The Seven Trauma Team
May 2020
Seven
System
7 Trauma
Parkland Health & Hospital System
Lauren Touhy, MSN, RN-BC, Jessica Thompson, RN, ADN, Alonso Urbina, BSN, RN, Brent Waggoner, BSN, RN and Dulce Lopez, MSN, RN, NEA-BC, CMSRN
"Teamwork makes the dreamwork" is frequently heard by visiting staff members on Seven Trauma. Our unit does not run, if we do not work as a team due to the daily demands of caring for high-risk, complex, and unique trauma patients at Parkland. Patients, families, and different disciplines within the hospital praise the teamwork of Seven Trauma. In 2019, the Culture of Safety Survey demonstrated a 98% agreement of teamwork within the unit. (The average agreement of teamwork within the Surgical Services was 74%). In addition, the team scored above 90% in the NDNQI survey when asked: In my job, am treated with dignity and respect by everyone. Teamwork on this unit is truly a quality that deserves recognition.
In October of 2018 during a staff meeting, Seven Trauma leadership presented quality data from Fiscal Year (FY)18. The unit had 23 patient falls in FY18. Staff felt this was unacceptable, and there was a call to action by clinical nursing staff to reduce patient falls in FY19. In the next couple of weeks during huddles, weekly updates, and meetings; nurses, patient care assistants (PCAs), and health unit coordinators (HUCs) brainstormed realistic and innovative ways to reduce patient falls. The team selected the themes of awareness, communication, compassion, and transparency as areas that needed specific interventions.
The aim of our project was to decrease patient falls by 10% by committing to patient safety by increasing awareness, communication, compassion, transparency, and teamwork.
Our ACCTTions helped us support our daily mission and vision of focusing on providing excellent patient care to all individuals/community and striving every day to keep patients safe. We have completed many other projects as a team; however for the purpose of this nomination we felt that this project was able to show how the team was able to show the impact we had on patients at a larger scale.
Reducing patient falls was selected based on our team's concern for injury and the everlasting effect it can have on patients. Though many falls do not result in serious injury, we have empathy for many patients who become afraid of falling in the future. For that reason, it is important for us to work together and prevent falls. (Compassion).
Awareness- The previous year, many staff reported that they did not know how many patients had fallen, the circumstances related to the falls, and any lessons learned from the falls. To increase awareness, every Safety Post post-fall narrative was displayed on a designated bulletin board for the entire team to view. This allowed team members who were not present during the fall event to be aware that the fall had happened, areas for improvement, and ways to prevent the fall from happening in the future. Displaying the fall data also allowed team members to have time to think about the event and provide feedback in our monthly staff meetings.
Communication- Staff felt that communication among team members contributed to a majority of patient falls the previous year. The team decided to focus on was communication between all staff. The team created a standardized HUC fall list in Epic to be used during a formal hand-off between HUCs during shift change (Leadership). The hand-off included reviewing Careview® and ensuring virtual side rails were activated for high-risk and non-compliant fall-risk patients. In addition, bedside report was required for PCAs and RNs, which includes a safety check (checking essential fall intervention were present) and reiterating fall risk education to ensure patient cooperation (Collaboration).
Compassion- To improve team morale, staff praised each other when a fall was prevented and showed support to staff who felt "guilty" after a fall. When there was a fall we learned as a team. Being an open, caring, and empathetic team allowed for the specific practice changes to be made quickly and without pushback, which ultimately improved patient care. As a team, we decided it was important to be transparent and honest after a fall to ensure everyone in the team learned from what went wrong/areas for improvement and to be able to openly discuss ways to prevent similar incidents. Team members were more comfortable sharing ideas to deal with our complex patient population and combat non-compliant patient falls with creative safety measures (Integrity).
Transparency- As a team, we decided it was important to be transparent and honest after a patient fall. This ensured everyone present during the event discussed the reason why the patient fell, areas for improvement, and ways to prevent the event from happening in the future (Excellence).
Teamwork- The unit focused on working as a team throughout every shift to ensure that all patients' needs were met. If a patient was a high risk for falling, the team would decide to alternate even/odd hours that the nurse or PCA would sit outside of the patient's room. The team would constantly ask "who needs help?" if the shift was really busy. In addition, by working as a team, we were able to implement interventions and manage resources (no cost accrued by the being positive and having open communication) responsibly (Stewardship).
All staff members played a role in project development and outcomes. Being an open and honest team helped different perspectives of different team members assist in making improvements/changes to deal with our complex patient population and in ensuring we had creative safety measures.
Once we set the goal, we discussed during huddles, weekly updates, and meetings various interventions that we considered would be beneficial to accomplishing our goal. Collectively ideas were generated and blended. After brainstorming, the team decided to move forward with a couple of proactive and positive interventions.
At the end of the fiscal year, we exceeded our goal and had a 41% reduction in falls. This result was not an overnight accomplishment or a momentary act, this project required the continuous commitment (365 days) of an entire team; this would not have been possible without all hands on deck. The team cultivated a culture of safety through their journey/commitment to preventing falls. (please see graphs for monthly breakdown) I must say the teamwork continues to be as strong or even stronger today, though HD did throw a small curveball, we are happy to announce we were Fall Free February and continue to strive to ensure our patients remain free of preventable injury.
In October of 2018 during a staff meeting, Seven Trauma leadership presented quality data from Fiscal Year (FY)18. The unit had 23 patient falls in FY18. Staff felt this was unacceptable, and there was a call to action by clinical nursing staff to reduce patient falls in FY19. In the next couple of weeks during huddles, weekly updates, and meetings; nurses, patient care assistants (PCAs), and health unit coordinators (HUCs) brainstormed realistic and innovative ways to reduce patient falls. The team selected the themes of awareness, communication, compassion, and transparency as areas that needed specific interventions.
The aim of our project was to decrease patient falls by 10% by committing to patient safety by increasing awareness, communication, compassion, transparency, and teamwork.
Our ACCTTions helped us support our daily mission and vision of focusing on providing excellent patient care to all individuals/community and striving every day to keep patients safe. We have completed many other projects as a team; however for the purpose of this nomination we felt that this project was able to show how the team was able to show the impact we had on patients at a larger scale.
Reducing patient falls was selected based on our team's concern for injury and the everlasting effect it can have on patients. Though many falls do not result in serious injury, we have empathy for many patients who become afraid of falling in the future. For that reason, it is important for us to work together and prevent falls. (Compassion).
Awareness- The previous year, many staff reported that they did not know how many patients had fallen, the circumstances related to the falls, and any lessons learned from the falls. To increase awareness, every Safety Post post-fall narrative was displayed on a designated bulletin board for the entire team to view. This allowed team members who were not present during the fall event to be aware that the fall had happened, areas for improvement, and ways to prevent the fall from happening in the future. Displaying the fall data also allowed team members to have time to think about the event and provide feedback in our monthly staff meetings.
Communication- Staff felt that communication among team members contributed to a majority of patient falls the previous year. The team decided to focus on was communication between all staff. The team created a standardized HUC fall list in Epic to be used during a formal hand-off between HUCs during shift change (Leadership). The hand-off included reviewing Careview® and ensuring virtual side rails were activated for high-risk and non-compliant fall-risk patients. In addition, bedside report was required for PCAs and RNs, which includes a safety check (checking essential fall intervention were present) and reiterating fall risk education to ensure patient cooperation (Collaboration).
Compassion- To improve team morale, staff praised each other when a fall was prevented and showed support to staff who felt "guilty" after a fall. When there was a fall we learned as a team. Being an open, caring, and empathetic team allowed for the specific practice changes to be made quickly and without pushback, which ultimately improved patient care. As a team, we decided it was important to be transparent and honest after a fall to ensure everyone in the team learned from what went wrong/areas for improvement and to be able to openly discuss ways to prevent similar incidents. Team members were more comfortable sharing ideas to deal with our complex patient population and combat non-compliant patient falls with creative safety measures (Integrity).
Transparency- As a team, we decided it was important to be transparent and honest after a patient fall. This ensured everyone present during the event discussed the reason why the patient fell, areas for improvement, and ways to prevent the event from happening in the future (Excellence).
Teamwork- The unit focused on working as a team throughout every shift to ensure that all patients' needs were met. If a patient was a high risk for falling, the team would decide to alternate even/odd hours that the nurse or PCA would sit outside of the patient's room. The team would constantly ask "who needs help?" if the shift was really busy. In addition, by working as a team, we were able to implement interventions and manage resources (no cost accrued by the being positive and having open communication) responsibly (Stewardship).
All staff members played a role in project development and outcomes. Being an open and honest team helped different perspectives of different team members assist in making improvements/changes to deal with our complex patient population and in ensuring we had creative safety measures.
Once we set the goal, we discussed during huddles, weekly updates, and meetings various interventions that we considered would be beneficial to accomplishing our goal. Collectively ideas were generated and blended. After brainstorming, the team decided to move forward with a couple of proactive and positive interventions.
At the end of the fiscal year, we exceeded our goal and had a 41% reduction in falls. This result was not an overnight accomplishment or a momentary act, this project required the continuous commitment (365 days) of an entire team; this would not have been possible without all hands on deck. The team cultivated a culture of safety through their journey/commitment to preventing falls. (please see graphs for monthly breakdown) I must say the teamwork continues to be as strong or even stronger today, though HD did throw a small curveball, we are happy to announce we were Fall Free February and continue to strive to ensure our patients remain free of preventable injury.