Implementation of TeamSTEPPS For Patient Safety In Long Term Care Settings

Purpose: Patient safety is a recognized component to reducing hospital readmissions and preventable adverse events, although little is known about improving patient safety in skilled nursing settings that have an increasingly frailer and more dependent patient population due to shorter inpatient hospital stays. With a long term goal of improving the safety and quality of care provided to skilled nursing facilities (SNF), the University of North Texas Health Science Centers’ Center for Geriatrics will use a case study method to evaluate factors related to the implementation of a patient safety improvement intervention in SNF. Methods: The research team will review SNF data from secondary data sources reporting on CMS quality measures over a twelve month period to assess facility characteristics and facility performance and patient outcomes against national benchmarks. The research team will develop and implement the TeamSTEPPS Long Term Care program at the two SNF in Fort Worth, Texas, with each case defined as an individual facility. The research team will work with SNF leadership, including the Medical Director, Director of Nursing, and a licensed administrator. Implementation will occur in three phases outlined by the TeamSTEPPS program: Phase 1) conduct the patient safety culture assessment using the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture Survey; Phase 2) develop performance goals and an action plan of delivering customized training on patient safety areas prioritized through the data review and patient safety culture assessment; and Phase 3) conduct patient safety training and monitor performance of action plan items. Research team members will conduct open-ended and structured interviews with facility staff to gather data on their opinions about processes and facts related to implementation. The research team will also document activities in each phase of implementation. This exploratory data will be combined with process measures established during the action plan phase to conduct a holistic investigation of the implementation processes. Results: Research will be conducted at Trinity Terrace and Brookdale Cityview skilled nursing facilities in Fort Worth, Texas. Quality improvement teams will be formed at each center to complete the TeamSTEPPS training and monitor the implementation of patient safety initiatives that increase the capacity of skilled nursing facilities to implement team approaches in quality improvement activities, and increase the ability of skilled nursing facilities to improve patient safety. Conclusions: This exploration of TeamSTEPPS implementation will develop a replicable model of implementation to improve patient safety in SNF that will improve the health status of skilled nursing facility patients.