Evidenced-based Interventions

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Evidenced-based Interventions

Interventions found in our literature search that have been shown to improve Safer Culture:

• Crew Resource Management
  Applies to: Teamwork & Collaboration |Communication & Information Exchange |
  Group Enabling Factors Crew Resource Management (CRM) formally began in the aviation industry as a means to enhance communication and teamwork between flight crew and pilots by fostering a less authoritarian cockpit culture- one where questions to the captain were encouraged if mistakes were observed. CRM training concepts have been modified for use in industries where there are time-critical decisions, e.g. healthcare.  Studies have shown that when communication barriers are reduced, especially in instances of hierarchy, problems can be solved leading to increased safety. CRM training also includes practice, formative feedback and tools to support transfer of training to everyday practice.
• Comprehensive Unit Based Safety Program (CUSP)
  Applies to: Organizational Enabling Factors | Individual Enabling Factors | Teamwork & Collaboration |Communication & Information Exchange Developed by Johns Hopkins Hospital and endorsed by AHRQ, the Comprehensive Unit Based Safety Program (CUSP) was designed to improve the culture climate in specific clinical areas in the hospital. The purpose of CUSP is to work with providers to identify hazards, learn from defects, partner with executive leadership, and implement communication and teamwork at the unit level.
• Obstetric Early Warning Systems
  Applies to: Group Enabling Factors | Individual Enabling Factors | Communication & Information Exchange |Teamwork & Collaboration Early Warning Systems (EWS) and Maternal Early Warning Systems (MEWS) were developed to provide an early warning system to alert care providers of impending critical illness and thus improve safety and outcomes. These warnings capture deterioration from a broad spectrum of conditions (e.g. hemorrhage, thromboembolism, and hypertension) in a timely manner to provide consistent care.
• High Fidelity Simulation
  Applies to: Group Enabling Factors | Individual Enabling Factors | Communication & Information Exchange |Teamwork & Collaboration High-fidelity simulation requires interaction with an interactive computerized manikin in a realistic environment, often is a simulation center. These simulations occur in a room set up as a normal working environment (e.g. labor room, operating room) with a full component of working equipment and staff.  The manikin is realistic with pulses, oxygen saturation, breath sounds, fetal heart sounds etc.  Situations are programmed into the computer and the staff are provided with a “real-life” experience. Additional link: California Maternal Quality Care Collaborative

 

• Huddles / Debriefings
  Applies to: All Enabling Factors | Communication & Information Exchange |Teamwork & Collaboration Briefings or huddles and post-procedure debriefings have been shown to be valuable across a wide variety of medical and surgical environments. A brief or a huddle is a meeting session designed to reinforce plans that are already in place. This allows for on-the-spot assessment, reassessment, and consideration of whether there is a need to adjust plans and how to make any needed changes. Debriefings are reviews and/or information sharing sessions that reviews the actions taken and is intended to improve team performance and effectiveness. Benefits of huddles and debriefings include improved patient safety, decreased incidence of preventable errors, increased efficiency, and promotion and continued development of a multidisciplinary care team model of patient care.
• IHI Patient Safety Essentials Toolkit
  Applies to: Organizational Enabling Factors | Teamwork & Collaboration | Communication & Information Exchange This toolkit was designed to aid in improving teamwork and communication so that there are fewer errors made and more reliable care provided to the patient.
• Low-Fidelity / In-situ Simulation
  Applies to: Group Enabling Factors | Individual Enabling Factors | Teamwork & Collaboration | Communication & Information Exchange Low-fidelity simulation, also referred to as drills, are often conducted on-site, in-situ, in the staff’s own environment (e.g. labor and delivery, postpartum.) Training in a familiar environment best prepares staff to learn to identify risk factors and interventions in the event of a true obstetric emergency.  The purpose of these simulations/drills is to best prepare staff for an emergent event in their working environment by practicing in controlled situations.  Low-fidelity simulation is useful when supplementing clinical /technical skills with nontechnical skills (e.g. interpersonal communication.)Codes and postpartum hemorrhage are low frequency, high-severity events that are major patient safety events in the acute care setting. We performed low-fidelity in-situ simulation training to create competence for all health care providers in these emergent situations. Additional link: California Maternal Quality Care Collaborative
• Magnet Recognition Program
  Applies to: All Enabling Factors | Teamwork & Collaboration The Magnet Recognition Program (MRP) was developed almost 40 years ago to improve workplace culture and improve patient outcomes. Unlike most programs, the MRP used both top-down and bottom-up methods because leadership personnel are equally as involved as nurses at the bedside.
• Mindfulness-Based Stress Reduction Training
  Applies to: Organizational Enabling Factors | Individual Enabling Factors The Mindfulness-Based Stress Reduction (MBSR) training program is an evidence-based intervention designed to reduce stress, burn out, anxiety, depression, chronic pain etc. in order to decrease occupational injuries and improve emotional health in healthcare professionals.
• Physician/Patient Localization or Geographic Localization
  Applies to: Organizational Enabling Factors | Teamwork & Collaboration | Communication & Information Exchange Communication is improved by care that is patient-centered, localized, coordinated, and comprehensive. Geographic localization of physician, nurses and patients to specific units can foster communication between patient caregivers and contribute to improved patient knowledge of diagnosis, patient satisfaction, provider satisfaction, and workplace culture of safety.
• Protocol-based Standardization of Practice
  Applies to: All Enabling Factors | Teamwork & Collaboration
  Standardization of practice reduces variability in processes and tools at the system level; thereby, improves patient safety and outcomes. Standardization improves communication, teamwork and reduces medical errors and adverse events.
• Standardized Hand-offs
  Applies to: Organizational Enabling Factors | Group Enabling Factors | Teamwork & Collaboration | Communication & Information Exchange Standardized hand off is the process of transferring information and responsibility of patients from one person/team to another in a consistent manner in order to maintain continuum of patient care. Additional link: I-PASS Better Hand offs Safer Care
• Surgical Safety Checklist
  Applies to: Organizational Enabling Factors | Group Enabling Factors | Teamwork & Collaboration | Communication & Information Exchange Initiated by WHO because of poor patient safety records in operating rooms, the Surgical Safety Checklist is a tool designed to improve the safety of surgical procedure by bringing together teams including surgeons, anesthesia providers, nursing staff and other care providers, to perform key safety checks during the vital phase of perioperative patient care: prior to the induction, skin incision and debriefing. Additional link: Safe Surgery Checklist Implementation Guide
• TeamSTEPPS
  Applies to: All Enabling Factors | Teamwork & Collaboration | Communication & Information Exchange TeamSTEPPS was developed in collaboration by AHRQ and the Department of Defense and is an evidence-based patient safety-training program designed to improve communication and teamwork among health care professionals by promoting a culture of team driven care. The program establishes interdisciplinary team training systems to serve as the foundation for a patient safety strategy.  Teamwork has been found to be one of the key initiatives within patient safety that can transform the culture within health care.
• Walk Rounds / Leadership Rounds
  Applies to: All Enabling Factors | Teamwork & Collaboration | Communication & Information Exchange | Incident Reporting | Fair Rewarding & Punishment Patient Safety Leadership Walk Rounds is designed as a means for senior leaders to demonstrate their organization’s commitment to building a culture of safety. It provides an informal way for leaders to talk to front line staff about safety issues in the organization and show support for staff reported errors. This tool is designed to assist hospital leaders in implementing mechanisms for promoting safety, keep them informed about the concerns of front-line providers, support appropriate accountability concepts, and allocate resources to areas of greatest risk.