Nursing News

New Initiatives Promote Clinical Teamwork to Improve Care


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By Debra Wood, RN, contributor

May 27, 2011 - Although interdisciplinary teamwork has become the norm at some hospitals, others are developing more collaborative practice models as a growing body of evidence indicates that better communication and cooperation leads to improved outcomes and as new health care models demand a collegial approach to care delivery.

Nurse-Doctor Teamwork
Geraldine “Polly” Bednash, Ph.D., RN, FAAN, supports interprofessional collaboration and said when physician–nurse communication breaks down, poor patient outcomes result.

“No individual provider is responsible for the complex array of interventions that have to come together to provide good health care,” said Geraldine “Polly” Bednash, Ph.D., RN, FAAN, executive director of the American Association of Colleges of Nursing (AACN) in Washington, D.C. “If we don’t understand and respect and value each other’s competencies, we cannot work together to give the best care to patients. When that collaboration breaks down we have the worst problems with health care.”

AACN is one of six organizations that formed the Interprofessional Education Collaborative to promote cooperation and teamwork during clinicians’ schooling, so they can work well together and deliver safe, high-quality patient care once they begin practicing.

Nurse-Doctor Teamwork
Robyn L. Stemmer, MSN, RN, said that better communication between physicians and nurses has brought several improvements to Mercy Medical Center.

“Collaboration with physicians is the ultimate important thing to do to make it better for the patient,” agreed Robyn L. Stemmer, MSN, RN, director of medical surgical services at Mercy Medical Center in Baltimore.

Mercy Medical Center has recently introduced the five-step Comprehensive Unit-based Safety Program (CUSP), developed by Johns Hopkins Medicine, to an oncology unit.

CUSP focuses on improvements to clinicians’ communication, teamwork and safety skills. CUSP is then combined with safety measures, such as bundles to reduce catheter line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia or pressure ulcers.

About 1,100 hospitals in the United States have implemented CUSP, primarily in intensive care units. The Agency for Healthcare Research and Quality reported in April a 35 percent reduction in CLABSI in participating hospitals’ ICUs.

“CUSP has enlightened the bedside staff nurses to go to the residents, the attending physicians, and have a knowledgeable conversation about what the situation is and work collaboratively to come up with what is best for the patient,” said Stemmer, adding that communicating more succinctly, using the Situation-Background-Assessment-Recommendation (SBAR) technique, has made nurses and physicians more efficient.

Nurse-Doctor Teamwork
Herb Perry, RN, called the team approach to care a “win–win” that leads to better communication and patient care.

The surgical unit at Long Island College Hospital in Brooklyn, N.Y., began moving toward an interdisciplinary approach to care several years ago and operates now with three teams, comprised of nurses, physicians, residents and physician assistants. Herb Perry, RN, nurse manager of surgical services and the stroke unit at Long Island College Hospital, said he cannot imagine providing patient care any other way.

“The biggest impact for my nurses is that it expedites their workflow,” Perry said. “There is mutual respect between all parties involved.”

Banner Health in Mesa, Ariz., also has embraced interdisciplinary teamwork and trains professionals to work well together as they develop new skills and competencies, said Carol Cheney, MS, Banner’s senior director of clinical education.

“Historically, physicians, nurses and ancillary staff train in separate academic and clinical environments, and they come together and are expected to perform in a superior manner together,” Cheney said. “But they didn’t learn the same lingo or learn it in the same way.”

During simulated team training sessions, professionals from various disciplines respond to different situations and develop a shared mental model. They understand each other’s roles, expertise and communication styles. The simulated environment offers opportunities to clarify directives, confirm that others have heard them, and discuss why a miscommunication may have occurred. Then by repeatedly practicing together, the communication skills, such as using SBAR, become second nature.

“It harbors more mutual respect,” Cheney said. “It’s like a sports team. There are different positions, but they train together. Otherwise it wouldn’t work well. In health care, we train in silos. Using simulation education, the environment allows them to come together in a safe [setting].”

Recognizing the importance of collaborative practice and that traditionally, nurses, physicians and other professionals have been educated separately, six associations—the AACN, the American Association of Colleges of Osteopathic Medicine, the American Association of Colleges of Pharmacy, the American Dental Education Association, the Association of American Medical Colleges (AAMC), and the Association of Schools of Public Health— formed the Interprofessional Education Collaborative to develop “Core Competencies for Interprofessional Collaborative Practice,” and with funding from the Macy Foundation, the Health Resources and Services Administration, the Robert Wood Johnson Foundation and the ABIM Foundation, produced “Team-Based Competencies, Building a Shared Foundation for Education and Clinical Practice,” a blueprint of action strategies to implement the competencies. Critical steps include development of shared learning resources and curricula linked to the core competencies, faculty preparation, and support for institutional leaders and shared models for success.

By coming together, “we thought we could accomplish more and model interprofessional collaboration,” said Carol A. Aschenbrener, M.D., executive vice president of AAMC.

The core team-based competencies are designed for new learners, so they can practice collaboratively immediately after graduation and before their professional identity has solidified. Aschenbrener said she also hopes people in practice will embrace the competencies.

“We have to do this as a team effort if we are going to provide the care we dream of, and the new models for delivery that are being proposed to provide better care, like the patient-centered medical home and the accountable care organization, will require interprofessional collaboration,” Aschenbrener said. “It’s about better patient care. While there’s not a huge body of evidence yet, there is a growing body of evidence that shows you can improve patient outcomes by collaboration across the professions.”

© 2011. AMN Healthcare, Inc. All Rights Reserved.