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An Interdisciplinary Approach to Creating a Culture of Safety
I N N O VAT I V E P R O G R A M P O S T E R S
Daniel, L.
Proceedings of the 2015 AWHONN Convention
Keywords limited English proficiency (LEP) culturally sensitive care communication disparity language barriers
Professional Issues Poster Presentation
LEP during their labor and delivery hospitalizations. Utilizing LSS concepts, a multidisciplinary team embraced the define, measure, analyze, improve, and control (DMAIC) process. Focus groups and surveys were conducted to elicit the voice of the customer from patients, nurses, and providers. Findings from a postpartum survey served as the baseline of measure for unmet needs for an interpreter in LEP patients. The number of patients with a completed “preferred language” field in the patient registration and billing system (PRBS) as well as use of qualified interpreters (in person and telephonic) were tracked. A standardized process (script) for soliciting the patient’s preferred language was established and education on race, ethnicity, and language was provided. Obstetric providers received training on the use of language services and effective communication. After training, there was a 25% increase in completed preferred language fields in PRBS. There was a significant increase (34%) in
the use of qualified medical interpreters (p < .01) and (41%) in the use of phone interpreters (p < .01). There was also a significant reduction (75%) in the number of LEP patients who reported an unmet need for qualified interpreters (p < .001). Implications for Nursing Practice Effective communication is critical to the delivery of safe, high-quality care. Identifying and delivering safe, high-quality care to patients with LEP can be challenging. Failure to address language barriers inadvertently affects health outcomes. National efforts are underway to address disparities in care. As direct care providers, nurses must appreciate the importance of providing culturally sensitive care to avoid miscommunication and misunderstanding. Nursing administrators need to recognize the challenges associated with caring for the LEP patient and advocate for appropriate support and resources to meet the needs of LEP patients and health care providers.
An Interdisciplinary Approach to Creating a Culture of Safety Sara Pasciolla, MSN-Ed, Purpose for the Program RNC-EFM, New York t New York Presbyterian Weill Cornell MedPresbyterian Weill Cornell ical Center, potentially unsafe behaviors or Medical Center, New York, NY
A
conditions have been observed on the labor and delivery unit. We demonstrate the successful imBarbara Alba, RN-IBCLC, New York Presbyterian Weill Cornell plementation of an innovative program to improve Medical Center, New York, NY the culture of safety within the obstetric unit with a goal to improve outcomes. Keywords culture of safety TeamSTEPPS senior administrative safety session
Professional Issues Poster Presentation
Proposed Change To use TeamSTEPPS as a basis and transform a less safe working environment into a safer, more collaborative, working environment. Implementation, Outcomes, and Evaluation A formalized plan for a culture of safety was gradually introduced to the obstetric department. Before the initial culture of safety roll out, an Agency for Healthcare Research & Quality (AHRQ) survey was completed by staff members. Formalized TeamSTEPPS training set the framework for communication tools and modalities that would be the expectation in all obstetric areas. Eighty-five percent (450 members) of the obstetric team completed TeamSTEPPS training by September 2014. Once staff had an understanding of the plan, leadership from nursing, obstetrics, and anesthesia were able to promote the use of tools, including multidisciplinary briefs, huddles, and debriefs, which created a general, nonpunitive, transparent department. This is demonstrated by a 45% in-
JOGNN 2015; Vol. 44, Supplement 1
crease in medical event reporting across all specialties from January 2013 to August 2014. Evaluation Metrics: Over a 2-year interval, increases were noted in the following domains of a Culture of Safety survey: (a) When patient safety issues or events were identified and reported to leadership, staff response indicated a 6% increase in feeling that their issues were heard; (b) When patient safety issues or events were identified and reported to leadership, staff response indicates a 14% increase in feeling that action was taken to address the event; (c) When patient safety issues or events were identified and reported to leadership, staff response indicated a 13% increase in feeling the action taken/planned in response prevented future harm or similar events from occurring; (d) When patient safety issues or events were identified and reported to leadership, staff response indicated a 17% increase in feeling that feedback and communication are given about the event. Implications for Nursing Practice Adapting a transparent environment grants nurses the ability to discuss obstetric events and near misses rather than fear retaliation from reporting. The integration of a formal culture of safety program laid the roadmap for everyone to follow, set expectations, and generally changed the way members of the department interacted with one another.
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Daniel, L.
Proceedings of the 2015 AWHONN Convention
Keywords limited English proficiency (LEP) culturally sensitive care communication disparity language barriers
Professional Issues Poster Presentation
LEP during their labor and delivery hospitalizations. Utilizing LSS concepts, a multidisciplinary team embraced the define, measure, analyze, improve, and control (DMAIC) process. Focus groups and surveys were conducted to elicit the voice of the customer from patients, nurses, and providers. Findings from a postpartum survey served as the baseline of measure for unmet needs for an interpreter in LEP patients. The number of patients with a completed “preferred language” field in the patient registration and billing system (PRBS) as well as use of qualified interpreters (in person and telephonic) were tracked. A standardized process (script) for soliciting the patient’s preferred language was established and education on race, ethnicity, and language was provided. Obstetric providers received training on the use of language services and effective communication. After training, there was a 25% increase in completed preferred language fields in PRBS. There was a significant increase (34%) in
the use of qualified medical interpreters (p < .01) and (41%) in the use of phone interpreters (p < .01). There was also a significant reduction (75%) in the number of LEP patients who reported an unmet need for qualified interpreters (p < .001). Implications for Nursing Practice Effective communication is critical to the delivery of safe, high-quality care. Identifying and delivering safe, high-quality care to patients with LEP can be challenging. Failure to address language barriers inadvertently affects health outcomes. National efforts are underway to address disparities in care. As direct care providers, nurses must appreciate the importance of providing culturally sensitive care to avoid miscommunication and misunderstanding. Nursing administrators need to recognize the challenges associated with caring for the LEP patient and advocate for appropriate support and resources to meet the needs of LEP patients and health care providers.
An Interdisciplinary Approach to Creating a Culture of Safety Sara Pasciolla, MSN-Ed, Purpose for the Program RNC-EFM, New York t New York Presbyterian Weill Cornell MedPresbyterian Weill Cornell ical Center, potentially unsafe behaviors or Medical Center, New York, NY
A
conditions have been observed on the labor and delivery unit. We demonstrate the successful imBarbara Alba, RN-IBCLC, New York Presbyterian Weill Cornell plementation of an innovative program to improve Medical Center, New York, NY the culture of safety within the obstetric unit with a goal to improve outcomes. Keywords culture of safety TeamSTEPPS senior administrative safety session
Professional Issues Poster Presentation
Proposed Change To use TeamSTEPPS as a basis and transform a less safe working environment into a safer, more collaborative, working environment. Implementation, Outcomes, and Evaluation A formalized plan for a culture of safety was gradually introduced to the obstetric department. Before the initial culture of safety roll out, an Agency for Healthcare Research & Quality (AHRQ) survey was completed by staff members. Formalized TeamSTEPPS training set the framework for communication tools and modalities that would be the expectation in all obstetric areas. Eighty-five percent (450 members) of the obstetric team completed TeamSTEPPS training by September 2014. Once staff had an understanding of the plan, leadership from nursing, obstetrics, and anesthesia were able to promote the use of tools, including multidisciplinary briefs, huddles, and debriefs, which created a general, nonpunitive, transparent department. This is demonstrated by a 45% in-
JOGNN 2015; Vol. 44, Supplement 1
crease in medical event reporting across all specialties from January 2013 to August 2014. Evaluation Metrics: Over a 2-year interval, increases were noted in the following domains of a Culture of Safety survey: (a) When patient safety issues or events were identified and reported to leadership, staff response indicated a 6% increase in feeling that their issues were heard; (b) When patient safety issues or events were identified and reported to leadership, staff response indicates a 14% increase in feeling that action was taken to address the event; (c) When patient safety issues or events were identified and reported to leadership, staff response indicated a 13% increase in feeling the action taken/planned in response prevented future harm or similar events from occurring; (d) When patient safety issues or events were identified and reported to leadership, staff response indicated a 17% increase in feeling that feedback and communication are given about the event. Implications for Nursing Practice Adapting a transparent environment grants nurses the ability to discuss obstetric events and near misses rather than fear retaliation from reporting. The integration of a formal culture of safety program laid the roadmap for everyone to follow, set expectations, and generally changed the way members of the department interacted with one another.
S39