HARDWIRING TEAMSTEPPS INTO TRAUMA … 2018 AHA Webinar UNC - FINAL.pdfLang Kirchheimer RN. Nicholas Mauriello RN. Kate Anzinger RN. UNC School of Medicine Sim Anita Swiman EMT -P

AHA Team Training Monthly WebinarOctober 10, 2018

HARDWIRING TEAMSTEPPS INTO TRAUMA RESUSCITATIONS: OPTIMIZING TAR HEEL TRAUMA CARE

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RULES OF ENGAGEMENT

Audio for the webinar can be accessed through your computer or through the phone • Please note: Today’s presentation will include several videos. The audio of the videos

will be played through the computer speakers. If you are dialed into the audio conference, please choose the drop down arrow located beside the speaker icon at the top of the webinar platform and select mute conference audio only.

A Q&A session will be held at the end of the presentation. Written questions are encouraged throughout the presentation and will be answered during the Q&A session

• To submit a question, type it into the Chat Area and send it at any time during the presentation

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UPCOMING TEAM TRAINING EVENTS

“Gaming in TeamSTEPPS: Where to Begin?”November 9, 2018 | Orlando, FL | $400 registration fee

Learn how TeamSTEPPS tools can be applied to a group of activities to develop and implement team strategies that will achieve the successful transfer of knowledge. This specialty course is designed around active participation and is meant to provide TeamSTEPPS facilitators with alternative ways to deliver in-person TeamSTEPPS training and education.

https://www.onlineregistrationcenter.com/register/222/page1.asp?m=347&c=406&usc=nemours

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Grab your cowboy boots and block your calendar - AHA Team Training is heading to San Antonio next June for our annual conference! We'll be sharing more conference information over the coming months, but first get ready to answer our Call for Proposals. Registration will open in January 2019.

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We have spots available in our Master Training Courses:• November 8-9 in Durham, NC with Duke University• December 6-7 in New Orleans, LA with Tulane University

Two more free webinars in 2018: • November 14: “Improving TeamSTEPPS in Medical Education: A Student-Veteran Inspired

Initiative to Improve Behaviors and Understand Barriers” with Rick Land and Tom Kuriakose, medical students at Rutgers University Robert Wood Johnson Medical School

• December 11: “Taking Stepps to Sustain a Just Culture” with Lynn Fricke, MPS, RN and Ronnie McKinnon RN, JD, CPHRM, CPSO, CPPS, Adjunct Professor Health Law, Loyola Law School, Beazley Institute for Health Law and Policy

https://www.aha.org/teamtraining-courses-regionalhttps://www.aha.org/teamtraining-webinars-upcoming

CONTACT INFORMATION

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Web: www.aha.org/teamtrainingEmail: [email protected]

Phone: 312-422-2609

http://www.aha.org/teamtrainingmailto:[email protected]

TODAY’S PRESENTERS

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Daryhl Johnson II, MD MPH FACSAdult Trauma Medical Director

UNC School of Medicine

Elizabeth Schroeder, RN BSN TCRN CENEmergency Preparedness Coordinator

UNC Hospitals

Alberto Bonifacio RN BSN MHA CENTrauma Program Manager

UNC Hospitals

Monday Afternoon, September 2016

traumaNOUNInjury to human tissues and organs resulting from the transfer of energy from the environment

Objectives1. Discuss how TeamSTEPPS and Kotter’s Model was effectively applied to

conduct a multi-disciplinary, large-scale quality improvement project to improve trauma resuscitations.

2. Describe how simulation can be used to hardwire TeamSTEPPS into processes by model new processes, probe for systems gaps, and educate teams in teamwork, communication, and leadership.

3. Explore how our methodology can be used to improve performance of other crisis teams and conduct research in situational awareness.

BACKGROUNDOptimizing Tar Heel Trauma Care

Improve adherence to trauma process

Provide more trauma education

Improve documentation

Establish pre-arrival huddle Electronic documentation problematic

Trauma process not followed

Ineffective Communication

Observers Disruptive

Ineffective leadership

Redesign trauma assignment

BASELINE

METHODSOptimizing Tar Heel Trauma Care

The UNC Institute for Healthcare Quality Improvement (IHQI) Seed Grant Program promotes the development of experience and expertise in quality improvement at

UNC Hospitals, Faculty Physician practices and Physician Network practices.

Improve the consistency, reliability and efficiency of

trauma resuscitation through the

implementation of a

standardized process in the

Emergency Department

Consistent Education and

Training

Focus on Teamwork,

Communication and Leadership

Uniform Trauma Bay Preparation

Consistent Patient Assessment

following ATLS @ UNC guidelines

Direct Observation and Performance

Feedback

Consistent Education and

Training

Focus on Teamwork,

Communication and Leadership

Uniform Trauma Bay Preparation

Consistent Patient Assessment

following ATLS @ UNC guidelines

Direct Observation and Performance

Feedback

Minutes

Phas

e: S

ign-

in /

Prep

arat

ion

/ Hud

dle

Phas

e: P

atie

nt A

rriv

al /

Rep

ort T

imeo

ut

Prep Identify and Fix Shock Secondary Survey Dispo.Tar Heel Trauma Resuscitation Process

Phas

e: P

rimar

y Su

rvey

Phas

e: D

ispo

sitio

n / P

repa

re fo

r Tra

nspo

rt

TRAUMA CAPTAINCHIEF / FELLOW

Lead Team Huddle

Takes Report

Lead Shared Mental Model

PRIMARY NURSE (T1)

Pre-reportManage Prep.

Asst. Team Huddle

Takes Report

Manages Transport / Handover

SECONDARY NURSE (T2)

Prep: IV, IVF, Bair Hugger,

Meds

PatientComfort

VS(Manual

BP)

Prepare for Transport

NURSING ASSISTANT

Prep: Monitor, O2, Bed,

Foley

Assists Transfer

EExpose PtMonitor


RESPIRATORY THERAPY Prep Vent

Assists Transfer Asst. with Airway Breathing

Airway Management / ABG


PROCEDURE PHYSICIANINTERN

Prep resusc. equip

Assists Transfer


BEDSIDE PHYSICIANPGY2

C D*Prep resusc. equipPrepare for Transport

AIRWAY PHYSICIANEM3

Prep: airway equip, suction

Patient Comfort AB

Phas

e: L

og R

oll

Rectal temp.

Secures

ETT

Log Roll

Back

Secures C-spine

HUC andFamily

0 3 12 15 20

Assists Transfer

RADIOLOGY TECH

Chest X-ray

Head to Toe*

May Assist with Assessment of Head;

Patient Comfort

Process and Deliver FilmsPre-set Plates

Assist with procedures (chest tube, central line, etc.)

Phas

e: S

econ

dary

Sur

vey

and

Oth

er A

djun

cts

PIVx2; IVF; Blood; Meds

VS q5; Blankets; Bair Hugger

Directs InterventionsDetermines Disposition

Send Labs; Foley; UPT

LSBRectal Temp

FAST

Meds; Labs; OGT

Other Procedur

es

Directs RN CareDocuments

* Airway Physician may assist with assessment of head per Bedside Physician / Trauma Captain

Pelvis X-ray

Adult Trauma Positions

Bedside Physician

Nursing Assistant

Secondary RN(T2)

RT

Trauma Captain

Hot Line

Primary RN(T1)

Charge RNChaplain

Trauma Attending

UNC PDHUC

X-Ray 2X-Ray1

Airway MD

ED Attending

AirCare/EMSAir Care/EMS

KEY

SupervisoryStaff

Physician

AncillaryStaff

Procedure Physician

Nurse

Support

Pharmacy

ATLS@UNC(VIDEO)

GUIDING PRINCIPLESOptimizing Tar Heel Trauma Care

Combining QI

Methodology

Guiding Principles: Kotter In Action


I feel we provide the

highest quality nursing

care for trauma

patients.

“TQIP* benchmark

rankings in the lower 50%

for patients in shock”

SENSE OF URGENCY IS DIFFERENT TO DIFFERENT PEOPLE


STAKE HOLDER ANALYIS / CORE TEAM / VOICE OF PATIENT


Process modeling

using in situ high

fidelity simulation


SUSTAIN WITH SIM / OBSERVE SUPPORTIVELY / DONUT POWER!!


STORIES, PRIDE AND OWNERSHIP MATTER

Teamwork, Communication and Leadership

Each individual behaviour will improve teamwork and

performance

“Perceived rudeness is the KILLER of Teamwork”

Lead by calm example –emotions are contagious

MEANS TO AN END

Guiding Principles: “Just Try It”

HARDWIRINGMaking It Stick

TYPE IN CHAT

Code Stork – Trauma Bay

Code Stork Real Time Debrief

(VIDEO)

Adult Trauma Positions

Bedside Physician

Nursing Assistant

Secondary RN(T2)

RT

Trauma Captain

Hot Line

Primary RN(T1)

Charge RNChaplain

Trauma Attending

UNC PDHUC

X-Ray 2X-Ray1

Airway MD

ED Attending

AirCare/EMSAir Care/EMS

Procedure Physician

Pharmacy

NICU Attending

NICU RN

NICU RN

NICU Resident

OB Attending

OB ResidentOB NurseOB Nurse

ROLES

Emergency

Surgery

Support

OB GYN

NICU

NNP

NNP

RRT

Debrief

RESULTSOptimizing Tar Heel Trauma Care

0

5

10

15

20

25

Pre Go-Live

7/1 8/2 9/6 11/1 12/21 1/16 2/7 3/6

Tim

e (m

inut

es)

Decreased Time to Log-Roll

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INTERVENTION: Lecture and Sim

with Surgery 1

3

Reasons for time > 10 minutes

1. Only RN and ED Resident initially present; requires more staff for safe log-roll2. Providing additional comfort measures to the patient prior to log-roll3. Resuscitation is lacking defined leadership and direction4. Delays in obtaining vital signs, which are required prior to log-rolling

0

2

4

6

8

10

12

14

16

Pre… 7/23 8/2 9/6 10/1 11/1 12/8 1/16 2/7 3/6

Tim

e (m

inut

es)

Decreased Time to Chest X-ray

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Reasons for delays1. Obtaining central access on a critical patient2. Change in radiology leadership and need for more education

INTERVENTION: Implementation

of Radiology Stretchers

Preliminary Data: 24 months (N=12)

“I wanted to reach out to you because I remember thetrauma/code stork simulation we did several months ago(while I was still in the ED) and I feel like that experiencehelped immeasurably with this one.

Overall, despite many teams and moving parts, this traumaran extremely smoothly, communication was great, andteamwork was truly outstanding.”

Megan K. Seston, MSN, RN, CCRN-CMC, CEN| Nursing House SupervisorNursing Staffing SystemsUNC Hospitals

HORIZONS

Eye Tracking in Trauma

Leadership and Teamwork in Trauma

Resident 1 Resident 2 Fellow

EHR in Trauma Documentation

Eye Tracker Footage

(VIDEO)

Expanding QI Capacity: Geriatrics

Thank You!

[email protected]

Project TeamLiz Dreesen MDDaryhl Johnson MDAlberto Bonifacio RN Elizabeth Schroeder RNKelly Revels RNNikki Waller MDChristian Lawson RNKatelyn Hausfeld RNTar Heel Trauma Team

UNC School of NursingKyle Lucky Smith RNKelsey Stroud RNLang Kirchheimer RNNicholas Mauriello RNKate Anzinger RN

UNC School of Medicine SimAnita Swiman EMT-PGene Hobbs CHESTommy Scarritt MD

Emergency ServicesJeff Phillips RNMichelle Pladsen RNKayla Wilkerson RNJessica Muckenfuss RNAmy Bruns RNHeather Tuttle RNED Trauma CommitteeRespiratory Therapy Pharmacy

RadiologySheila LevinerLauren BurtonRadiology Team

Carolina Air CareJosh ComptonLeanne Reaves

Daryhl Johnson II MD MPH [email protected]

Elizabeth Schroeder RN BSN CEN [email protected]

Alberto Bonifacio RN BSN MHA [email protected]

mailto:[email protected]:[email protected]

STAY IN TOUCH!

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Visit www.aha.org/teamtraining or email us at [email protected]!

http://www.aha.org/teamtrainingmailto:[email protected]

Slide Number 1Rules of engagementUpcoming team training eventsUpcoming team training eventsUpcoming team training eventsContact informationTODAY’S PRESENTERSSlide Number 8Slide Number 9ObjectivesBACKGROUNDSlide Number 12Slide Number 13Slide Number 14BASELINEMethodsSlide Number 17Slide Number 18Slide Number 19Slide Number 20Slide Number 21Slide Number 22Guiding PrinciplesSlide Number 24Guiding Principles: Kotter In ActionGuiding Principles: Kotter In ActionGuiding Principles: Kotter In ActionGuiding Principles: Kotter In ActionGuiding Principles: Kotter In ActionGuiding Principles: Kotter In ActionSlide Number 31Guiding Principles: “Just Try It”Guiding Principles: “Just Try It”HardwiringTYPE IN CHATSlide Number 36Slide Number 37Slide Number 38DebriefResultsSlide Number 41Slide Number 42Slide Number 43Preliminary Data: 24 months (N=12)Slide Number 45HorizonsEye Tracking in TraumaLeadership and Teamwork in TraumaEHR in Trauma DocumentationSlide Number 50Expanding QI Capacity: GeriatricsThank You!STAY IN TOUCH!