AIR TeamSTEPPS  National Conference June 3, 2009

Improving Individual & Team Performance: The Power of In Situ  Simulation “Safe Phrases” to support Fairview’s Culture of Safety Stan Davis, MD, FACOG Kristi Miller RN, MS

Transformation to a Culture of Safety Zero Birth Injury Zero Preventable Birth Injury High Reliability Changed behavior: In Situ  Simulation TeamSTEPPS™ Just Culture™ Evidence Based Clinical Practice ACOG/AWHONN IHI BUNDLES NICHD Standard Language Policies & Ordersets System wide infrastructure Empower group for Decision making Local ownership & learning Expectations & support Set by Senior Leadership Stan Davis, MD, FACOG & Kristi K Miller RN, MS

The gap: Human error is inevitable because …  We work in complicated systems, have a culture where safety is assumed but not assured and where we rely on the expert individual NOT teams of experts working together for the plan of care.  Health care teams do not have: Stable membership, ( High Variability of membership) Constant leadership and Team members rarely train together. First… To Safety Stan Davis, MD, FACOG & Kristi K Miller RN, MS

We can train individuals at the point of care how to be a skilled team member adaptable and resilient in any situation! The “Patient’s team” Assessment of need Situational Awareness New Team Members Are called in when Risk is recognized The Emergency team Activated- have a Shared Mental Model Of the plan

Every individual in Fairview can become an “expert team member” by learning:  Situational Awareness- “ME”  Standard Communication – “YOU”  SBAR  Closed-Loop Communication  Shared Mental Model- “US” First… To Safety Stan Davis, MD, FACOG & Kristi K Miller RN, MS

“Breaches in Safety”in 35 Simulations at 6 Hospitals Fairview Health Services & University of Minnesota Academic Health Sciences, Active Failures 50.2%Latent Issues 49.8%

Strategy to create Highly Reliable Teams within a culture of organizational learning High Reliability Just Culture™ Principles of risk, Accountability, Behavioral choices, Drift, and use of Coaching after errors TeamSTEPPS™ Define the team, Curriculum Training & implementation of Action Plans “ME-YOU-US” In Situ™ Simulation Experiential learning & application, test for gaps In the “real world” First… To Safety Stan Davis, MD, FACOG & Kristi K Miller RN, MS

Actions every Fairview Team can do to assure safety  Briefing  Huddle  Debriefing  Be vigilant to use “Me-You-Us” skills at key critical junctures:  When teams are changing  Symptoms change or  In a new environment. First… To Safety Stan Davis, MD, FACOG & Kristi K Miller RN, MS

Fairview/UM AHRQ Perinatal Patient Safety Study Stan Davis MD Kristi Miller RN, MS William Riley PhD Phase II; 37% Reduction of Clinical Weighted Adverse Outcome Index after Saturation of In Situ Simulation and TeamSTEPPS training at intervention. No change or Worsening trend at control sites with only education or neither intervention.

Fairview Zero Birth Injury: 2008 Adverse Outcome Index Maternal Deaths0 Intrapartum Neonatal Death >=2500 grams3 Uterine Rupture2 Unplanned Maternal Admission to the ICU2 Birth Trauma23 Return to OR/L&D41 Admission to NICU of neonate birthweight >=2500 g and >= 37 weeks165 APGAR 5 <754 Maternal Blood Transfusion131 3rd or 4th degree perineal laceration335 Total756

“Safe Phrases” to Enhance Teamwork

1414 Please Use CUS Words but only when appropriate! TeamSTEPPS 

1515 “I need Clarity” Empower any member of the team to “stop the line” if he or she senses or discovers an essential safety breach or not sure of the direction the care is heading. Requires immediate cessation of the process and resolution of the safety issue. Innocuous and non-threatening.

“Do the Hussle” We don’t have time for you to complain or whine right now…we need everyone to really kick it in gear. A charge nurse may use this to indicate that she needs physician/nurse/pharmacy/lab or whomever to pick up the pace.

“Cease Fire” Use when you know an inappropriate discussion or argument is occurring. Meant to “stop” the discussion-communicate that this is NOT promoting a positive work environment or culture of respect in the workplace.

Discussion: Endorse “Safe Phrases” for Fairview Schedule your In Situ  Simulations & TeamSTEPPS  Training