Using Simulation in TeamSTEPPS ® Training. T EAM STEPPS 05.2 Mod 1 05.2 Page 2 Page 2 Simulation...

Using Simulation in

TeamSTEPPS® Training

TEAMSTEPPS 05.2Mod 1 05.2 Page 2 Page 2

Simulation

Objectives

To know and be able to apply the Event Based Approach to Training

To know and be able to develop TeamSTEPPS training scenarios

To know and be able to develop TeamSTEPPS performance measures

To know and be able to conduct effective debriefs of team performance


Simulation

Course Outline

Phase 1. Scenario Development Exercise

Phase 2. Measurement Development Exercise

Phase 3. Debriefing

Lessons Learned


Simulation

Simulation

Team skills are developed through practice and feedback

Simulation allows health care professionals to practice TeamSTEPPS skills and strategies in a safe learning environment

Simulation includes Role play

Part-task trainers

Human patient simulation

Standardized patients


Simulation

Keys to Success

Proper scenario design Focus on learning objectives Provide more than one opportunity to practice team

behaviors

Accurate measurement Include process and outcome measures Capture behaviors

Debriefing Learning happens in the debrief Include feedback on how to improve performance


Simulation

TeamSTEPPS Resources

Scenarios – Tab I 131 Vignettes

Organized by department and TeamSTEPPS skill and tool

Team Performance Observation Tool – Tab A, Appendix C Tool for observing team performance

Observers should practice using the tool

Can be adopted to a particular type of care


Simulation

EBATEvent-Based Approach to Training (EBAT)

Not a new method U.S. Navy, Targeted Acceptable Responses to Generated

Events (TARGETs) (Fowlkes, Lane, Salas, Franz, & Oser, 1994)

FAA Advisory Circular 120-35C

Line Operational Simulations

How to design simulation scenarios

Health care domain Simulation Module for Assessment of Resident Targeted

Event Responses (SMARTER) (Rosen, Salas, Silvestri, Wu, & Lazzara, 2008)


Simulation

Phase 1

Scenario Development

1. Specify teamwork skills

2. Define learning objectives

3. Choose clinical context

4. Define event sets

5. Define targeted responses


Simulation

Specify Teamwork Skills

Skills are general categories of behavior you want to train

Teamwork is too complex to train in a single scenario

Need to focus on a subset of competencies

There are four core skills in TeamSTEPPS


Simulation

Define Learning Objectives

Learning objectives should be explicit and measurable

Focus on specific TeamSTEPPS behaviors Include the following information

Performance – Specifies the behavior Condition(s) – Specifies the conditions under which

the behavior occurs Standards – Specifies the level of expected

performance


Simulation

Learning Objective: Uses two-challenge rule or CUS to advocate for a patient in labor experiencing frequent, strong contractions

Example Objective

Communication


Simulation

Choose a Clinical Context

Considerations

Medicine is a notoriously task-specific domain

Not all contexts are equal for training purposes

Choose a clinical context that affords opportunities to perform

TeamSTEPPS provides 131 scenarios (Tab I)

Contexts should be appropriate for eliciting the team behavior of interest


Simulation

TeamSTEPPS Scenario 86

Sally Rodgers, a 25-year-old nullip in labor at term who is dilated 3 cm. This is

a change from 2cm over the previous 90 minutes. Sally is having frequent,

strong to palpation contractions that are extremely uncomfortable. She is

trembling, complaining of nausea, and begging her nurse for pain relief. The

patient’s primary nurse believes epidural anesthesia would be appropriate and

informs the obstetrician (OB) attending. The OB attending states he wants the

patient to be dilated 4–5 cm before she receives the epidural. The nurse

reiterates to the attending OB that her assessment is that the patient is in

active labor. Although Sally’s cervix has not demonstrated active labor yet, her

nurse believes the pain relief and relaxation resulting from an epidural would

be beneficial for the patient. The attending OB agrees to the epidural

placement. The patient is fully dilated and begins pushing 3 hours after the

placement.


Simulation

Clinical Context

Scenario 86 Sally Rodgers, a 25-year-old nullip in labor at term who is

dilated 3 cm. This is a change from 2cm over the previous 90 minutes. Sally is having frequent, strong to palpation contractions that are extremely uncomfortable. She is trembling, complaining of nausea, and begging her nurse for pain relief.


Simulation

Define Event Sets

Event sets are the building blocks of a scenario Event sets consist of:

Trigger – The incident to elicit the team behavior Distracters – Characteristics of the situation (i.e.,

conditions) in which the behavior is to occur

Examples Trigger: The OB attending states he wants the patient to be

dilated 4–5 cm before she receives the epidural Distracter: Sally has a strong contraction and screams


Simulation

Define Targeted Responses

Targeted responses Behavioral responses to each event set trigger

Expected levels of performance (i.e., standards)

Example Trigger: The OB attending states he wants the patient to be

dilated 4–5 cm before she receives the epidural

Response: The nurse uses two-challenge rule or CUS to advocate to the physician that Sally should receive pain medication now


Simulation

Guidance

Simulation scenarios should consist of 3-5 event sets Provides more than one opportunity to demonstrate

behaviors Creates reliability

Each event set should not include more than one trigger event

Event sets can be created by breaking a clinical procedure into chunks Embed triggers into these chunks


Simulation

Trauma ExamplePre-Hospital/Transport

Trauma PhaseEvent Set

TriggersExpected Team

Behaviors

Pre-Hospital/Transport

Patient arrives without advance notice ("zero time")

Leadership Team leader assembles team quickly Team leader advocates a plan

Inaccurate or incomplete information from EMS/rescue team

Leadership Team leader advocates a plan based on

known information

Communication Team members use call-outs and check-

backs to share accurate patient injury information and discoveries through surveys

Team members request information from EMS/rescue when information has not been provided


Simulation

Trauma ExamplePrimary Survey

Trauma Phase TriggerExpected Team

Behaviors

Primary Survey

Too many people in room

Leadership Team leader may ask non-team

members to leave

Communication Team members communicate findings

and orders with clear call-outs and check-backs

Team members are not distracted by others

Equipment not working or is missing

Situation Monitoring Team member identifies equipment

issue Team member remedies issue (e.g.,

replaces, fixes, or obtains needed equipment) quickly


Simulation

Scenario Development

Select a scenario from Tab I Identify/develop the following items

TeamSTEPPS skill Learning objective(s) Clinical context Event set

Trigger and distracters

Targeted responses

Be prepared to present your results


Simulation

Develop Measures

1. Consider level of analysis

2. Clarify purpose

3. Decide what to measure

4. Select a measure

Phase 2


Simulation

Team Performance Observation Tool

Leadership Utilizes resources efficiently to

maximize team performance Balances workload within the team Delegates tasks or assignments, as

appropriate Conducts briefs, huddles, and

debriefs Empowers team members to speak

freely and ask questions

Situation Monitoring Includes patient/family in

communication Cross monitors fellow team

members Applies the STEP process when

monitoring the situation Fosters communication to ensure

team members have a shared mental model

Mutual Support Rating Provides task-related support Provides timely and constructive

feedback to team members Effectively advocates for the patient Uses the Two-Challenge rule, CUS,

and DESC script to resolve conflict Collaborates with team members

Communication Rating Provides brief, clear, specific, and

timely information to team members Seeks information from all available

sources Verifies information that is

communicated Uses SBAR, call-outs, check-backs

and handoff techniques


Simulation

Individuals MD

Nurse

Anesthesia

Teams Delivery team

C-Section team

Multi-team – Team Structure Core team

Contingency team

Administrative team

Consider Level of Analysis


Simulation

Diagnose root causes of performance deficiencies Identify specific weaknesses

Provide feedback

Relay information regarding strengths and weaknesses as a remediation plan

Assessment

Evaluate the level of proficiency or readiness

Clarify the Purpose


Simulation

Outcomes tend to be more quantifiable and answer the question “What happened?”

Processes answer the question “Why did it happen?”

Decide What to Measure


Simulation

Outcomes Sometimes referred to as measures of effectiveness

(MOEs)

Provide an indication of the extent to which the outcome of the task was successful

Are important for most measurement purposes What outcomes could we assess?

Accuracy – Precision of performance (e.g., correct medication) Timeliness – How long (e.g., time to incision) Productivity – How much (e.g., patient volume in ED) Efficiency – Ratio of resources required versus used (e.g., OR

supplies)

Outcomes


Simulation

Processes

Sometimes referred to as measures of performance (MOPs)

Explain how and why certain outcomes may have happened (“Was the decision made right?” versus “Was the right decision made?”)

Important when diagnosing root causes of performance deficiencies and providing feedback or follow-on training

Types of Process Procedural – Taskwork

Non-procedural – Taskwork

Teamwork

Process


Simulation

Assess processes as well as outcomes when diagnosing performance deficiencies or providing feedback

Consider measuring at multiple levels to identify the weak link

Provide multiple opportunities to perform the same task or skill over the course of an exercise

Measurement Tips


Simulation

Checklists Consist of items/actions that have dichotomous answers

such as Yes/No; Right/Wrong; Performed/Not Performed Example: Primary Survey ABCs

Frequency counts Indication of the number of times that a behavior, action, or

error occurs Example: Use of CUS, SBAR, Two-Challenge

Rating scales Numerical or descriptive judgment of how well a task was

performed

Select a Measure


Simulation

Best used with a scripted scenario versus “free play”

Items should be related to triggers embedded into the scenario

Each item should represent a single action taken by the individual, team, or battlegroup

Label or define the response category that you are using

Checklist Tips


Simulation

NoYes

Assess Airway

Breathing

Circulation/FAST Exam

Action/Behavior

Disability

Exposure and Environment

Checklist


Simulation

Frequency counts are better when measuring acts of commission than acts of omission Overt actions or errors versus failing to demonstrate a

particular behavior

Frequency counts are good when you want to know how often a specific action is taken or task is performed

Frequency counts can be recorded during a critical event in an exercise or throughout the entire scenario

Frequency Count Tips


Simulation

Two-Challenge

CUS

Task Assistance

Check-back

Call-outs

SBAR

Unintelligible Communications

Communication

Mutual Support

Positive Instances

Positive Instances

Frequency Count


Simulation

1. The team leader assigned roles to the Trauma Team.

2. The PGY2 used check-back to confirm orders.

Strongly Disagree

Strongly Agree

1 2 3 4 5 6

IneffectiveVery

Effective

1 2 3 4 5 6

x

x

Graphic Rating Scale


Simulation

Communication: Used check-back during trauma resuscitation.

x

Did not use

check- back

1 2 3 4 5Used

check-back once to confirm

care plan at end of case

Used check-back to confirm

all medication

orders

Used check-back to confirm

critical orders,

primary and secondary

survey

Used check-back to confirm all critical

orders

Anchored Rating Scale


Simulation

Rating Scales Uses

Rating scales are good for assessing quality when it does not equate to a sum of quantity

Rating scales are good for assessing tasks that are less procedural in nature

Rating scales are better to use when you are evaluating performance on a continuum

Tips Define or clearly describe what you are measuring Include a specific stem or item to accompany the rating

scale


Simulation

Measures

Develop a measure to assess performance for the scenario you

developed earlier

Be prepared to present your measures


Simulation

Phase 3

Debriefing

1. Introduce the debrief process

2. Describe what happened

3. Conduct an analysis of performance

4. Identify lessons learned


Simulation

Description Phase

Recap of what happened in the scenario Team members share their perspectives on what occurred during

the scenario and reach common ground This helps ensure everyone takes away similar lessons from the

experience

How measurement can help Provides a structure for understanding the scenario

The event sets or behavior categories can be used to structure discussion

Focus on critical aspects of performance Helps to keep the discussion focused on events relevant to the learning

objectives


Simulation

Analysis Phase

A systematic investigation of why things happened in the scenario as they did The team focuses on understanding what went well and what

could have been done better

How measurement can help Can help compare the team’s performance with standards of

performance Were the TeamSTEPPS behaviors performed when necessary?

If so, were they performed correctly or could they be improved?


Simulation

Application/Generalization Phase

A look ahead to how the team can generalize what they learned in the scenario to their daily practice The team generates lessons learned and discuss what

needs to be corrected and how to correct it

How measurement can help Explicit event sets can be used to draw parallels between the

scenario and the actual clinical environment Explicit measures associated with these events help promote

reflection about how to transfer what went well to the actual clinical environment


Simulation

Tip for Success 1

Tip 1: Don’t overwhelm learners or observers — Keep it simple People can integrate only a few key learning points from a

scenario

Observers have a limited attention span and frequently have to multi-task. Don’t ask too much; you won’t like what you get

Rule of thumb: Have a key event every 1 to 2 minutes of scenario time


Simulation

Tip for Success 2

Tip 2: Telling someone how well they did is not good enough

They need diagnostic feedback Specific

Behaviorally focused

Descriptive


Simulation

Tip for Success 3

Tip 3: Train observers Training, by definition, is systematic. For measurement to

guide this process, it too must be systematic, reliable, and valid

Make sure everyone has common expectations about performance

Develop and use a scoring guide


Simulation

Rater Scoring Guide


Simulation

Tip for Success 4

Tip 4: Keep teamwork and clinical skills separate Use “dual debriefs”

Provide feedback on teamwork skills as a team Correct an individual’s major clinical deficiencies in a follow-up

session

Don’t overcomplicate the clinical nature of the scenario when your main purpose is to train teamwork Teamwork novices especially should be given the chance to

focus on teamwork in the scenario, not complex clinical issues As the team members’ teamwork skills advance, more complex

clinical scenarios can be used


Simulation

Tip for Success 5

Tip 5: Event-based methods involve more than just measurement Good training design practices

Good scenario design practices

Good debrief facilitation practices


Simulation

Teamwork Actions

Apply the Event Based Approach to Training

Able to develop TeamSTEPPS training scenarios

Able to develop TeamSTEPPS performance measures

Know how to conduct effective debriefs of team performance

Date post:	23-Dec-2015
Category:	Documents
Upload:	donna-hood
View:	232 times
Download:	1 times

Using Simulation in TeamSTEPPS ® Training. T EAM STEPPS 05.2 Mod 1 05.2 Page 2 Page 2 Simulation...

Documents