Samantha Baynes - PACU - Improving Team Performance & Safety in Practice by Implementing Team STEPPS® into the Operating Theatre
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Samantha Baynes - PACU - Improving Team Performance & Safety in Practice by Implementing Team STEPPS® into the Operating Theatre

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Samantha Baynes delivered the presentation at the 2014 Operating Theatre Management Conference. ...

Samantha Baynes delivered the presentation at the 2014 Operating Theatre Management Conference.

Focusing on strategies for implementing the National Safety and Quality Health Service Standards and the importance of communication to improve patient safety and clinical practice, the 2014 Operating Theatre Management Conference brought together operating room management and perioperative professionals to review current initiatives across the country.

For more information about the event, please visit:

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  • 1. IMPROVING TEAM PERFORMANCE AND PATIENT SAFETY IN THE OPERATING THEATRE by Introducing TeamSTEPPS® Presented by Samantha Baynes Clinical Services Coordinator – Mount Gambier & Districts Health Service
  • 2. SA Health MOUNT GAMBIER HOSPITAL Currently: • 91 acute beds – includes 17 bed private hospital • 13 same day beds • Services include emergency, medical, surgical, paediatric, obstetric, renal, palliative care, chemotherapy, mental health Redevelopment commenced June 2013 will include: • A new 22 bed ward, including rehabilitation and palliative care beds and a mental health unit • Expansion of the Emergency Department increasing the number of treatment spaces from 10 to 22 • An additional eight outpatient consulting/treatment rooms • Four new dental chairs, increasing the dental service from six to 10 chairs • New staff office accommodation and medical records facilities.
  • 3. SA Health
  • 4. SA Health South East SA Catchment Area • The South East region of South Australia covers 2.2% of the state with a land area of 21,327 square kilometres and supports 3.9% of the South Australian population. • MGDHS service area covers the South East of South Australia which has a population 63,077(ABS 2011), with a catchment area that extends across the border into Western Victoria, with a population of 26,951. 50 km 183 km
  • 5. SA Health Mount Gambier Perioperative Services > 13 day surgery chairs > 7 recovery bays > 4 operating theatres > Day surgery is also DOSA unit > Sterilization services department – sterilizes all equipment for the Hospital and also for outlying clinics > Number of inpatient admissions last financial year: > 2,186 day surgery patients 2013/14 > 1,696 overnight patients 2013/14 > 1,191 outpatient procedures 2013/14 > 292 infusion procedures in day surgery unit > 1,191 outpatient procedures 2013/14
  • 6. SA Health Perioperative Services Staffing profile > Surgeons – > 11 resident > 6 visiting > General Surgery registrar – 6 month rotation > Anaesthetists – > 5 resident > Anaesthetic registrar – 6 month rotation > Nurses > 27 Registered nurses > 9 Enrolled nurses > Other staff > 4 theatre orderlies/technicians > 3 Sterilization Services Staff > 2 FTE (3 staff) clerical
  • 7. SA Health TeamSTEPPS® Team Strategies & Tools to Enhance Performance & Patient Safety “Initiative based on evidence derived from team performance…leveraging more than 30 years of research in military, aviation, nuclear power, business and industry… to acquire team competencies”
  • 8. SA Health Why TeamSTEPPS® > Report was commissioned – showed gaps and risks regarding communication with all members of the Perioperative team > Recommendation – ensure timely identification, assessment and treatment of deteriorating patients > Support effective handover and communication with all members of the team > Focus on patient safety
  • 9. SA Health Why Do Errors Occur - Some Obstacles • Workload fluctuations • Interruptions • Fatigue • Multi-tasking • Failure to follow up • Poor handovers • Ineffective communication • Not following protocol • Excessive professional courtesy • Halo effect • Passenger syndrome • Hidden agenda • Complacency • High-risk phase • Strength of an idea • Task (target) fixation
  • 10. SA Health
  • 11. SA Health Issues Identified > Poor channels of communication between all disciplines > Chinese whispers > Staff punctuality > Dissemination of information > Lack of team work > Lack of role clarity
  • 12. SA Health SWOT Analysis > Strengths > Team cohesive – pull together in emergency > Care for one another – supportive of family > Advocacy > Patient safety a priority > Opportunities > Communication > Respect > ISBAR > Embracing change > honesty > Weaknesses > Poor communication > Reliance on others / management to fix problems > Chinese whispers > Doctors pass information to their favourites, not the correct person for the job > New forms / procedures / equipment – no time for inservice education > Threats > Negativity > Ego > Ingrained culture/history > Slow adaptation to change
  • 13. SA Health Paradigm Shift to Team System Approach Dual focus (clinical and team skills) Team performance Informed decision-making Clear understanding of teamwork Managed workload Sharing information Mutual support Team improvement Team efficiency Single focus (clinical skills) Individual performance Under-informed decision- making Loose concept of teamwork Unbalanced workload Having information Self-advocacy Self-improvement Individual efficiency
  • 14. SA Health Why Teamwork? • Reduce clinical errors • Improve patient outcomes • Improve process outcomes • Increase patient satisfaction • Increase staff satisfaction • Reduce indemnity claims
  • 15. SA Health Barriers to Team Performance • Inconsistency in team membership • Lack of time • Lack of information sharing • Hierarchy • Defensiveness • Conventional thinking • Varying communication styles • Conflict • Lack of coordination and follow-up • Distractions • Fatigue • Workload • Misinterpretation of cues • Lack of role clarity
  • 16. SA Health Eight Steps of Change
  • 17. SA Health Role of the Manager > Identify issues > Site assessment application > Staff survey > Reflection on own practice > Choosing the change team > Keeping the momentum > Making room for change
  • 18. SA Health Staff training > The change team attended 2.5 days of training > Change team returned to the unit being responsible for the training of all other staff > 3 hour fundamentals course for staff conducted on site
  • 19. SA Health Training %
  • 20. SA Health What changes were implemented? > Morning Briefs > Huddles > ISBAR Handovers > Staff provided with tools to improve, enhance and empower their communication skills
  • 21. SA Health Morning Brief > It’s brief! > Start promptly at 0800 > Staff from all disciplines who are on duty are encouraged to attend > Nursing staff are expected to attend > Led by Manager or Floor Manager > Issues for the day discussed > Pertinent, succinct dissemination of changes, roles, responsibilities relating to patient care > Not the time for gripes, moans and general conversations
  • 22. SA Health Huddles > Ad hoc planning to re-establish situational awareness > Discuss critical issues and emerging events > Reassign roles or duties > Attendance required by those staff affected
  • 23. SA Health ISBAR – RECOVERY COMMUNICATION Standardised ISBAR Handover Recovery staff to receiving Ward Staff IDENTIFY: Give patient’s name, DOB, and MRN. Check patient’s armband with receiving staff. SITUATION: Give name of procedure / operation performed. BACKGROUND: Any relevant history to surgery performed. Any allergies. Was procedure performed under LA, Regional, IV Sedation or GA? Anything to report during procedure eg, blood loss, laryngospasm, difficult intubation, etc. ASSESSMENT: Give latest clinical assessment of observations. Start from head to toe with O2 requirements, IVT, dressings, IDC, bellovacs, calf stimulators etc. Pain score and any pain protocol initiated. Any tests undertaken such as ECG, BSL, Has the surgeon or anaesthetist reviewed patient in the recovery room? RECOMMENDATION: Any post op instructions including routine care following surgery. IVT orders, medication orders, follow up tests, positioning of patient, use of O2 adjuncts, care and removal of drains and catheters, wound care, and mobilization post op. Need for follow up appointments? Have they been made? Assign responsibility for any tasks that require undertaking. Ensure receiving staff understand everything discussed.
  • 24. SA Health Barriers to Implementation > Inability to “shut up shop” to train staff > Staff unwilling to embrace change > Staff apathy – why bother?? > Time constraints > Keeping up momentum >
  • 25. SA Health
  • 26. SA Health Improvements - Staff Feedback > Morning briefs have improved communication in the unit > Patient safety is a core value > All team members are on the same page > Decreased constant questioning about additions to lists > Improved relationships between Medical staff and nursing staff > Staff punctuality improved > Staff communication improved > Team work culture
  • 27. SA Health Work still to do > Keeping up the momentum > Encourage and empower staff to call a Huddle > Implement debriefs at the end of the shift > Keep sight of the patient safety core value > Increase compliance of Medical Officers training
  • 28. SA HealthSA Health MOUNT GAMBIER