Jen:
Welcome to today's onboarding session titled, "A Team Member's Guide to a
Culture of safety." This is the first of 4 onboarding modules for the Agency for
Healthcare, Research, and Qualities, or AHRQ, safety program for long-term care.
Healthcare acquired infections/CAUTI. This brief module is intended for all levels
of long-term care staff and will introduce you in your roles in a culture of safety.
I'm Jen Pettis, a member of the national project team for the HAI/CAUTI-LTC
Program, and I'm happy to provide you with this educational program today.
Jen:
Here are our goals for today's session. Attendees who complete this module will
be able to list three characteristics of a culture of safety, discuss the importance
of a culture of safety in achieving positive resident outcomes, and explain the
importance of their role in supporting a culture of safety.
Jen:
Let's start by answering this question. Why are we talking about a culture of
safety? The HAI/CAUTI-LTC Program places as much emphasis on the importance
of a strong and positive safety culture in long-term care facilities, as on evidence
based technical interventions to prevent CAUTI and other healthcare associated
infections. Their expectations for HAI/CAUTI-LTC Program participants related to
safety culture. It expected that participant will implement the cultural
interventions along with the CAUTI interventions, assess resident safety culture
at baseline and followup, identify cultural and environmental barriers to success,
and implement new processes and learnings to overcome those barriers.
Jen:
Program participants will implement the HAI/CAUTI interventions that will
include a cultural component. The cultural intervention is based on the
T.E.A.M.S. mnemonic, which is designed to assist long-term care staff in
developing skills and strategies to improve all aspects of resident safety, not just
infection prevention. While we won't delve into each of these components of
the T.E.A.M.S. intervention today, I do at least want to introduce it to you.
I'm sure that your facility team lead, the person that serves as the HAI/CAUTILTC program champion will be telling you more about this in the future. The
T.E.A.M.S. intervention includes: team formation to plans and implement the
program, excellent communication skills learned, assess what's working and pan
to expand, meet monthly to learn together, and sustain efforts and celebrate
success.
Jen:
Before we talk about a culture of safety, let's talk just a bit about culture in
general. Merriam-webster.com defines culture as a way of thinking, behaving or
working that exists in a place or organization, such as a business. It consists of
values, attitudes, and beliefs that can have an impact on outcomes of resident
care. One frontline healthcare worker described culture as, "the way we do
things around here." Change or lack of change is strongly influenced by culture.
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Jen:
THere's no question that a culture of safety is linked to positive clinical
outcomes. For example, fewer falls or pressure ulcers, and operational outcomes
such as more satisfied staff and less staff turnover. The safety of resident care is
critical to the quality of care in a long-term care setting. As long-term care care
facilities continually to strive to improve, there is a growing recognition of the
importance of establishing a culture of safety.
Jen:
Achieving such a culture requires an understanding of the values, beliefs, and
norms in the organization. One must also understand what is important in the
organization, and what attitudes and behaviors related to resident safety are
expected and appropriate. Through improved teamwork and optimizing
communication skills, safety issues, and opportunities for improvement can be
identified, and new processes can be developed, tested, and evaluated with the
goal of making the long-term care facility a better place to live and work. When
teams are effectively communicating with each other about resident safety
concerns, they are better positioned to make changes in order to prevent those
concerns from impacting residents care in the future.
Jen:
Consider how your facility focuses on safety by thinking about a care team at
your facility may approach resident falls. Is a proactive approach used? Does
your team focus on preventing falls through proactive risk assessment and using
a valid reliable risk assessment tool? Do they implement individualized care plan
approaches for each resident that have been developed with the input of the
interdisciplinary team, including the nursing assistants? Are environmental
factors considered as part of the assessment? When risk factors for a resident
change, is their care plan re-evaluated? Do nursing assistants feel comfortable
reporting sultle changes in the resident, and confident that when they do report
them, that they will be investigated by the nurse? Does the nurse close the
communication loop by reporting back to the nursing assistant regarding the
outcome of the investigation?
Jen:
These types of processes are commonplace in a culture of safety. Reporting
subtle changes in resident status helps to prevent adverse events like falls and it
helps to identify issues like CAUTI early.
Contrast this with an approach to falls where prevention is purely reactive. The
team does not act on subtle changes in the resident, but rather implements care
plan changes only after the resident experiences a fall. In such a case, perhaps a
resident fall is what leads the staff to identify that a resident has an infection or
other medical conditions. The subtle changes in their status are missed and are
not reported and acted on.
Jen:
An AHRQ survey users guide of the nursing home survey on patient culture
survey, patient safety culture, it states that the safety culture of an organization
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is the product of individual and group values, attitudes, perceptions,
competencies, and patterns of behavior that determine the commitment to, and
the style and proficiency of, an organization's health and safety management.
Organizations with a positive safety culture are characterized by communications
founded on mutual trust, shared perceptions of the importance of safety, and
confidence in the efficacy of preventative measures.
Jen:
Excellent communication is critical to a culture of safety. Whether you're
communicating regarding opportunities for improvement or regarding
something else, its important that communication be clear, complete, brief, and
timely. It's important to verify that the information that you've communicated
was received as intended. Validating or acknowledging what you think was
communicated to you, can help to prevent misunderstanding.
Jen:
A team consists of two or more people who interact dynamically,
interdependently, and adaptivly toward a common and valued goal, and have
specific roles or functions. A team's mission is of greater value than the goals of
the individual members. Team members include anyone involved in the process
of resident care who can take action, including the leader. Team members have
clearly defined goals. Team members are accountable to the team for their
actions and must stay continually informed for effective team functioning.
Jen:
Through the HAI/CAUTI-LTC program, you'll have several learning activities. Your
participation in these, as well as other inservices and other learnng opportunities
offered at your organization, will help to ensure you have the skills needed to
promote resident safety. Complying with organizational procedures is an
important step toward ensuring resident safety. Policies and procedures should
be routinely reviewed to ensure that they are up to date and in line with
regulatory requirements and based on the most current evidence available. As
these updates occur, it's important that all levels of staff are involved in the
policy and procedure development. It is important that honest and openly
feedback is provided regarding errors and incidents that occurred. Armed with
this feedback, long-term teams are able to engage in meaningful investigations
as to what lead to the error or incident and what measures to put into place to
prevent future occurrences.
Jen:
Finally I want to mention the nursing home survey on patient safety culture.
Throughout your organizations involvement, in the HAIs/CAUTI-LTC Prgram, you
will be asked to participate in this survey to measure your organization's culture
of safety. Your open and honest participation is vital to your facility receiving the
most accurate feedback.
Jen:
Let's spend the next few minutes examining what the long-term care staff's role
is in HAIs/CAUTI-LTC. There are multiple levels of staff that are viewing this
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program who will have slightly different roles in HAIs/CAUTI-LTC. Let's talk about
some aspects of those roles.
Jen:
Staff can help to educate peers and team mates formally and by example. For
instance, some of you will be involved in conveying more formal education
information to team members. Others may be involved in reinforcing positive
behaviors related to communication or infection control. Many of you will be
involved in relaying project information to residents, families, and other staff,
and share with others that you're involved with the HAIs/CAUTI-LTC Program.
Residents, families, and others will be interested to know that you're working on
a project aimed at improving resident safety. Resident and families can be
partners in the work to improve resident safety and reduce infections.
Jen:
Nurses in particular will be involved in communicating with physicians and nonphysician providers regarding the program. For instance, you may learn new
information regarding antibiotic use, or when it's appropriate to obtain a urine
culture that you want to share with a physician. Participate in training
opportunities and inservices that are offered. Actively participating in learning
opportunities will enhncne your skills and help build your team.
Jen:
There's a core team of people that are working on HAI/CAUTI-LTC program and
you can help them to identify practical ways to ensure proper insertion and
maintenance of catheters, achieve routine assessments of catheter necessity,
after all, if there is no catheter, there can't be a catheter related urinary tract
infection.
Jen:
Improved teamwork within your team and between teams with your facility
make the long-term care setting safer for your residents. As part of HAIs/CAUTILTC program, infection control data will be collected and reported. Nurse
managers and charge nurses will likely be asked to participate in this data
collection. You may be asked to help support this work in other ways. Check with
your leaders to find out ways in which you can help.
Jen:
Here's another look at the T.E.A.M.S. intervention, an infographic that I shared
with you at the beginning of the program. You'll hear much more about this in
the future and should be on the lookout for it in your facility. Remember the
T.E.A.M.S. intervention includes: team formation to plan and implement the
program, excellent communication skills learned, asses what is working and plan
to expand, meet monthly to learn together, and sustain efforts and celebrate
success.
Jen:
As we wrap up with today's discussion, I'd like to leave you with a few questions
to discuss with your peers at your facility. What are characteristics of a culture of
safety? During today's program, I listed several characteristics of a culture of
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safety. As a group, reflect on those and consider which of those describe the
culture in your facility. Also considering which of those characteristic you could
work to improve upon. A few characteristics that come to my mind are open
communication, shared values and beliefs regarding the need to focus on safety,
and a commitment to evaluate and act on patient safety concerns, including
near-misses.
Jen:
Why is a culture of safety essential to achieve positive resident outcomes? As a
group, I encourage you to reflect a bit as a team regarding why a culture of
safety is important to resident safety and other positive resident outcomes.
When I talk to you about the importance of a culture of safety, I used the
example of how a facility may focus on falls. Consider using this issue, or perhaps
focus on your approach to infection prevention, or on how medication errors are
approached in your facility. Clearly defining how you, as a team, approach these
types of events and occurrences will help you to define your progress toward a
culture of safety.
Jen:
What can you do to support a culture of safety. Finally, spend a few minutes
talking about what each of you can do to support a culture of safety and to
examine your individual roles in the HAIs/CAUTI-LTC program. Each and every
one of you are important members of the team to prevent catheter associated
urinary tract infections, or CAUTIs, and to improve resident safety overall.
Thanks very much for your time and attention to this program and for working to
make your long-term care facility a safer place for the residents that live there.
Jen:
The following resources are available to you as participants in the AHRQ Safety
Program for Long-term Care: Healthcare Acquired Infections/CatheterAssociated Urinary Tract Infection Project. We hope that these resources will be
helpful on your journey to reduce CAUTIs and other HAIs and improve your
facility's culture of safety.
Jen:
The first resource is a link to the AHRQ Safety Program for Long-term Care:
HAIs/CAUTI Project website. On the website you'll find a variety of tools to help
you prevent CAUTIs and improve your facility's culture of safety.
The second resource is a link to the TeamSTEPPS for Long-term Care webpage.
TeamSTEPPS is a communication and teamwork system that offers solutions to
improving collaboration and communication within healthcare facilities. The
resources on this page are specifically designed for the long-term care
environment.
Jen:
The third resource is a link to AHRQ Safety Program for Long-term Care:
HAIs/CAUTI Long-term care safety toolkit. The toolkit is designed to support
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learning and implementation efforts to improve safety culture in long-term care
facilities. In 6 learning modules, the toolkit provides concepts and tools that aim
to change the way facilities do their work and provide care. Allowing better for
outcomes and higher quality of care for residents.
And the fourth resource is a link to a downloadable version of the T.E.A.M.S
Inforgraphic that we discussed during this onboarding module.
Jen:
Thanks so much for joining us for this program and for all that you do to make
your nursing homes and long-term care facilities safer places for your residents
to live.
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