Friday December 19th 2014

Better, safer patient care through evidence-based practice and teamwork

Marie-Elena Barry

In today’s health care environment, patients rely on multiple providers for their care. For that care to be safe and of the highest quality, the Institute of Medicine, the nursing community and others have recognized the need for health care providers to embrace a collaborative, team-based approach to care. Patients, health care team members and the organization all benefit from interprofessional teamwork.

How can evidence-based teamwork be implemented?

Providers need to promote a change in organizational culture from an environment of working in silos to one that supports interprofessional collaboration. This, in turn, improves communication and reduces errors. One approach supported by the Agency for Healthcare Research and Quality (AHRQ) is TeamSTEPPS®, an evidence-based system that supports improving teamwork and communication skills with the goal of optimizing patient outcomes and improving patient quality and care.

TeamSTEPPS has been successful as the foundation for many evidence-based teamwork and quality improvement initiatives by using a three-phase approach. The first phase is for the organization to establish a multidisciplinary change team that assesses the need for practice change and that is committed to providing quality care by implementing evidence-based practices (EBP). Phase two focuses on planning, staff education and putting EBP into practice. Honest communication is crucial in this phase, because some team members may be resistant to practice changes and will need to share concerns and ask questions. The last phase of TeamSTEPPS is sustainability. The purpose of phase three is to sustain and spread improvements regarding teamwork performance. Sustainability can be achieved by asking for honest feedback from staff and by providing continual reinforcement and support.

To move away from silos to a team-based approach, Chaboyer, Wallis and Getherston make the following recommendations in their article “Implementing bedside handover: strategies for change management,” as reported in the Journal of Clinical Nursing. An organization’s leadership team should:

• Commit to a collaborative and interdisciplinary, or interprofessional, team approach.

• Be open to input from all staff members.

• Encourage frequent and honest conversation.

• Be patient. Change in organizational culture takes time.

Case scenario

Mrs. Hall was a frequent visitor to the pulmonary unit in the small urban community hospital. She acquired COPD from years of smoking, gained 30 pounds and needed frequent medication changes just to maintain her current oxygenation needs. Alex was the nurse assigned to care for Mrs. Hall and remembered her from previous admissions. What Alex didn’t realize was that Mrs. Hall lived alone and had been cared for inconsistently by multiple unlicensed caregivers since her last discharge. Since Alex “knew” the patient and was unusually busy that shift, the admission assessment was unfortunately swift and incomplete.

Tara, a new physical therapist, was assigned to evaluate Mrs. Hall’s mobility. Before the assessment, she read the patient’s history and physical exam report and quickly identified Mrs. Hall as being at high risk for pressure ulcers. Tara asked Alex and a nursing student, Angela, to help her with getting Mrs. Hall out of bed. Without hesitation, both the nurse and the nursing student agreed to assist in Mrs. Hall’s mobility assessment. Alex noticed that Mrs. Hall’s mobility status had declined, as she was no longer able to sit unassisted.

Immediately, Tara determined that Mrs. Hall was exceptionally weak and unable to support her own weight while sitting. Recognizing this as an opportune time to teach, Alex recommended that Angela examine the patient’s skin during the transfer in order to complete her admission assessment. Although Alex had previous experiences working with Mrs. Hall, she was surprised to learn that Mrs. Hall had developed a stage-three pressure ulcer on her sacrum and had breakdown on her hips and heels bilaterally.

Lessons learned

Alex, Tara and Angela worked together as a team and were able to identify a care issue that required immediate attention and action. It takes an interprofessional team to optimally care for a patient. If it weren’t for Tara, Mrs. Hall’s pressure ulcer might not have been noticed until later in the shift. Input from each health care team member influences the patient’s plan of care regardless of the health care setting. A team-based approach provides unique perspectives that will benefit patient care quality and safety.

Practice recommendations

• Teamwork is essential in improving patient safety.

• Speak up … recognize that you have a unique perspective to share.

• Acknowledge interprofessional expertise and value input from others.

• An evidence-based teamwork system improves communication among health professionals and impacts patient care.

Implications

Highly functioning teams:

• Are one element in high-quality care.

• Protect patient safety.

• Reduce duplication of services and save organizational resources.

• Improve community access to care.

Resources

Learn about the Agency for Healthcare Research and Quality’s TeamSTEPPS system at http://teamstepps.ahrq.gov.


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