Today’s talk and interactive session were delivered by Amy Weinstein on IPE Teams in Primary Care.
TeamSTEPPS
IPE teams consist of attending physicians, med students, nurses, pharmacists, social workers, case managers, admins, medical assistants, front desk. The physician and nurse workflows sometimes do not line up. Some of them, such as the phone scheduling staff, are never seen when working with patients yet they are all part of patient care. How do we interact with all of these team members? TeamSTEPPS is designed to break down the barriers and come together as a team.
Barriers to teamwork:
Case— Background:
The patient is a 49 y/o F with Type 2 diabetes and depression comes in for follow up care. She takes Lantus and Humalog. The patient also takes insulin morning and evening, but rarely at lunch. She's been getting increasingly depressed.
MD: Biggest concern is depression
PharmD: Wants to review medication regimen and discuss action plan for hypoglycemia
Case— Clinical encounter: It’s a busy IPE night and the team rushes off to see the patient before huddling. The attending goes in with her own agenda about depression and the PharmD doesn’t get to talk to the patient about hypoglycemia and changes to the medication regimen. The MD thought the visit went well but not the PharmD.
Strategies for addressing breakdowns:
Case— Solutions: deal with pt chief complaint, pt centered; have a plan in advance, finding time to debrief after; knowing what the pt thinks about the plan, making sure pt understands regimen and offer perspective on big picture. have pts repeat directions back to ensure understanding, checking in mid visit. debriefing afterward. otherwise it wont be a good set up for teamwork. keep in mind that we’re all here for the pt.
Take home points:
TeamSTEPPS
- The program our clinic uses for inter-professional education.
- Provides an opportunity to learn about them to enhance patient care.
- Created by the AHRQ that provides skills in 4 areas for us to work in teams.
- Performance
- knowledge
- skills
- attitudes
- This nationally studied program works.
- We can see a 50% reduction in weight adverse outcome score which describes the adverse event score per delivery.
- We also see significant improvement in teamwork outcomes, communication, supportive behavior, reductions in turnover rate, increases in employee satisfaction, and better continuity of care.
IPE teams consist of attending physicians, med students, nurses, pharmacists, social workers, case managers, admins, medical assistants, front desk. The physician and nurse workflows sometimes do not line up. Some of them, such as the phone scheduling staff, are never seen when working with patients yet they are all part of patient care. How do we interact with all of these team members? TeamSTEPPS is designed to break down the barriers and come together as a team.
Barriers to teamwork:
- people: workload, distraction, conflict
- systems: hiearchy, lack of coordination, miscommunication, lack of role clarity.
Case— Background:
The patient is a 49 y/o F with Type 2 diabetes and depression comes in for follow up care. She takes Lantus and Humalog. The patient also takes insulin morning and evening, but rarely at lunch. She's been getting increasingly depressed.
MD: Biggest concern is depression
PharmD: Wants to review medication regimen and discuss action plan for hypoglycemia
Case— Clinical encounter: It’s a busy IPE night and the team rushes off to see the patient before huddling. The attending goes in with her own agenda about depression and the PharmD doesn’t get to talk to the patient about hypoglycemia and changes to the medication regimen. The MD thought the visit went well but not the PharmD.
Strategies for addressing breakdowns:
- Leadership:
- Process of motivating people to work together
- Anyone can be a leader
- They are role models who shape teamwork through open sharing of info
- Give constructive and timely feedback
- Faciliates briefs, huddles, debriefs, and conflict resolution.
- Organize ppl to achieve common goal.
- Involves planning, processing, and improvement.
- Planning:
- form the team and huddle
- designate team roles and responsibilities
- establish climate and goals
- engage in short and long term planning
- Problem solving:
- touch base
- discuss critical issues and emerging events
- anticipate outcomes and likely contingencies
- assign resources
- express concerns.
- Debrief:
- brief and information information exchange and feedback session
- occurs after event or shift
- designed to improve teamwork skills
- designed to improve outcomes
- recognize what good teamwork is
Case— Solutions: deal with pt chief complaint, pt centered; have a plan in advance, finding time to debrief after; knowing what the pt thinks about the plan, making sure pt understands regimen and offer perspective on big picture. have pts repeat directions back to ensure understanding, checking in mid visit. debriefing afterward. otherwise it wont be a good set up for teamwork. keep in mind that we’re all here for the pt.
Take home points:
- Everyone can be a leader
- Hold huddling sessions
- Hold debriefs to bring the team together
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