STEPPING into a Safer Environment

Purpose:
To ensure a culture of safety on an obstetrical unit, the TeamSTEPPS program, which focuses on promoting teamwork and communication to reduce errors and ensure patient safety was implemented.

Significance:
Concentrating on the core concepts of the model, important changes resulted in positive outcomes related to both patient safety and Registered Nurse (RN) Satisfaction.

Strategy and Implementation:
Teamwork strategies, such as shift briefs, huddles, debriefs and use of communication tools for standardized reporting and transferring of critical information have change practice on this unit. Acceptance of these changes was variable at first, but since its inception in June 2010, these practices have become encultured in the daily routine. The team found debriefs to be the most challenging strategy to implement; however, the importance was recognized and a successful plan was implemented to ensure regular debriefs. RN Satisfaction scores have improved in many areas within the NDNQI survey. From 2010 to 2011, RN satisfaction scores regarding RN perceptions related to the overall Practice Environment Scale Scores (PES); Nursing Foundations for Quality of Care; Collegial Nurse Physician Relationship; Unit Perceived Quality of Care on Last Shift, in General and Over the Past Year; Last Shift Overall and Appropriate Patient Assignments were areas of marked improvement for this unit.

Evaluation:
Nursing Foundations for Quality of Care (2.84 to 3.05); Collegial Relationships (2.30 to 2.55); Mean PES (2.59-2.66); Rating Last Shift (3.38 to 3.55); Rating in General (3.29 to 3.36) ; Change Over Past Year ( 0.15 to 0.27); Overall Good Shift (4.29 to 4.91); Appropriate Assignment (4.33 to 4.73).

Implications for Practice:
The implementation of TeamSTEPPS has been successful, not only as evidenced by improved Culture of Safety Survey scores and reductions in maternal and newborn complications, but improved RN Satisfaction scores are also reflective of this culture transformation.