TeamSTEPPS Fundamentals Course: Module 7. Summary

Instructor's Guide

TeamSTEPPS is a teamwork system developed jointly by the Department of Defense (DoD)and the Agency for Healthcare Research and Quality (AHRQ) to improve institutional collaboration and communication relating to patient safety.
Penguin doctor with clipboard in conversation with two penguins wearing scrub tops.


 Instructor Online Summary

Icon: An eye Instructor Note: 

In this module, you will summarize the information taught across modules and facilitate opportunities for participants to synthesize what they have learned.

The Summary module includes the content provided in the outline below. More content is available than can be covered in the time provided; therefore, optional content and activities are noted. It is strongly recommended that instruction not focus solely on lecture, but also include exercises, videos, and other activities. As such, instructors should use the information below to plan how the module will be taught within the time available.

Content Page # Approx. Time
1. Introduction 4 2 min.
2. Summary of TeamSTEPPS Skills, Tools, and Strategies 5-6 4 min.
3. Review of TeamSTEPPS Outcomes 7 2 min.*
4. Skills Practice Exercise 8-10 25 min.*
5. Identifying Opportunities to Use and Effective Use of TeamSTEPPS Tools and Strategies (Videos) 11-12 15 min.
6. Summary 13 1 min.
7. Applying TeamSTEPPS Exercise 14 10 min.
8. Practice Teaching Session Preparation 15 5 min.*

* Although all instructional content and activities are recommended to ensure participants achieve the learning objectives, these activities may be considered "optional" if time is constrained. Additional information about the Practice Teaching Session is provided in the TeamSTEPPS Course Management Guide.

 

Icon: Document Subsections
  • Review of Teamwork Skills, Team Effectiveness, and TeamSTEPPS Outcomes.
  • Skills Practice Exercise.
  • Identifying Opportunities to Use TeamSTEPPS Strategies and Tools.
  • Practice Teaching Session Preparation.
Icon: clock Module Time: 50 Minutes

Icon: Materials

Materials
  • Flipchart or Whiteboard (Optional)
  • Markers (Optional)
  • Summary Skills Practice Exercise Sheet
  • Video Vignette (INPTSURG_Opportunity_Compete_Vignette.mpg)
  • Video Vignette (INPTSURG_Success_Complete_Vignette.mpg)
  • TeamSTEPPS Implementation Worksheet


Contents


 Objectives

Objectives: Discuss how to use the tools and strategies presented in this training; Demonstrate how to appropriately apply the tools and strategies to real-life situations; and Practice using tools and strategies for overcoming barriers to team effectiveness.

Say:

The purpose of the TeamSTEPPS curriculum is to develop an understanding of how to leverage teamwork skills to promote patient safety and decrease medical error. In this training, you have been presented with a number of tools and strategies for building teamwork skills in your organization. In this module, we will synthesize what you have learned.

After completing this module, you will be able to:

  • Discuss how to use the tools and strategies presented in this training.
  • Demonstrate how to appropriately apply the tools and strategies in clinical scenarios.

Return to Contents


 Review of Team Skills

TeamSTEPPS logo. For details, go to [D] Text Description. Each TeamSTEPPS teamwork skill: Facilitates teamwork: Is dependent upon or moderated by the other skills. Contributes to team performance, quality of care, and patient safety

[D] Select for Text Description

Say:

The tools and strategies presented in the TeamSTEPPS curriculum correspond to individual teamwork skills; however, each tool and strategy can be applied to support teamwork in a variety of complex situations. In each case, the tool or strategy can have a direct effect on team results, such as team performance, quality of care, and patient safety.

As you have seen, all of the teamwork skills are intimately linked:

  • Team Structure facilitates teamwork by identifying the individuals among which information must be communicated, a leader must be clearly designated, and mutual support must occur.
  • Communication facilitates teamwork by enabling team members to effectively relay relevant information in a manner that is known and understood by all.
  • Leadership facilitates teamwork through leaders' effective communication with their team members to ensure a plan is conveyed, reviewed, and updated; continuous monitoring of the situation to better anticipate team members' needs and effectively manage resources; and fostering of an environment of mutual support through role modeling and reinforcement.
  • Situation Monitoring facilitates teamwork by ensuring that new or changing information about the environment or the patient is identified for communication and decision making by the leader; and leads to the effective support of fellow team members.
  • Mutual Support facilitates teamwork by ensuring that by giving task assistance, sharing feedback, and speaking up, team members provide safe, timely, and quality care. It is moderated by communication and modeled by team leaders. In addition, mutual support depends on information gathered through situation monitoring.

Finally, it is also important to recognize the patient as part of the team and be aware that clinical and nonclinical staff have an important role in affective the care of the patient..

Return to Contents


 Tools & Strategies Summary


Go to Text Description below for details

Say:

Throughout this course, you have received information about barriers to team effectiveness; tools and strategies to overcome such barriers; and outcomes of effective teamwork.

You have learned communication tools, such as SBAR, handoffs, and call-outs. You have also learned about leadership strategies for managing resources, along with tools for facilitating team events, such as briefs, huddles, and debriefs. You have also learned the situation monitoring mnemonic STEP and mutual support tools, such as the Two-Challenge Rule, CUS, and DESC script.

Remember that enhanced patient safety is the ultimate outcome of consistently using the TeamSTEPPS tools and strategies to overcome barriers to team effectiveness.

Return to Contents


 (Optional) TeamSTEPPS Outcomes

Improved team performance (e.g., Weaver, et al., 2010). Improved team processes (e.g., Capella, et al., 2010).  Improved patient safety culture (e.g., Thomas & Galla, 2013)

Say:

Before we practice applying the TeamSTEPPS tools and strategies, let's review what this program can do for your facility, unit, or organization.

Research has shown that team training in general and specifically for health care teams results in positive team outcomes. More specifically, research demonstrates that TeamSTEPPS training produces positive outcomes. These include improved team performance, improved processes, and improved patient safety culture.

Return to Contents


 (Optional) Exercise: Skills Practice

Image of a penguin in a cape holding a sword and a book.


Icon: clock Module Time: 25 minutes

Icon: Materials

Materials
  • Flipchart or Whiteboard (Optional)
  • Markers (Optional)
  • Summary Skills Practice Exercise Sheet

Icon: An eye Instructor Note: The details of the scenario used for this exercise may be changed so the activity is relevant to your specific group of learners.

Do:

Help the participants form four small groups. Distribute the Summary Skills Practice Exercise Sheet to each group. Assign one teamwork skill (communication, leadership, situation monitoring, or mutual support) per group. During the exercise, you may need to remind groups that they may refer to their course materials for specific tools and strategies for their assigned teamwork skill.

Say:

  • Each of you should be in one of four small groups, each assigned to focus on one of four teamwork skills.
  • Read the scenario.
  • Identify the instances where a breakdown in teamwork has occurred as it relates to the specific teamwork skill assigned to your team.
  • Identify 2 to 3 tools or strategies related to the specific teamwork skill assigned to your team that can be applied to remedy the teamwork breakdowns. Refer to your course materials if needed.
  • Assign roles among your team members and create a script to enact the scenario, based on the tools and strategies that your team has decided on.
  • Present your scripted scenario to the class (time permitting).

Do:

If time permits, conduct a debrief of each group's presentation.

Return to Contents


 (Optional) Skills Practice Scenario

Icon: An eye Instructor Note: The following scenario is included on the Summary Skills Practice Exercise Sheet.

Scenario

It is flu season in the Pediatric Inpatient Ward, and the number of admissions is high because of the influenza epidemic. Dr. Powers, who is notoriously difficult to work with and does not work well under stress, is attending to a new patient who has been over-sedated. Dr. Powers gives a verbal order for 1 Amp Narcan to Nurse Shelley. Nurse Shelley repeats the verbal order as "1 Amp Narcan."

In a rush, Nurse Shelley writes the verbal order on the chart. The written order is then sent to the pharmacist. He is a float pharmacist who does not usually work on the pediatric floor, and he is fatigued from approaching the 10th hour of his 7th day of working. He is also overloaded and overburdened by the large number of admissions in the ward. The pharmacist misreads the poorly written transcription as "1 Amp Norcuron."

At the end of Nurse Shelley's shift, she hands off to Nurse Givens. During the handoff, the Code Team is activated, and Nurse Shelley has to respond. Nurse Givens then returns to the pharmacist, who dispenses Norcuron. Nurse Givens suspects something is wrong with the order but decides Norcuron must be a generic name for Narcan. (Norcuron is actually a neuromuscular blocker.) Nurse Givens administers Norcuron to the patient, who immediately experiences respiratory arrest and requires intubation.

Icon: Dialog balloon Discussion: 

  • Which TeamSTEPPS tools and strategies could have been used?
  • How would the outcome have been different if the TeamSTEPPS tools and strategies had been used?
    • The pharmacist would have done a check-back on the irregular order.
    • A better handoff would have occurred.
    • Nurse Givens would have done a check-back and challenged the order to the pharmacist or physician.
    • Team members would have advocated for the patient.
    • Situation monitoring would have ensured that team members were monitoring the situation and other team members and caught the error.
    • Improved team structure and leadership would have helped to facilitate improved care.

Return to Contents


Identifying Opportunities to Use TeamSTEPPS Tools and Strategies

Photo of a nurse with a patient in a hospital bed

Icon: Video Video Time: 3:26 minutes
Icon: Materials Materials:
  • Flipchart or Whiteboard (Optional)
  • Markers (Optional)
  • Video Vignette (INPTSURG_Opportunity_Complete_Vignette.mpg)

Say:

To review what we've learned across the modules, we will watch a video scenario that demonstrates breakdowns in teamwork. Let's see if you can identify the breakdowns and apply a TeamSTEPPS tool or strategy to remedy them. As you watch the video, make note of any barriers presented and the tools and strategies that could be used to address the barriers.

Do:

 Icon: Video Play the video by selecting the director icon on the slide.

Icon: Dialog balloon Discussion:

  • What were the barriers presented in this video scenario?
    • Lack of information-sharing; lack of coordination; lack of followup; lack of shared mental model.
  • Which of the TeamSTEPPS tools and strategies could have been used, and how would the outcome have been different?
    • Debrief after the surgery or a huddle after Mrs. Peters was in the recovery room to ensure the entire care team knew of Dr. Daniel's concerns.
    • Better handoff from recovery to floor nurse.
    • Followup by the nurse who noticed something in the charts but did not follow up with the doctor to confirm or clarify.
    • Sharing of test results came back with important information that was not shared with the care team.Sharing of information by Mrs. Peters to make the care team aware of her changing symptoms.

Return to Contents


 Effective Use of TeamSTEPPS Tools and Strategies

Photo of a nurse and a woman in a purple shirt.

 

Icon: Clock Video Time: 6:59 minutes
Icon: Materials Materials:
  • Flipchart or Whiteboard (Optional)
  • Markers (Optional)
  • Video Vignette (INPTSURG_Success_Complete_Vignette.mpg

Say:

Now that we have analyzed the scenario and identified opportunities to use TeamSTEPPS strategies and tools to improve the outcome, let's watch an example of the same scenario when effective teamwork is displayed.

Do:

 Icon: Video Play the video by selecting the director icon on the slide.

Icon: Dialog balloon Discussion:

  • Which TeamSTEPPS strategies and tools were used in this scenario?
    • Several TeamSTEPPS strategies and tools were used, including:
      • SBAR between the physician and the recovery room nurse.
      • Structured handoff from recovery nurse to floor nurse.
      • Brief at start of new nursing shift.
      • Check-back by Mrs. Peters and her daughter of signs and symptoms to monitor.
      • Check-back to confirm understanding of medication orders and dosing between the physician and pharmacist.
    • How did the use of these TeamSTEPPS tools and strategies affect the course and outcome of the scenario?
      • Information was continually shared with the care team, resulting in a shared mental model of Mrs. Peters' status and plan of care.
      • Team members appeared aware of their role and responsibilities and ensured that the team leader (the physician) was informed of changes in Mrs. Peters' status so that she could modify the plan of care.
      • Mrs. Peters was discharged because the team's performance ensured patient safety.

Return to Contents


 Summary

In the preceding section, we learned that teamwork strategies and tools: Are available to both team members and leaders. Can be used to address barriers to team effectiveness in a given situation. Can all be applied to most situations because they complement one another.

Say:

In the preceding section, we learned that team strategies and tools—

  • Are available to both team members and leaders.
  • Can be used to address barriers to team effectiveness in a given situation.
  • Can all be applied to most situations because they complement one another.

Return to Contents


 Applying TeamSTEPPS Exercise

1. Are there any changes you would make to your assessment of the teamwork issue that needs to be addressed in your organization? 2. If yes, what is the teamwork issue that needs to be addressed? 3. If you had to identify only one tool or strategy to implement first, which one would it be and why?


Icon: Materials Materials:
  • TeamSTEPPS Implementation Worksheet

Say:

Now that we have reviewed all the TeamSTEPPS tools and strategies, and practiced applying what we learned to a teamwork scenario, let's return to your own teamwork issues. On your Implementation Worksheet, you will now think across all the modules and reassess your issue. Then you will review the tools and strategies that you indicated as possible interventions and think strategically about which one to start with in your implementation plan. This will serve as a primer for the Implementation Workshop tomorrow.

Take some time to complete the Module 7 questions, and we'll discuss some of your answers as a group.

Do:

Give participants 5-10 minutes to complete the Module 7 questions; then select a few teams to share their responses to the questions below.

Icon: Dialog balloon Discussion:

  • How did your initial assessment of your teamwork issue change?
  • What considerations did you make in identifying one tool or strategy to implement first?
  • What types of obstacles do you anticipate and what ideas do you have for overcoming these?

Return to Contents


 (Optional) Practice Teaching Session

Icon: An eye Instructor Note: If you choose to conduct the Practice Teaching Session as part of the Train-the-Trainer/Coach course, introduce the exercise here. At the end of Day 1 or Day 2 of instruction, assign participants with Fundamentals course modules 1-6 to teach back to the class during the practice teaching exercise on Day 3.

Each participant should play the role of the lead instructor and assistant instructor. Depending on class size, participants may have to repeat modules to play both roles.

Say:

On Day 3 of this course, you and a partner are going to have an opportunity to teach back assigned modules from the Fundamentals course. You will each play both the role of lead instructor and assistant instructor. Feedback will be provided by the group and by a senior trainer who will provide written comments on the teaching feedback form.

Icon: An eye Instructor Note: The lead and assistant instructor assigned to each module should decide whether both will be presenting different segments of the module, or if the assistant instructor will provide more of an audiovisual support role.

Say:

  • Now that you have been assigned as both a lead and assistant instructor, take a few minutes to discuss with your partner how to split the instruction. The assistant instructor can assume an active teaching role or provide audiovisual support.
  • It is important to practice with your partner, as well as read the Course Management Guide. The Course Management Guide includes useful information about teaching the course.
  • During the practice teaching session, you are responsible for incorporating any module exercises and videos, as well as facilitating discussion of the content.

Ask:

Are there any questions?

Return to Contents
Return to Index

Current as of March 2014
Internet Citation: TeamSTEPPS Fundamentals Course: Module 7. Summary : Instructor's Guide. March 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/instructor/fundamentals/module7/igsummary.html