Download Interprofessional Teamwork and Communication Skills Workshop

Foundations of Interprofessional
Collaboration (FIPC): An Introduction
to TeamSTEPPS®
LEVEL 3
Focusing on Teamwork in the Clinical
Environment
Helping You Help Your Patients!
Introductions
Foundational Program
Level 1
Level 2
Level 3
• Learned about other
health professions.
• Built paper chain
using
TeamSTEPPS©
concepts.
• Built transition of
care plan as a team.
• Practiced using the
TeamSTEPPS©
SBAR and CUS
tools.
• Work as a team to
provide patient care
using the
TeamSTEPPS©
SBAR and Huddle
tools.
Goal for Today…
Take the interprofessional and
teamwork skills you learned over
the last two years for a test
drive!
Today’s Schedule
Overview of the Day
Orientation to the Day
Patient Case
Debrief
Patient Case
Debrief
Course Evaluation
Management of an
Anaphylaxis Emergency in the
Hospital
Anaphylaxis Definition
“A serious allergic
reaction that is rapid in
onset and may cause
death.”
National Institute of Allergy and Infectious Disease and the Food Allergy and Anaphyla
Anaphylaxis Pathogenesis
EXPOSURE
IMMUNE
REACTION
SYMPTOMS
DIAGNOSIS
Acute onset of
illness (minutes
to hours) with:
EMERGENT
MANAGEMENT
Identify
patient with
possible
anaphylaxis
URGENT
MANAGEMENT
Airway, Breathing,
Circulation
Identify/Remove trigger
Calm Patient and
Consider Positioning
Bronchodilator
Fluid Bolus
Steroids
Monitor, Oxygen, IV
(bolus)
Antihistamine
Epinephrine IM 0.3 mg
Diagnosis (tryptase)
STABILIZE
Continued stabilization
and ongoing monitoring
Discharged with Long-term
Management Plan and Education
Anaphylaxis Practice Parameter; Annals of Allergy Asthma & Immunology; 2015; 115: 341-384.
Your Teamwork Toolbox…
®
TeamSTEPPS
Key Principles
Team
Structure
Identification of the components of a multi-team system that
must work together effectively to ensure patient safety
Leadership
Ability to maximize the activities of team members by ensuring
that team actions are understood, changes in information are
shared, and team members have the necessary resources
Situation
Monitoring
Process of actively scanning and assessing situational
elements to gain information or understanding, or to maintain
awareness to support team functioning
Mutual
Support
Ability to anticipate and support team members’ needs through
accurate knowledge about their responsibilities and workload
Communication
Structured process by which information is clearly and
accurately exchanged among team members
Recipe for a High-Functioning
Interprofessional Teamwork
• Key the Ingredients of a huddle we will
practice today are
– Calling the huddle
– Identify a leader
– Input from all team members
– Closed-loop communication
The Huddle
Huddles are quick team
meetings to review
patient information and
decide on a plan of care
approach.
A huddle helps the team
be on the same page
and adjust the plan
based on changes.
When to Huddle
At the beginning
of a patient
encounter.
During a patient
encounter when…
• Patient status changes
• Team members change
• Treatment is not working
or additional needs
What should a Huddle
include?
1. The problem
2. The plan
3. Who does what
4. Input/Agreement
How long and how often should
we Huddle?
• Your first huddle
– After SBAR
– NO more that 30 seconds
• Your second huddle
– After the epi and the patient is feeling better
– 1-2 minutes
Video of huddle before and
during a patient event
• Pre-Huddle
• Inter-event Huddle
• Key principles within the huddle
(leadership, closed-loop, all voices, etc.)
Simulation Provides a “Safe Container” to Practice
• Try something new…this is a safe
environment to make mistakes.
• Simulation can be a little
unnerving and awkward.
• Agree that what happens here,
stays here.
SIMULATION
Your Patient
• Chuck Townsend 70 yo male admitted
through ED with diagnosis of urosepsis
• History of Present Illness:
– C/O urinary pain, back pain and altered
mental status
– Neighbor dropped him off because he was in
pain and confused
– Patient only able to provide limited history in
ED
Your Patient
• PMH
–
–
–
–
COPD
Type 2 DM
HTN
Current Smoker (98 pack years)
• Current Medications
–
–
–
–
–
–
Zosyn 3.375 g IV Q 6 hours
Glyburide 10 mg PO BID
Metformin 850 mg PO BID
Amlodipine 10 mg PO Qday
Advair 50/500 1 puff BID
Albuterol MDI 2 puffs Q 4 hours PRN
• Labs Drawn in ED
– Significant were WBC 14, Lactate 2, Scr 1.1, Positive UA
• Admitted to medicine floor for Urosepsis
Let’s get started…
• The Patient
• Primary Nurse
• Rapid Response Team
o Physician
o Pharmacist
o Nurse
o Additional Members may
include Respiratory Care,
Clinical Lab Science, or
Health Policy
Management
Tips for Today
• Use the alogorithim
• Additional patient information is available
in a chart in the room
• General Roles
– Leader (oversees, delegates, and leads)
– Patient communication and assessment
– Drawing up medications
– Medication administration
– Documentation (clipboard in the room)
Phase 1:
The primary RN
recognizes the
patient has possible
anaphylaxis, calls a
Rapid Response,
and communicates
using SBAR.
Phase 2:
After the SBAR, the Rapid Response
Team huddles around the patient to
decide who is going to perform which of
the following emergent actions.
Identify an Event Lead
(Assigns roles and monitors
situation)
Assess & Communicate
with Patient
Identify
patient with
possible
anaphylaxis
Phase 3:
Once the patient stabilizes, team
calls a second huddle in order to
discuss next steps in patient
assessment and management.
(Physical exam, keep informed, obtain
history, monitor vital signs & overall
status)
Review Patient Chart for
relevant History
Consider second line
medications:
•
•
Methylprednisolone 1 mg/kg
H1 antihistamine:
Diphenhydramine 25 mg IV
H2 antihistamines: Cimetidine
4 mg/kg IV
•
Identify & remove
trigger
(Other possible diagnoses? Possible
causes of anaphylaxis?)
Epinephrine 0.3 mg IM
Fluid Bolus
Consider alternative
diagnoses and
additional testing
Start Oxygen and
Bronchodilator
(consider confirmatory testing
(tryptase))
(Albuterol 2.5 mg in 3 mL of saline)
Anaphylaxis Practice Parameter; Annals of Allergy Asthma & Immunology; 2015; 115: 341-384.
Let’s get started!