Step’N It Up

Seattle Veterans Affairs Medical Center, VA Puget Sound Healthcare System, Seattle, Washington

CSI Summary

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CSI Presentation

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CSI Toolkit

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Project Topic:

Improve communication between nurses during shift change handoff by using the TeamStepps2 communication tools: IPASS (Illness severity /Patient summary/Action list/Situation awareness/Synthesis by receiver)

Hospital, City and State:

Seattle Veterans Affairs Medical Center, VA Puget Sound Healthcare System, Seattle, Washington

Unit:

2 West Acute Care and Oncology

Marrow Transplant Unit (MTU)

CSI Participants:

  • Hardeep Kaur, BSN, RN
  • Suzanne McDonough, BSN, RN
  • Lawrence Merkert, BSN, RN, OCN, PCCN
  • Victoria Vita-Muth, BSN, RN

Project Goals/Objectives:

  1. Decrease staff callouts 30%
  2. Decrease patients' falls 30%
  3. Decrease medication administration safety events 30%
  4. Increase the AACN Healthy Work Environment Assessment Tool (HWEAT)response rate from 69% to 80%
  5. Increase HWEAT Skilled Communication and True Collaboration standard scores
  6. Improve communication between nurses during shift change handoff by using the TeamSTEPPS communication tool: IPASS (Illness severity /Patient summary/Action list/Situation awareness/Synthesis by receiver)
  7. Improve teamwork as it relates to conflict resolution by using scripts from TeamSTEPPS communication tool: DESC (Describe/Express/Specify/Consequences) and CUS (Concerned/Uncomfortable/Safety)
  8. Improve patient care overall

Project Outcomes:

  1. Decreased callouts 23%
  2. Decreased patient falls 42.4%
  3. Decreased medication safety events 14%
  4. HWEAT response rate decreased 19%
  5. HWEAT aggregate score increased from 3.54 to 3.97
  6. HWEAT Skilled Communication score increased from 3.36 to 3.68
  7. HWEAT True Collaboration score increased from 3.13 to 3.54
  8. Improved all HWEAT standard scores
  9. These outcomes resulted in a potential positive estimated annual fiscal impact of $1,011,696.

Project Overview:

The CSI team identified incomplete communication between day and night shift nurses during shift change hand-off as a problem. This resulted in missing important information during patient handover, negatively impacting patient care. The lack of teamwork in both units further complicated matters, leading to increased frustration among the nursing staff. We needed to make significant improvements in our communication processes. To address this, the CSI team implemented TeamSTEPPS2, an evidence-based method to improve skilled communication and true collaboration between staff. Staff were educated about how to use the communication tools CUS and DESC.

The team also implemented the I-PASS nurse report hand-off tool, to enhance communication between the day and night shift nurses. The implementation of all of the communication tools have effectively managed and resolved conflicts among the staff, further fostering a collaborative work environment.

The CSI team received positive feedback about our project's interventions. In addition, data showed decreased falls, medication administration errors and fewer unplanned callouts.

Permission to Reuse Materials
The materials associated with this AACN Clinical Scene Investigator (CSI) Academy project are the property of the participating hospital noted above, not AACN. Requests to use content contained in the CSI team’s summary, presentation or toolkit should be directed to the hospital. We suggest reaching out to the hospital’s Communications, Marketing or Nursing Education department for assistance.

Disclaimer
The AACN CSI Academy program supports change projects based on quality improvement methods. Although CSI teams seek to ensure linkage between their project and clinical/fiscal outcomes, data cannot be solely attributed to the project and are estimations of impact.