a patient’s blood pressure reading was already low, Parker said. The nurse could use SBAR to clearly communicate a concern about the medication ordered. “If someone has two seconds for you, then this is a

way to pull out the relevant information in a way that makes sense,” Parker said. “The techniques help to reduce the level of intimidation in an interaction. It’s not about personalities or who may or may not like whom. It’s about conveying the facts and keeping the patients central in interactions.” Another element of the curriculum teaches caregivers to use techniques such as a huddle, a brief meeting with a caregiving team to assess a situation and possibly adjust the plan. “If a patient’s situation is deteriorating, just take a few minutes to huddle and decide what to do,” Parker said. “This may be useful during a code.”

Steps in process Before approaching other nursing faculty at St. John Fisher College about the idea of integrating the Team- STEPPS program into the curriculum, Smith reviewed the literature to fi nd out if other nursing schools in the U.S. had done the same. She was surprised to discover only a few schools throughout the country had published anything about incorporating TeamSTEPPS into their program. When she suggested the idea to the nursing faculty, they were supportive. They met with pharmacy school faculty to see if they were interested in teaching the curriculum collaboratively to students from both disciplines. Ideally TeamSTEPPS is taught in an inter- professional learning environment to allow students from diff erent fi elds to learn and practice the strategies together, Smith said. The nursing and pharmacy schools created an interpro-

fessional education committee, which decided to send several nursing and pharmacy faculty to a two-day course to learn how to become TeamSTEPPS trainers. The next hurdle was carving out time to teach the class to students. The only viable time was a Friday evening or Saturday. While the students were not happy about using weekend time, their evaluations of the program have been overwhelmingly positive, Smith said. The feedback from partner hospitals has also been encouraging. “For example, we had one student who noticed something was abnormal with a patient during a clinical rotation, and she used TeamSTEPPS communication skills when she reported her fi ndings to someone on staff ,” Abraham said. “They were impressed with her ability to articulate what had happened and ultimately it helped the patient get the necessary care.” The TeamSTEPPS strategies are incorporated into the didactic coursework as well as clinical and simula- tion training at the school, which gives students more opportunities to practice the strategies.

Infl uencing hospital culture While Smith hopes all nursing students will eventu- ally be equipped with the TeamSTEPPS tools before

graduating, seasoned nurses are also learning the strategies and seeing an impact. “It has created an entire culture change at our hospital,” said Heather Sisk, RN, a nurse in

“The techniques help to reduce the level of intimidation in an interaction.”

the cardiac step down unit at Rochester General Hospital in New York. “I’ve been in nursing for 27 years, and when I started nurses did what they were told by doctors. Team- STEPPS has taught us how to advocate for patients and not be afraid to ask questions.” She recently used SBAR when she was concerned about changes in a patient’s mental status after a procedure. The physician had already seen the patient after the procedure and attributed the changes to medication, but Sisk and the family were still concerned. “Normally I would have been second-guessing myself because I knew the doctor had aleady seen the patient, but I felt comfortable calling the doctor to express my concern,” Sisk said. As a result, the physician ordered a CT scan, which confi rmed the changes were not the result of something more serious. The TeamSTEPPS acronyms were also helpful when the hospital implemented an initiative that required nurses to do handoff reporting in front of patients, rather than at the nursing station. The handoff tools helped nurses organize their thinking, which improved communication and understanding during these interactions, Sisk said. The huddle technique also is frequently used, Sisk said. Recently a nurse manager called a huddle to share with staff on the unit about a change in the concentration of heparin delivered to the unit. During the meeting, caregivers learned the change would aff ect the drip rate for IVs, and the intrave- nous pumps needed to be set correctly to refl ect the change. Whether new graduates from St. John Fisher’s College join hospitals that are using TeamSTEPPS or not, the nursing faculty from the school hopes their students will be role models. Smith, Parker and Abraham recently shared at a New York Organization of Nurse Executives conference about how they incorporated TeamSTEPPS into the curriculum. “I wanted to make other people aware of what we were doing and incite others to do the same,” Smith said. “This isn’t something we need to keep to ourselves because we are all focused on better patient care and patient safety.” •

Heather Stringer is a freelance writer. TO COMMENT, email

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