Doing What We Have Always Done...Stopping the Insanity

Purpose:
The Nephrology Unit at DMC Harper-Hutzel Hospital is a 32 bed unit caring for nephrology, renal transplant and other medical patients. Issues identified included a lack of team work that led to increased falls and low patient satisfaction. A survey taken of the staff revealed low teamwork scores.

Significance:
Working as a cohesive unit would allow the nurses and other healthcare providers to keep the patients safe from falls while improving both patient and nurse satisfaction.

Strategy and Implementation:
Previous programs included hourly rounding verified by a log(inaccurate)and administrative oversite. Continuing in the same way was not a sane approach. Staff nurses, management and advance practice nurses met to identify underlying causes. Nursing staff felt they did not have quality team members. The nurses identified a need for increased suport staff. Structure for building teamwork was absent. The knowledge of nursing theory and care delivery models was weak. A plan was formulated using Swanson's Caring Model and TeamStepps training as the structure for a new care delivery model that incorporates, bedside report, intentional hourly rounding, shift safety and caring huddles. The staff were responsible for the implementation of their model after team training. New methods of selecting team members: group interviews and candidates shadowing staff plus innovative ways to refresh old practices such as a pt bathroom club and a unit safety coach were developed and implemented.

Evaluation:
Falls decreased from 10 the 1st month of the intervention to a 1.5 average in most recent 9 months. HCAHPS scores for satisfaction with nursing communication rose from a low of 14% to 8 of past 9 months being above the national benchmark of 78%. Self report Team work up from 63% topbox to 88%.

Implications for Practice:
The TEAMstepps training and new care delivery model are enculturated to this unit. They are being implemented by other acute and specialty care areas. Improved care has lead to safer more effective patient care and improved nursing satisfaction with team work and team members.