Text-based Document. The Effectiveness of Team Training on Fall Prevention. Authors Spiva, Elizabeth; Robertson, Bethany D.

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1 The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based nursing materials. Take credit for all your work, not just books and journal articles. To learn more, visit Item type Format Title Presentation Text-based Document The Effectiveness of Team Training on Fall Prevention Authors Spiva, Elizabeth; Robertson, Bethany D. Downloaded 19-Jun :12:30 Link to item

2 Effectiveness of Team Training on Fall Prevention Elizabeth LeeAnna Spiva, PhD, RN

3 Disclosure Authors: Bethany Robertson, DNP, CNM; Marcia Delk, MD, MBA; Sara Patrick, MSN, RN; Margaret Kimrey, MSN, RN, PCCN-CMC; Beverly Green, MSN, RN, CNL; Erin Gallagher, BS Work supported through Prevention Above all Discovery Grant, Medline Industries Authors had full access to all of the study, take responsibility for data integrity, accuracy of the data analysis, and presentation Learner Objectives To describe effectiveness of TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) training as a mediator to reduce falls and injuries To identify communication strategies learned from training used to improve team performance and patient outcomes

4 WellStar Health System Not-For-Profit 5-Hospital System ~ 1394 Beds Integrated Health System: 2 Health Parks, 1 Nursing Home, 2 Hospices, 8 Urgent Care Centers, 16 Imaging Centers, 1 Pediatric Center 160 Physician Offices (800+ Medical Group Providers) 62,000+ Admissions/year 10,000+ Deliveries/year 13,500+ Employees Revenues > $1 Billion

5 Background/Significance Falls are the most frequently reported safety event among United States hospitalized patients 1-4 Falls are associated with increased risk of mortality and morbidity, estimated annual cost of $34 billion 5,6 Evidence exists on fall risk factors, interventions and prevention guidelines, yet reducing falls in the acute care setting has been challenging 7-12

6 Purpose To evaluate the effect of a training curriculum based on TeamSTEPPS with video vignettes focusing on fall prevention for debriefing and reinforcement on team members safety culture, teamwork attitude, teamwork perception and communication as a mediator to reduce falls and injuries

7 Design Methods Longitudinal, quasi-experimental, repeated measures, with intervention and comparison groups Setting/Sample 2 community acute care hospitals; 4 medical-surgical acute care units Intervention group: 16-bed orthopedic unit and 17-bed neurology unit (received training) Control group: 22-bed orthopedic unit and 30-bed neurology unit (received no training and continued with usual practice) registered nurses, pharmacists, physical therapists and physicians

8 Measures Demographic Hospital Survey on Patient Safety (HSOPS) 13 TeamSTEPPS Teamwork Attitudes Questionnaire (T-TAQ) 14 TeamSTEPPS Teamwork Perceptions Questionnaire (T-TPQ) 15 Trained observers recorded teamwork communications and behaviors bedside shift report (patient handoff), safety huddle, interdisciplinary care meeting and unit-level observer assessments Falls data

9 Training Intervention Based on TeamSTEPPS curriculum, four domains: communication, situational monitoring, mutual support, and leadership 16 Three 30-minute training sessions; held on the units Brief didactic lecture Custom designed patient video scenarios Facilitated debriefing of the content covered

10 Intervention: Training Content Session I Didactic: purpose of team training and 4 domains Video: poor teamwork related to fall prevention Debriefing: role teamwork plays in fall prevention Session II Didactic: communication and situational monitoring Video: demonstrated optimal bedside shift report, safety huddle, and SBAR related to patient fall risk Debriefing: effectiveness of these team strategies

11 Intervention: Training Content (cont.) Session III Didactic: mutual support and leadership Video: vignette of team briefs, huddles and hand-offs Debrief: information sharing fosters mutual support and task assistance; leadership for communication events; knitted all 4 domains from training together

12 Study Timeline Activity April 2012 May June July Aug Sept Oct Nov Dec Jan 2013 Feb Aug Recruitment x x Champion Training Training (Intervention) x x x x Observation x x x x Survey x x x

13 Data Analysis Plan SPSS 18.0: Statistical methods - descriptive, chi-square (x 2 ), repeated measures analysis of variance (ANOVA), and t tests Chi-square (x 2 ) or t tests were used to compare demographic variables of the 2 groups NVivo 10 used to code observers handwritten notes Descriptive statistics were calculated for patterns Repeated measures conducted to evaluate effects over time A p value of.05 was considered statistically significant

14 Findings Demographics (SD = 10.45) sample mean age Most were registered nurses (29.4%), female (97.1%), white (64.7%), baccalaureate prepared (41.2%), primarily worked day shift (79.4%) Differences between the two groups for age, gender, education (P <.001) 72% of the intervention group sample attended all three training sessions

15 Questionnaire Findings Intervention Group Only Hospital Survey on Patient Safety Subscales Improved: Feedback and communication about error (F = 4.95, P =.01) Communication openness (F = 5.46, P =.01 ) Teamwork within hospital units (F = 4.07, P =.03) Teamwork across hospital units (F = 4.81, P =.02) Teamwork Attitude Improved: Mid (M = 4.16) compared to (M = 4.55) post (P =.009)

16 Questionnaire Findings (cont.) Teamwork Perception: Decreased overtime pre (M = 2.35), mid (M = 2.23), postintervention (M = 1.66) (F = 3.92, P =.03) No statistical differences found within control group Scores decreased except teamwork within hospital units and teamwork attitudes increased slightly No significant differences in the study variables between the 2 groups

17 Observation Findings Bedside shift report (n = 154): Intervention group improved over time conducting report in patient rooms, discussing patient mobility status, and improving communication between caregivers regarding patient care plan compared to the control group Safety huddles (n = 16) and interdisciplinary meetings (n = 25): Intervention group improved over time expressing less uncertainty about patient care plan and frequently communicated patient fall risk status compared to control group

18 Observation Findings (cont.) Observer assessments (N = 57): Over time intervention group improved communication related to patient fall risk status (F = 7.48, P =.01) Fall related observations included consistent implementation of fall preventative interventions such as signage and visual fall reminders (arm bracelet, yellow socks, door sign), bed alarm usage, ambulation assistance improved in the intervention group (F = 6.67, P =.01) Findings remained consistent seven months post follow-up No significant observation findings were noted in the control group

19 Fall Data Findings Intervention group: Falls decreased by 13 (62% reduction) and fall-related injuries by 5 (71% reduction) Pre-fall rates were 2.69 (SD =.12) and 1.03 (SD =.43) post-fall rates (t = 4.27, P =.15) Pre-injury rates were.97 (SD =.55) and.24 (SD =.34) post-injury rates (t = 5.05, P =.122) Control group: Fall and injury rates increased

20 Limitations Training sessions were not always interdisciplinary Even though training sessions were short and unit based, staff had difficulty attending and managing care duties Local variations in patient volumes and staff turnover impacted study Low statistical power may have limited ability to detect certain differences because of small sample size Questionnaire length may have resulted in instrument fatigue

21 Conclusions Unique study: control group, self-report survey and observations all over time Team training was found to be an effective method to reduce falls and related injuries with steady improvements in perceptions of safety culture and teamwork attitude Observed improvements with caregivers implementing fall preventative interventions and use of communication information exchange strategies between caregivers related to a patients fall risk status, during bedside shift report, post-fall huddle, and safety huddles

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