Facility cuts falls 88% and med errors 30%
Butler County Health Care Center (BCHCC) in David City, NE, is small — it has 25 beds serving a rural community of 2,500 — but the administrators think big. Using a program that enhances teamwork, the hospital has reduced patient falls by 88% and medication errors that reach the patient by 30%.
The improvements came as a result of the free Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) program offered by the Agency for Healthcare Research and Quality (AHRQ), which improves communication teamwork.
The effort began as BCHCC was working on a project to reduce medication errors, explains CEO Don Naiberk. "We had had a couple of medication errors that, although they didn't result in harm to the patient, were significant and could have caused harm," Naiberk says. "We really felt like we needed to do something different."
By studying error reports and the results of root cause analyses, the organization learned that poor communication was the most frequent cause of mistakes. The organization's staff needed to find a way to work as a team, not as independent healthcare providers. TeamSTEPPS training was identified as a way to help BCHCC staff overcome communication barriers and improve workplace culture. With that goal in mind, Naiberk and two other hospital leaders — a registered nurse from the outpatient department and the new director of patient safety — took the master training course offered by AHRQ in 2008.
BCHCC began implementing TeamSTEPPS incrementally. The Surgery Department was among the first, and two TeamSTEPPS tools were introduced there: CUS ("I'm Concerned, Uncomfortable, this is a Safety issue") and the two-challenge rule, which requires assertively voicing a concern at least twice to make sure it is heard. The Magic Wand exercise — in which participants are asked what they would improve in their department if they had a magic wand — was used in the first meeting to help identify safety problems that were rooted in exchanges with other departments and staff members.
After a few sessions, it was evident that a global approach was needed to improve patient safety, Naiberk says.
Training began with supervisors and managers. During a supervisor retreat, TeamSTEPPS fundamentals were taught in a four-hour session. After evaluating this phase of the training, the TeamSTEPPS team realized that more support for TeamSTEPPS was required, so five more master trainers were added, including a member of the medical staff. To increase its effectiveness, training became more interactive, and class size was limited to 14 participants.
A series of two training sessions, each lasting one-half day, for all employees was scheduled during a four-week period to intensify the training and results. Training was held off site to minimize distractions and lend a sense of priority to the sessions. Finally, training groups were implemented across departmental lines.
All 117 employees at BCHCC have received TeamSTEPPS Fundamentals training, and the hospital regularly offers refresher courses and training for new employees, Naiberk says. There have been numerous improvements as a result, he says. The most prominent improvements were reducing medication errors that reach the patient by 30% and patient falls by 88%, both the result of using TeamSTEPPS tools to identify problems and improve communication, he says.
"The program leads you to identify the underlying issues in any target problem. TeamSTEPPS doesn't by itself solve your patient safety problem, but it gives you the tools to work together and identify those root causes better," Naiberk says. "Staff communicate better, and there don't seem to be the conflicts that we used to have. They're given tools to deal with conflict and avoid having things escalate to the point that administration has to intervene."
(For the schedule and other information on TeamSTEPPS, go to http://teamstepps.ahrq.gov.)
Butler County Health Care Center (BCHCC) in David City, NE, is small it has 25 beds serving a rural community of 2,500 but the administrators think big.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content