diagnosis. S Situation—Current status/circumstances, including code status, level of uncertainty, recent changes, response to treatment. S Safety Concerns—Critical lab values/reports, socio-economic factors, allergies, alerts (falls, isolation, etc.) THE B Background—Co-morbidities, previous episodes, current medications, family history. A Actions—What actions were taken or are required? Provide brief rationale. T Timing—Level of urgency and explicit timing and prioritization of actions. O Ownership—Who is responsible (nurse/doctor/team)? Include patient/family responsibilities. N Next—What will happen next? Anticipated changes? What is the plan? Are there contingency plans? Do: Play the video by clicking the director icon on the slide.Discussion:
Return to Contents Additional Handoff Tools And ResourcesSay: Numerous tools and resources are available to facilitate effective handoffs. Each facility should adopt the tool that best meets its needs. In addition to I PASS the BATON, other handoff tools and resources include:
Ask:
Return to Contents Tools And Strategies SummarySay: Communication skills interact directly with leadership, situation monitoring, and mutual support:
Communication tools that can enhance teamwork include the SBAR, call-out, check-back, and handoff. These tools facilitate effective and efficient communication within and across teams. Good communication facilitates the development of shared mental models, adaptability, mutual trust, and patient safety. Return to Contents Exercise: Applying TeamSTEPPSInstructor Note: This slide is intended for the Master Training course only. The previous slide should be the last one shown to staff participants at your organization.Say: Now return to your TeamSTEPPS Implementation Worksheet. Think about the teamwork issue you previously identified. Then, review and answer the questions for Module 3. Think about:
Do: Ask a few individuals to report on their communication issue and which TeamSTEPPS tools or strategies they will consider implementing to address the issue.
Return to Contents What is sbar a system for quizlet?SBAR, which stands for "Situation-Background-Assessment-Recommendation," is a system for delivering information. It is an adaptation of a US Navy communication technique and can be an effective means to communicate urgent patient care issues.
When considering your role within a health care team it is important to keep in mind that quizlet?When considering your role within a health care team, it is important to keep in mind that: No matter what profession you belong to, you will be a member of the team and must work intentionally toward making that team effective.
Which of the following actions is essential for closed loop communication?Which of the following actions is essential for closed-loop communication? The receiver repeats to the sender what he has heard. The efficient care in this case is an example of: The benefits of having a clear plan for emergencies.
Why is teamwork important in a pharmacy quizlet?a) Effective teams reduce the risk of errors by providing a "safety net" for individual caregivers. b) Effective teams limit the number of caregivers patients have to speak with, reducing confusion among patients and families.
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