Promoting Patient Safety

Promoting Patient Safety Promoting Patient Safety This article uses a mixed methods research design. Discuss the characteristics of a mixed methods research. Within the discussion, speak to the strengths and weaknesses of this method. Explain why this study used this approach. promoting_safety.pdf _grading_rubric_mo JONA Volume 46, Number 4, pp 201-207 Copyright B 2016 Wolters Kluwer Health, Inc. All rights reserved. THE JOURNAL OF NURSING ADMINISTRATION Promoting Patient Safety A Results of a TeamSTEPPS Initiative Teresa Gaston, DNP, RN Nancy Short, DrPH, MBA, RN Christina Ralyea, DNP, MS-NP, MBA, OCN, NE-BC Gayle Casterline, PhD, RN Teamwork is an essential component of communication in a safety-oriented culture. The Joint Commission has identified poor communication as one of the leading causes of patient sentinel events. The aim of this quality improvement project was to design, implement, and evaluate a customized TeamSTEPPS training program. After implementation, staff perception of teamwork and communication improved. The data support that TeamSTEPPS is a practical, effective, and low-cost patient safety endeavor. nication has been gaining momentum in healthcare. In 2006, the Department of Defense and the Agency for Healthcare Research and Quality (AHRQ) partnered to develop a teamwork program designed specifically for healthcare called Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS ). TeamSTEPPS promotes the use of standardized communication tools and addresses 5 areas of teamwork including leadership, communication, situational monitoring, team structure, and mutual support.8 Positive improvements have been reported in the 18 TeamSTEPPS research studies reviewed by the authors. Staff perceptions regarding teamwork and/or communication were the most common areas in which measurable improvement occurred.9-22 TeamSTEPPS implementation has demonstrated improved outcomes in a variety of specialty areas and settings including the operating room,22 pediatric and adult intensive care units,15 emergency department,23 mental health,18 neonatal intensive care,24 a combat hospital,25 and outpatient oncology.10 One study reported a 13% increase in positive staff perceptions of teamwork and a 20% increase in positive staff perceptions of communication measured by the Hospital Survey on Patient Safety Culture (HSOPSC) 1 month after implementation.22 Several studies16-18 measured knowledge, reporting anywhere from a 6% to 9% increase following the training program. In addition, decreased patient incident events have been reported following training.25,26 The aims of this quality improvement project (QIP) were to improve staff perceptions of teamwork and communication by customizing and implementing TeamSTEPPS training for the oncology service line (OSL) in an academic health center and to evaluate A Following the momentous report To Err Is Human,1 the Institute of Medicine and The Joint Commission (TJC) recommended teamwork and communication training in healthcare to assist in decreasing medical errors.2 Although teamwork is cited as an essential component of both communication and a safetyoriented culture,3 effective teamwork is often absent in healthcare settings4 and requires cultivation.5 According to TJC,6 communication is one of the leading causes of patient sentinel events.Promoting Patient Safety For decades, the aviation industry and the US military have enforced training in teamwork and communication as a means to decrease errors and increase positive outcomes.7 The goal of improving patient safety with highly effective teams and coordinated commuAuthor Affiliations: Nurse Informatics Educator (Dr Gaston), Information Services, Carolinas HealthCare System, Charlotte; Associate Professor (Dr Short), School of Nursing, Duke University, Durham; and Assistant Vice President (Dr Ralyea), Patient Care Services Oncology Division, and Nursing Research & Evidence Based Practice (Dr Casterline), Carolinas HealthCare System, Charlotte, North Carolina. The authors declare no conflicts of interest. Correspondence: Dr Gaston, Carolinas HealthCare System, 5039 Airport Center Pkwy, Charlotte, NC 28208 ([email protected]). DOI: 10.1097/NNA.0000000000000333 A JONA Vol. 46, No. 4 April 2016 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. 201 the overall effectiveness. Based on previously reported 2013 HSOPSC results, nursing leaders identified teamwork and communication on the OSL as an improvement opportunity. Important stakeholders, including nursing leadership and the Quality and Patient Safety (QPS) team, were highly supportive. Targeted outcomes for implementation included the following: 1. observe an improvement in staff perceptions of team structure and communication as measured by the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ);27 2. observe an increase in positive staff perceptions of teamwork by 13% and communication openness by 20% as measured by the HSOPSC28; 3. observe a 5% increase in staff knowledge as measured by the TeamSTEPPS Learning Benchmark Test (LBT)29; and 4. discover and describe staff perceptions toward the application of TeamSTEPPS tools and behaviors into clinical practice as measured by the focus groups. Methods Design This QIP incorporated a mixed-methods approach including both quantitative and qualitative data collection. A preimplementation/postimplementation design measured perceptions of teamwork, perceptions of communication, knowledge, and number of patient incident reports. In addition, the design measured course evaluations, focus groups, and exit surveys after training only. Qualitative information was gathered from the focus groups. The settings were 3 oncology acute patient care units (total of 72 beds) within the OSL of an 874-bed academic health center located in the southeast United States. Promoting Patient Safety At project onset, 95 RNs, 35 clinical nurse assistants (CNAs)/healthcare technicians (HCTs), and 14 physicians were eligible to participate. Each received an e-mail invitation to voluntarily sign up for a TeamSTEPPS training session. RNs and CNAs/ HCTs received 2 hours_ pay outside their scheduled shift work to attend 1 training session. Nurses who completed the training course received 2.0 contact hours, whereas physicians did not receive any continuing medical education. The convenience sample of voluntary staff included full- and part-time staff (n = 92 RNs, n = 12 CNAs/HCTs, n = 6 physicians) who work within the OSL. Of the participating staff, 94% (n = 103) denied ever attending a formal TeamSTEPPS training prior to this QIP. 202 Project Implementation Training Because the TeamSTEPPS program was purposely designed to be customizable by healthcare organizations,8 a few studies have successfully provided 2-hour training sessions in lieu of the 6-hour session promoted by the AHRQ.10,15,30 Therefore, in collaboration with the QPS team, the content was customized to a 2-hour training session. These training sessions included didactic instruction along with an audiovisual slide presentation containing videos, discussion questions, scenarios, and oncology-specific examples. Seven staff members volunteered to become TeamSTEPPS Master Trainers (MTs) and attended a 1-day course. The project team scheduled 10 TeamSTEPPS sessions with 1 make-up session to implement during September 2014. Coaching Coaching is an essential element of sustainability,18 although not well studied. The MTs provided coaching on each of the patient care units after training for 3 months. The latest version of the TeamSTEPPS program has a new coaching guide, and this module was reviewed by all MTs. The nurse managers or the MTs either e-mailed staff or verbally reviewed with staff a Tool of the Month for 3 months following training. Focus Groups During the training sessions, all participants (n = 110) received a thank-you card, and of those participants, a randomized 40% (n = 44) received a special thankyou card containing a focus group invitation. Three focus groups met 1 month after the completion of all training sessions to answer specific questions. Data Collection and Measures Data were obtained during 4 time periods: immediately prior to and immediately following each of the 11 training sessions, approximately 1 month after the final training session was conducted, and at the conclusion of this project. Data collection included the following: demographics, T-TPQ, HSOPSC, LBT, focus group questions, exit survey, training course evaluation, and number of patient incident reports. The T-TPQ, HSOPSC, and the LBT are open-access tools and available on the AHRQ Web site, whereas the demographic survey, focus group questions, exit survey, and training course evaluation were created for this QIP (Table 1). Demographic data included patient care unit(s) to ensure employment by the OSL, professional credentials, and a yes/no question to identify JONA Vol. 46, No. 4 April 2016 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Table 1. Data Collection Detail Types of Data Collected Time Periods of Data Collection Administered immediately prior to the start of each training session (September 2014) September 2014VIntervention Administered immediately following each training session (September 2014) Focus groups (October 2014) Paper surveys made available for a 2-wk period 1 mo following the completion of the last training sessions (October 2014) Patient incident report no. Promoting Patient Safety ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS (January 2015) Demographics T-TPQ ¾ ¾ HSOPSC LBT ¾ Course Evaluation Exit Survey ¾ 11 TeamSTEPPS training sessions ¾ ¾ ¾ 3 Small group sessions ¾ ¾ ¾ ¾ Retrospective data collection upon completion of this project including 3-mo pretraining (June, July, August 2014) then 3-mo posttraining (October, November, December 2014) numbers those who had previously completed TeamSTEPPS training. Individual participant responses were not identifiable by demographic data. AHRQ developed the T-TPQ tool to measure the effectiveness of the TeamSTEPPS training program. This tool can be administered in conjunction with the HSOPSC tool.27 For the purpose of this QIP, we selected only 2 subscales, team structure and communication from the T-TPQ (Likert scale 1-5). The reliability values of team structure (Cronbach_s ! = .89) and communication (Cronbach_s ! = .88) subscales have been reported to be good and have construct validity.31 For the purpose of this QIP, we selected only 2 subscales from the HSOPSC tool (Likert scale 1-5) including staff perceptions of teamwork within the units (Cronbach_s ! = .83) and communication openness (Cronbach_s ! = .73). Given these values, the HSOPSC has acceptable reliability.32 The items and subscales are psychometrically sound.33 The HSOPSC has been administered across hundreds of healthcare organizations supporting its validity with national benchmarking data that are also available.28 AHRQ developed the LBT specific to the educational content of the training program to measure participant knowledge. This was modified by decreasing the number of multiple-choice questions from 23 to 10 and by selecting questions specific to the revised 2-hour course content. Three focus groups were conducted to gather staff_s perceptions regarding the application of training to clinical practice. See Table 2 for focus group questions. Resources regarding how to plan and conduct focus groups, as well as how to create questions, and analyze the results were utilized.34,35 Gift cards were given to those who participated. Only summative information was reported to protect participants_ anonymity and confidentiality. An exit survey was designed to gather more information about the application to clinical practice, and the questions were created specifically for this QIP, thereby lacking reliability and validity. A training course evaluation tool assessed staff satisfaction following each of the training sessions. This was based on the standard evaluation tool used for in-services by the academic health center. In addition, 2 additional questions were created to illicit more information from staff regarding future application of the newly learned tools. Patient incident report counts were obtained to indirectly observe if the training impacted staff behaviors and patient events in the clinical setting. Data Analysis Data were analyzed using SPSS version 22 software (IBM, Armonk, New York). The quantitative data were normally distributed. Descriptive statistics were used for the demographics, T-TPQ, HSOPSC, LBT, exit survey, and course evaluation data. An unpaired, 2-sample t test was conducted for the T-TPQ, HSOPSC, and LBT. In addition, a comparison was made from the previously reported 2013 HSOPSC data for the entire health center and the 2013 AHRQ 75th percentile comparative database versus the 2014 HSOPSC data from this QIP. The qualitative data from 3 focus groups were organized by major themes and coded by 2 individuals separately. Patient JONA Vol. 46, No. 4 April 2016 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. 203 Table 2. Focus Group Information Questions Asked Most Common Themes 1. Promoting Patient Safety What facilitators do you see in your work area that promote or support the use of TeamSTEPPS? 2. Describe a time or an experience when you used a TeamSTEPPS tool. 3. Tell me some ideas on how we can better integrate TeamSTEPPS tools into everyday practice. 4. Describe how we can keep TeamSTEPPS going for newly hired staff. 5. Tell me about some of the barriers that you may have experienced when applying the TeamSTEPPS tools in your work area. & Huddle time & BI need clarity[ and CUSa tool used for medication orders, communication between nurses and physicians, and electronic chemotherapy orders & Verbal reminders during huddle time and team meetings & Visual reminders on the nursing unit bulletin boards and in the break rooms & Written reminders via e-mail and communication books & More educational in-services & Add to general hospital orientation program & Add to nursing unit-specific orientation & Personal attitudes of staff & Nurse-physician communication a CUS: “I am Concerned! I am Uncomfortable! This is a Safety issue!” (TeamSTEPPS). incident report numbers were compared 3 months pre/post. Statistical significance was set at P < .05. Results TeamSTEPPS Teamwork Perceptions Questionnaire The 2 selected subscales of the T-TPQ (n = 107 pre, n = 73 post) were calculated using a 2-sample t test based on the user manual.27 The mean for the team structure subscale before training on a 1- to 5-point Likert scale was 3.89 and at 1 month after training was 4.43 (t178 = j5.62, P = .000). The mean for the communication subscale from pretraining was 4.08 and at 1 month after training was 4.58 (t180 = j 6.22, P = .000). Both subscales measured demonstrated an improvement in staff perceptions for team structure and communication with statistical significance (Figure 1). tile and (b) communication openness at 67% for the overall health center and 66% for the AHRQ comparative database 75th percentile benchmark. The 2 selected safety culture subscales of the HSOPSC (n = 109 pre, n = 73 post) were calculated using a 2-sample t test based on the mean percent positive responses utilizing the HSOPSC survey user_s guide.28 Staff perceptions for the teamwork within unit subscale increased from 74% before training to 91% at 1 month after training (t182 = j3.66, P = .000), and the communication openness subscale increased from 58% before training to 79% at 1 month after training (t176 = j4.43, P = .000); both demonstrated improved staff perceptions with statistical significance (Figure 2). Hospital Survey on Patient Safety Culture Baseline 2013 retrospective data obtained from the academic health center showed (a) teamwork within units at 85% for the overall health center and 84% for the AHRQ comparative database 75th percen- Learning Benchmark Test A 2-sample t test (n = 110 each sample) showed a pretraining mean score of 92% (range, 40%-100%; median, 100%) and an immediate posttraining mean score of 94% (range, 30%-100%; median, 100%) on a scale of 0% to 100%. Although staff knowledge increased by 2%, this was not statistically significant (P = .207). The t test was selected based on a Figure 1. T-TPQ results: mean scores for team structure and communication.Promoting Patient Safety *Statistical significance at P < .05. Figure 2. HSOPSC results: mean % positive responses. *Statistical significance at P < .05. 204 JONA Vol. 46, No. 4 April 2016 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. sufficient sample size and only slightly skewed data for the immediate posttraining group. Focus Groups Another aim of this project was to describe staff perceptions toward the application of TeamSTEPPS into clinical practice. Three focus groups (n = 20) were conducted to gather this qualitative information. Table 2 displays the common themes that resulted from a content analysis of the responses. Exit Survey All eligible participants (n = 74) who completed the exit survey 1 month after training (67% response rate) reported that they attended a training session prior to answering these questions. Improved teamwork was reported by 81% (n = 60) of staff, and improved communication was reported by 85% (n = 63) of staff. Following the training sessions, 89% (n = 66) of staff reported that they used a TeamSTEPPS tool or demonstrated a behavior at work during the past month since their training. The top 3 reported tools that were used following training included huddles, I need clarity, and debriefs. Course Evaluation Questions 1 to 9 (n = 110) pertained to overall staff satisfaction with the training sessions, and staff selected good or excellent 96% to 100% of the time. Question 10 (n = 97) asked how likely they are to use the training materials in their clinical practice, and staff reported 66% (n = 64) definitely, 33% (n = 32) likely, and 1% (n = 1) not likely. Question 11 asked which tools or behaviors staff plan to use immediately following the training, and the top 3 reported tools included briefs, 2-challenge rule, and debriefs. Patient Incident Reports The number of patient incident reports voluntarily reported by staff via the electronic reporting system 3 months before training was 87 and 3 months after training was 87. Discussion The results indicate that TeamSTEPPS training improved staff perceptions of teamwork and communication as measured by both the T-TPQ and the HSOPSC tools, supporting previous findings.9-26 A comparison of these 2014 HSOPSC results to baseline 2013 HSOPSC results shows the OSL exceeded both the overall academic health center results and the AHRQ comparative database 75th percentile benchmarking results. Although the primary outcome measures (T-TPQ and HSOPSC) showed statistical significance, the LBT and the patient incident report numbers were basically unaffected by the training. The LBT had only a 2% knowledge increase and did not support the results of previous studies.16-18 The pretraining scores were higher than expected with a 92% mean, possibly indicating either the test was too easy or the staff already had sufficient baseline knowledge of teamwork, communication, and patient safety. The number of patient incident reports, although a broad measure of how teamwork training can impact staff behaviors and patient care, surprisingly remained unchanged, thus not substantiating 2 previous studies25,26 from the literature. In addition, other positive outcomes included staff satisfaction, behavior change, and staff input. The course evaluation showed that staff were satisfied with the training, which can be helpful in the momentum and sustainment of a QIP. Signifying a positive behavior change, 89% (n = 64) of staff reported that they used a tool in clinical practice that they learned from their training session. Without TeamSTEPPS research studies including focus groups to reflect upon, the benefits of staff insight regarding facilitators, barriers, and sustainability ideas are key. This information can be beneficial for nursing leadership moving forward. Overall, QIP outcomes 1, 2, and 4 were met, whereas out …Promoting Patient Safety Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

Promoting Patient Safety Promoting Patient Safety This article uses a mixed methods research design. Discuss the characteristics of a mixed methods research. Within the discussion, speak to the strengths and weaknesses of this method. Explain why this study used this approach. promoting_safety.pdf _grading_rubric_mo JONA Volume 46, Number 4, pp 201-207 Copyright B 2016 Wolters Kluwer Health, Inc. All rights reserved. THE JOURNAL OF NURSING ADMINISTRATION Promoting Patient Safety A Results of a TeamSTEPPS Initiative Teresa Gaston, DNP, RN Nancy Short, DrPH, MBA, RN Christina Ralyea, DNP, MS-NP, MBA, OCN, NE-BC Gayle Casterline, PhD, RN Teamwork is an essential component of communication in a safety-oriented culture. The Joint Commission has identified poor communication as one of the leading causes of patient sentinel events. The aim of this quality improvement project was to design, implement, and evaluate a customized TeamSTEPPS training program. After implementation, staff perception of teamwork and communication improved. The data support that TeamSTEPPS is a practical, effective, and low-cost patient safety endeavor. nication has been gaining momentum in healthcare. In 2006, the Department of Defense and the Agency for Healthcare Research and Quality (AHRQ) partnered to develop a teamwork program designed specifically for healthcare called Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS ). TeamSTEPPS promotes the use of standardized communication tools and addresses 5 areas of teamwork including leadership, communication, situational monitoring, team structure, and mutual support.8 Positive improvements have been reported in the 18 TeamSTEPPS research studies reviewed by the authors. Staff perceptions regarding teamwork and/or communication were the most common areas in which measurable improvement occurred.9-22 TeamSTEPPS implementation has demonstrated improved outcomes in a variety of specialty areas and settings including the operating room,22 pediatric and adult intensive care units,15 emergency department,23 mental health,18 neonatal intensive care,24 a combat hospital,25 and outpatient oncology.10 One study reported a 13% increase in positive staff perceptions of teamwork and a 20% increase in positive staff perceptions of communication measured by the Hospital Survey on Patient Safety Culture (HSOPSC) 1 month after implementation.22 Several studies16-18 measured knowledge, reporting anywhere from a 6% to 9% increase following the training program. In addition, decreased patient incident events have been reported following training.25,26 The aims of this quality improvement project (QIP) were to improve staff perceptions of teamwork and communication by customizing and implementing TeamSTEPPS training for the oncology service line (OSL) in an academic health center and to evaluate A Following the momentous report To Err Is Human,1 the Institute of Medicine and The Joint Commission (TJC) recommended teamwork and communication training in healthcare to assist in decreasing medical errors.2 Although teamwork is cited as an essential component of both communication and a safetyoriented culture,3 effective teamwork is often absent in healthcare settings4 and requires cultivation.5 According to TJC,6 communication is one of the leading causes of patient sentinel events.Promoting Patient Safety For decades, the aviation industry and the US military have enforced training in teamwork and communication as a means to decrease errors and increase positive outcomes.7 The goal of improving patient safety with highly effective teams and coordinated commuAuthor Affiliations: Nurse Informatics Educator (Dr Gaston), Information Services, Carolinas HealthCare System, Charlotte; Associate Professor (Dr Short), School of Nursing, Duke University, Durham; and Assistant Vice President (Dr Ralyea), Patient Care Services Oncology Division, and Nursing Research & Evidence Based Practice (Dr Casterline), Carolinas HealthCare System, Charlotte, North Carolina. The authors declare no conflicts of interest. Correspondence: Dr Gaston, Carolinas HealthCare System, 5039 Airport Center Pkwy, Charlotte, NC 28208 ([email protected]). DOI: 10.1097/NNA.0000000000000333 A JONA Vol. 46, No. 4 April 2016 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. 201 the overall effectiveness. Based on previously reported 2013 HSOPSC results, nursing leaders identified teamwork and communication on the OSL as an improvement opportunity. Important stakeholders, including nursing leadership and the Quality and Patient Safety (QPS) team, were highly supportive. Targeted outcomes for implementation included the following: 1. observe an improvement in staff perceptions of team structure and communication as measured by the TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ);27 2. observe an increase in positive staff perceptions of teamwork by 13% and communication openness by 20% as measured by the HSOPSC28; 3. observe a 5% increase in staff knowledge as measured by the TeamSTEPPS Learning Benchmark Test (LBT)29; and 4. discover and describe staff perceptions toward the application of TeamSTEPPS tools and behaviors into clinical practice as measured by the focus groups. Methods Design This QIP incorporated a mixed-methods approach including both quantitative and qualitative data collection. A preimplementation/postimplementation design measured perceptions of teamwork, perceptions of communication, knowledge, and number of patient incident reports. In addition, the design measured course evaluations, focus groups, and exit surveys after training only. Qualitative information was gathered from the focus groups. The settings were 3 oncology acute patient care units (total of 72 beds) within the OSL of an 874-bed academic health center located in the southeast United States. Promoting Patient Safety At project onset, 95 RNs, 35 clinical nurse assistants (CNAs)/healthcare technicians (HCTs), and 14 physicians were eligible to participate. Each received an e-mail invitation to voluntarily sign up for a TeamSTEPPS training session. RNs and CNAs/ HCTs received 2 hours_ pay outside their scheduled shift work to attend 1 training session. Nurses who completed the training course received 2.0 contact hours, whereas physicians did not receive any continuing medical education. The convenience sample of voluntary staff included full- and part-time staff (n = 92 RNs, n = 12 CNAs/HCTs, n = 6 physicians) who work within the OSL. Of the participating staff, 94% (n = 103) denied ever attending a formal TeamSTEPPS training prior to this QIP. 202 Project Implementation Training Because the TeamSTEPPS program was purposely designed to be customizable by healthcare organizations,8 a few studies have successfully provided 2-hour training sessions in lieu of the 6-hour session promoted by the AHRQ.10,15,30 Therefore, in collaboration with the QPS team, the content was customized to a 2-hour training session. These training sessions included didactic instruction along with an audiovisual slide presentation containing videos, discussion questions, scenarios, and oncology-specific examples. Seven staff members volunteered to become TeamSTEPPS Master Trainers (MTs) and attended a 1-day course. The project team scheduled 10 TeamSTEPPS sessions with 1 make-up session to implement during September 2014. Coaching Coaching is an essential element of sustainability,18 although not well studied. The MTs provided coaching on each of the patient care units after training for 3 months. The latest version of the TeamSTEPPS program has a new coaching guide, and this module was reviewed by all MTs. The nurse managers or the MTs either e-mailed staff or verbally reviewed with staff a Tool of the Month for 3 months following training. Focus Groups During the training sessions, all participants (n = 110) received a thank-you card, and of those participants, a randomized 40% (n = 44) received a special thankyou card containing a focus group invitation. Three focus groups met 1 month after the completion of all training sessions to answer specific questions. Data Collection and Measures Data were obtained during 4 time periods: immediately prior to and immediately following each of the 11 training sessions, approximately 1 month after the final training session was conducted, and at the conclusion of this project. Data collection included the following: demographics, T-TPQ, HSOPSC, LBT, focus group questions, exit survey, training course evaluation, and number of patient incident reports. The T-TPQ, HSOPSC, and the LBT are open-access tools and available on the AHRQ Web site, whereas the demographic survey, focus group questions, exit survey, and training course evaluation were created for this QIP (Table 1). Demographic data included patient care unit(s) to ensure employment by the OSL, professional credentials, and a yes/no question to identify JONA Vol. 46, No. 4 April 2016 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Table 1. Data Collection Detail Types of Data Collected Time Periods of Data Collection Administered immediately prior to the start of each training session (September 2014) September 2014VIntervention Administered immediately following each training session (September 2014) Focus groups (October 2014) Paper surveys made available for a 2-wk period 1 mo following the completion of the last training sessions (October 2014) Patient incident report no. Promoting Patient Safety ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS (January 2015) Demographics T-TPQ ¾ ¾ HSOPSC LBT ¾ Course Evaluation Exit Survey ¾ 11 TeamSTEPPS training sessions ¾ ¾ ¾ 3 Small group sessions ¾ ¾ ¾ ¾ Retrospective data collection upon completion of this project including 3-mo pretraining (June, July, August 2014) then 3-mo posttraining (October, November, December 2014) numbers those who had previously completed TeamSTEPPS training. Individual participant responses were not identifiable by demographic data. AHRQ developed the T-TPQ tool to measure the effectiveness of the TeamSTEPPS training program. This tool can be administered in conjunction with the HSOPSC tool.27 For the purpose of this QIP, we selected only 2 subscales, team structure and communication from the T-TPQ (Likert scale 1-5). The reliability values of team structure (Cronbach_s ! = .89) and communication (Cronbach_s ! = .88) subscales have been reported to be good and have construct validity.31 For the purpose of this QIP, we selected only 2 subscales from the HSOPSC tool (Likert scale 1-5) including staff perceptions of teamwork within the units (Cronbach_s ! = .83) and communication openness (Cronbach_s ! = .73). Given these values, the HSOPSC has acceptable reliability.32 The items and subscales are psychometrically sound.33 The HSOPSC has been administered across hundreds of healthcare organizations supporting its validity with national benchmarking data that are also available.28 AHRQ developed the LBT specific to the educational content of the training program to measure participant knowledge. This was modified by decreasing the number of multiple-choice questions from 23 to 10 and by selecting questions specific to the revised 2-hour course content. Three focus groups were conducted to gather staff_s perceptions regarding the application of training to clinical practice. See Table 2 for focus group questions. Resources regarding how to plan and conduct focus groups, as well as how to create questions, and analyze the results were utilized.34,35 Gift cards were given to those who participated. Only summative information was reported to protect participants_ anonymity and confidentiality. An exit survey was designed to gather more information about the application to clinical practice, and the questions were created specifically for this QIP, thereby lacking reliability and validity. A training course evaluation tool assessed staff satisfaction following each of the training sessions. This was based on the standard evaluation tool used for in-services by the academic health center. In addition, 2 additional questions were created to illicit more information from staff regarding future application of the newly learned tools. Patient incident report counts were obtained to indirectly observe if the training impacted staff behaviors and patient events in the clinical setting. Data Analysis Data were analyzed using SPSS version 22 software (IBM, Armonk, New York). The quantitative data were normally distributed. Descriptive statistics were used for the demographics, T-TPQ, HSOPSC, LBT, exit survey, and course evaluation data. An unpaired, 2-sample t test was conducted for the T-TPQ, HSOPSC, and LBT. In addition, a comparison was made from the previously reported 2013 HSOPSC data for the entire health center and the 2013 AHRQ 75th percentile comparative database versus the 2014 HSOPSC data from this QIP. The qualitative data from 3 focus groups were organized by major themes and coded by 2 individuals separately. Patient JONA Vol. 46, No. 4 April 2016 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. 203 Table 2. Focus Group Information Questions Asked Most Common Themes 1. Promoting Patient Safety What facilitators do you see in your work area that promote or support the use of TeamSTEPPS? 2. Describe a time or an experience when you used a TeamSTEPPS tool. 3. Tell me some ideas on how we can better integrate TeamSTEPPS tools into everyday practice. 4. Describe how we can keep TeamSTEPPS going for newly hired staff. 5. Tell me about some of the barriers that you may have experienced when applying the TeamSTEPPS tools in your work area. & Huddle time & BI need clarity[ and CUSa tool used for medication orders, communication between nurses and physicians, and electronic chemotherapy orders & Verbal reminders during huddle time and team meetings & Visual reminders on the nursing unit bulletin boards and in the break rooms & Written reminders via e-mail and communication books & More educational in-services & Add to general hospital orientation program & Add to nursing unit-specific orientation & Personal attitudes of staff & Nurse-physician communication a CUS: “I am Concerned! I am Uncomfortable! This is a Safety issue!” (TeamSTEPPS). incident report numbers were compared 3 months pre/post. Statistical significance was set at P < .05. Results TeamSTEPPS Teamwork Perceptions Questionnaire The 2 selected subscales of the T-TPQ (n = 107 pre, n = 73 post) were calculated using a 2-sample t test based on the user manual.27 The mean for the team structure subscale before training on a 1- to 5-point Likert scale was 3.89 and at 1 month after training was 4.43 (t178 = j5.62, P = .000). The mean for the communication subscale from pretraining was 4.08 and at 1 month after training was 4.58 (t180 = j 6.22, P = .000). Both subscales measured demonstrated an improvement in staff perceptions for team structure and communication with statistical significance (Figure 1). tile and (b) communication openness at 67% for the overall health center and 66% for the AHRQ comparative database 75th percentile benchmark. The 2 selected safety culture subscales of the HSOPSC (n = 109 pre, n = 73 post) were calculated using a 2-sample t test based on the mean percent positive responses utilizing the HSOPSC survey user_s guide.28 Staff perceptions for the teamwork within unit subscale increased from 74% before training to 91% at 1 month after training (t182 = j3.66, P = .000), and the communication openness subscale increased from 58% before training to 79% at 1 month after training (t176 = j4.43, P = .000); both demonstrated improved staff perceptions with statistical significance (Figure 2). Hospital Survey on Patient Safety Culture Baseline 2013 retrospective data obtained from the academic health center showed (a) teamwork within units at 85% for the overall health center and 84% for the AHRQ comparative database 75th percen- Learning Benchmark Test A 2-sample t test (n = 110 each sample) showed a pretraining mean score of 92% (range, 40%-100%; median, 100%) and an immediate posttraining mean score of 94% (range, 30%-100%; median, 100%) on a scale of 0% to 100%. Although staff knowledge increased by 2%, this was not statistically significant (P = .207). The t test was selected based on a Figure 1. T-TPQ results: mean scores for team structure and communication.Promoting Patient Safety *Statistical significance at P < .05. Figure 2. HSOPSC results: mean % positive responses. *Statistical significance at P < .05. 204 JONA Vol. 46, No. 4 April 2016 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. sufficient sample size and only slightly skewed data for the immediate posttraining group. Focus Groups Another aim of this project was to describe staff perceptions toward the application of TeamSTEPPS into clinical practice. Three focus groups (n = 20) were conducted to gather this qualitative information. Table 2 displays the common themes that resulted from a content analysis of the responses. Exit Survey All eligible participants (n = 74) who completed the exit survey 1 month after training (67% response rate) reported that they attended a training session prior to answering these questions. Improved teamwork was reported by 81% (n = 60) of staff, and improved communication was reported by 85% (n = 63) of staff. Following the training sessions, 89% (n = 66) of staff reported that they used a TeamSTEPPS tool or demonstrated a behavior at work during the past month since their training. The top 3 reported tools that were used following training included huddles, I need clarity, and debriefs. Course Evaluation Questions 1 to 9 (n = 110) pertained to overall staff satisfaction with the training sessions, and staff selected good or excellent 96% to 100% of the time. Question 10 (n = 97) asked how likely they are to use the training materials in their clinical practice, and staff reported 66% (n = 64) definitely, 33% (n = 32) likely, and 1% (n = 1) not likely. Question 11 asked which tools or behaviors staff plan to use immediately following the training, and the top 3 reported tools included briefs, 2-challenge rule, and debriefs. Patient Incident Reports The number of patient incident reports voluntarily reported by staff via the electronic reporting system 3 months before training was 87 and 3 months after training was 87. Discussion The results indicate that TeamSTEPPS training improved staff perceptions of teamwork and communication as measured by both the T-TPQ and the HSOPSC tools, supporting previous findings.9-26 A comparison of these 2014 HSOPSC results to baseline 2013 HSOPSC results shows the OSL exceeded both the overall academic health center results and the AHRQ comparative database 75th percentile benchmarking results. Although the primary outcome measures (T-TPQ and HSOPSC) showed statistical significance, the LBT and the patient incident report numbers were basically unaffected by the training. The LBT had only a 2% knowledge increase and did not support the results of previous studies.16-18 The pretraining scores were higher than expected with a 92% mean, possibly indicating either the test was too easy or the staff already had sufficient baseline knowledge of teamwork, communication, and patient safety. The number of patient incident reports, although a broad measure of how teamwork training can impact staff behaviors and patient care, surprisingly remained unchanged, thus not substantiating 2 previous studies25,26 from the literature. In addition, other positive outcomes included staff satisfaction, behavior change, and staff input. The course evaluation showed that staff were satisfied with the training, which can be helpful in the momentum and sustainment of a QIP. Signifying a positive behavior change, 89% (n = 64) of staff reported that they used a tool in clinical practice that they learned from their training session. Without TeamSTEPPS research studies including focus groups to reflect upon, the benefits of staff insight regarding facilitators, barriers, and sustainability ideas are key. This information can be beneficial for nursing leadership moving forward. Overall, QIP outcomes 1, 2, and 4 were met, whereas out …Promoting Patient Safety Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10