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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!