7 TCAB Academic Partners – The Faculty Team Facilitator: Patricia Chiverton, EdD, RN, FANP Dean, University of Rochester School of NursingDeborah Struth, MSN, RNUPMC Shadyside School of NursingBerni Jordan, PhD, CRNP, FHCEUniversity of Pittsburgh School of NursingKim Amer, PhD, RNDePaul UniversityLinda Leach, PhD, RNUCLA School of NursingLorie Judson, PhD, RNCalifornia State – LADeborah Cantero, MSN, ARNPUniversity of South FloridaConnie Overman BSN, RNSacramento State UniversityGeri L Wood, PhD, RN, FAANUniversity of Texas, HoustonBernadette Curry, PhD, RN, DeanMolloy CollegeDenise CundySouth Dakota State UniversityLinda CarpenterUniversity of Texas, AustinShelley Mitchell, MS, RNAustin Community CollegeCarrie ThompsonFox Valley Community CollegeJen BaslerUniversity of Wisconsin
8 UPMC Shadyside’s Faculty Transformational Journey TCAB TeamFaculty RetreatTest of Change Methodologyin CurriculumDeep DiveFaculty VitalitySurveyUPMC ShadysideSchool of Nursing
10 Patient Safety Objectives Addressed through the ACGME Prism The resident will be able to :Recognize and understand team behaviors that strengthen/weaken patient safety.Incorporate effective team behaviors into their practices.Identify errors in their practices, analyze them and learn from them.Develop system-based strategies to prevent recurrence of errors.Recognize and understand communication behaviors that strengthen/weaken patient safety.Incorporate effective communication behaviors into their practices.Provide appropriate disclosure to patients when errors occur.
11 QSENAssumptionsEach competency is broad and contains elements of the othersPatient-centered care SafetyTeamwork/collaboration InformaticsQuality improvement Evidence-basedpracticeUPMC ShadysideSchool of Nursing
12 Example: Teamwork and Collaboration Function effectively within nursing and inter-professional teams, fostering open communication, mutual respect and shared decision-making to achieve quality patient care.KnowledgeSkillsAttitudesDescribe examples of the impact of team functioning on safety and quality of careExplain how authority gradients influence teamwork and patient safetyIdentify system barriers and facilitators of effective team functioningFollow communication practices that minimize risks associated with handoffs among providers and across transitions in careAssert own perspective (using SBAR or other team communication models)Participate in designing systems that support effective teamworkAppreciate the risks associated with handoffs among providers and across transitions in careValue the influence of system solutions in achieving effective team functioningUPMC ShadysideSchool of Nursing
13 Example: Safety Minimizes risk of harm to patients and providers through both system effectiveness and individual performance.KnowledgeSkillsAttitudesDiscuss effective strategies for reducing reliance on memoryDescribe processes used in understanding causes of error and allocation of responsibility (such as, root cause analysis)Use appropriate strategies for reducing reliance on memory (such as, forcing functions and checklists)Use organizational error reporting systems for near miss and error reportingEngage in root cause analysis rather than blaming when errors or near misses occurAppreciate the cognitive and physical limits of human performanceValue own role in preventing errorsValue vigilance and monitoring (even of own performance of care activities) by patients, families, and other members of the health care teamUPMC ShadysideSchool of Nursing
14 Blending: Transforming Care at the Bedside (TCAB) Patient Centered CareValue AddingVitality and TeamworkSafety and ReliabilityTransformational LeadershipQuality and Safety Education for Nurses (QSEN)SafetyPatient-centered careTeamwork/collaborationInformaticsQuality improvementEvidence-based practice
15 TCAB:“While there were a wide range of changes being tested, sustained, and spread in participating hospitals, participants repeatedly emphasized in our interviews that the change in unit culture and engagement of front line staff in improvement activities were central to their TCAB experience…no single innovation made a difference. Rather it was the process of TCAB, that made a difference.” Jack Needleman, PhD, FAAN
16 Initial Areas of Program Development Incorporation of Crew Resource Management principlesInvestigation of clinical education utilizing Work Sampling Methodology of faculty and studentsCurricular additions of Human Patient SimulationIncorporation of teamwork and safety utilizing TeamSTEPPS curriculumUPMC ShadysideSchool of Nursing
17 N101: Introduction to Professional Nursing Teaching ActivitiesRelationship-Based Care introduced and integrated throughout courseLab: Hospital of the Future: emphasizes need for effective communication, teamwork, rapid response, a caring and healing environment, and TCAB initiativesCitation for this model and I wonder if Sue M has a clearer picture…still fuzzy when blown up. (WJG)Koloroutis, Mary, (2004). Relationship-Based Care: A Model for Transforming Practice Creative Health Care ManagementRelationship-Based Care: A Model for Transforming Practice Creative Health Care Management. Koloroutis, Mary, (2004).UPMC ShadysideSchool of Nursing
18 N102: Introduction to Nursing Practice Strategies Teaching ActivitiesSBAR-R60 Second “Situational Assessment”High-fidelity Patient SimulationFocused standardized communication strategies to minimize risk and error.SA--- not only patient but environmental and team based observations to assure safetyUPMC ShadysideSchool of Nursing
21 N300: Nursing Practice Strategies Pediatrics/Obstetrics/Mental Health/Critical Care Eight-hour day high-fidelity high risk simulation experiences every 8 weeksStudent and faculty members utilize SBAR-R for communication pathways throughout the scenariosPre- and post-test evaluations related to problem-based scenario with improvements notedUPMC ShadysideSchool of Nursing
22 N400: Professional Role Transitions Teaching ActivitiesStudent driven test of changeprojects designed to identifypractice system vulnerabilitieswhich impact patient safety anddevelop action plans for bestpractice solutionsStudents utilize SBAR-Rwhen collaborating with healthcare team membersStudents perform open chart audits to identify patient risk using Global Triggers toolUPMC ShadysideSchool of Nursing
23 N200 Level Courses: PDA Time Study Goal: Redesign of Clinical Education into Structured Standardized Clinical Education CurriculaPI MethodologyCollect data regarding current process – TCABValidate assumptions – TCAB Observation ProcessInvolve workers in redesignPrototype: Rapid Cycle Tests of ChangeAdopt, Adapt or Abandon
24 DefinitionsTCAB: All care processes are free of waste and promote continuous flow – MudaValue added nursing careNecessary but not necessarily value addedNon-value added nursing care
25 Using the latest technology, adapted for the education environment. What the study is…A form of work/self sampling designed to give minutes back to the clinical instructor and the studentUsing the latest technology, adapted for the education environment.What the study isA form of work/self sampling designed to give minutes back to the clinical instructor and the studentWe will be using the latest technology, adapted for the educational environment. No other school is doing this, so we have the privilege of being at the forefront of this technology.
26 What is getting in the way? BarriersWork aroundBroken processesTime eatersWhat are the barriers, the broken processes, the workarounds, in other words… the time eaters?Are their factors that get in the way of best opportunities to expose students to the best possible clinical experience.
27 Faculty EngagementPresented study idea at Nursing 200 (Medical Surgical Nursing) Faculty Retreat
28 Easy to use interface redesigned for education Time Study FeaturesEasy to use interface redesigned for educationStudy is conducted with minimal distractionDetailed category list developed by instructorsOver 80 hospitals currently using for RN studiesStatistical software automatically provides analysis-in the form of pie charts, stack charts, pareto charts and tabular outputOriginal program designed for IHI TCAB initiativesTime Study FeaturesEasy to use interface redesigned for educationStudy is conducted with minimal distractionDetailed category list developed by instructorsOver 80 hospitals currently using for RN studiesStatistical software automatically provides analysis-in the form of pie charts, stack charts, pareto charts and tabular outputOriginal program designed for IHI TCAB initiatives
29 Randomly Selected Clinical Instructors and Students
30 MethodologyEach week, 2 random faculty and 2 random students carry a PDA to their clinical site.8 hour day on Wednesday and ThursdayThe PDAs are returned to the school for downloading of data and subsequent “turnaround” to the next 4 people carrying them.System analyst assists in organizing the data into graphs and pareto charts.Not necessarily the same site
31 Data PointsApproximately data points are captured in an 8 hour clinical dayGoal – 300 data points/semester
39 The Redesign: Improvement Specialists to observe and clarify PDA data. Situational Assessment adapted to meet clinical judgment expectations of the student nurse in the medical-surgical environment.DisseminationRedistributing clinical unit based hours to simulation centerN200 level team to design idealized medical-surgical clinical curricula, incorporating QSEN competencies