Team

Application
Project #2
Taylor Morris, Deja Taggart,
Haley Ehmann, Katheryne Forkel

University of Arizona BSN-IH

Nursing 390: Quality, Safety, and

Technology for Nursing

Dr. Lorre Laws

 Box Breathing:
Follow the arrows.
Inhale for 4 seconds → hold
for 4 seconds →
exhale for 4 seconds → hold
for 4 seconds

Opening Mindful Moment

Objectives and Definitions
Presentation Objectives

❖ Define related terms

❖ Review synthesis of literature
❖ Describe the model for improvement
❖ Discover the use of simulation practice to increase healthcare
team communication
❖ Describe the PDSA cycle and its use to decrease HAIs
❖ Explanation of increased communication skills leading to a
decrease in hospital acquired MRSA infections
 Definitions

Health-associated These are infections that occur in a healthcare setting (such as a hospital) that a patient didn't have before they came
infections (HAI) in. Factors such as illness, age and treatment being received can all make patients more vulnerable to infection
(University Hospital Southampton NHS Foundation Trust, n.d.).

MRSA Methicillin resistant staphylococcus aureus (MRSA) is a type of staphylococcus aureus that has become resistant to the
antibiotic Methicillin and some other commonly used antibiotics (University Hospital Southampton NHS Foundation
Trust, n.d.).

Four Phases of a 1. Innovation- coming up with new ideas for change. 2. Pilot- testing a change on a small scale. 3. Implementation-
QI Project making the change the new standard process in one defined setting. 4. Spread- implementing the change in several
settings (Institute for Healthcare Improvement, n.d.).

Run Chart A simple and effective way to determine whether the changes you are making are leading to improvement (Institute for
Healthcare Improvement, n.d.).

Common Variation Also known as random variation, is inherent to the system or process, due to normal causes that affects all the
outcomes of the process. Ot results in a stable process that is predictable (Institute for Healthcare Improvement, n.d.).

Special Cause Also known as non-random variation, is not inherent to the process design, results in an unstable process that is not
Variation predictable to irregular and/or unnatural causes and affects some, but not all aspects of the process (Institute for
Healthcare Improvement, n.d.).
 Case Study Summary

▪ Whitney Ross was a sophomore in college, who came to the

post operative unit after an appendectomy
▪ She contracted an infection that contributed to her death.
▪ The infection could have been prevented by better
prevention practices and through communication.
▪ Several healthcare providers had the opportunity to make
better decisions.
Background and Significance
Background and Significance

● Communication
○ Improved patient care (Khan et al., 2021)
○ Decreases errors (Granheim, Shaw, &
Mansah, 2018)
○ Nurse-physician skills (Liaw et al., 2020)
● Teamwork
○ Hierarchies (Lee & Doran, 2017)
○ Simulating communication (Granheim,
Shaw, & Mansah, 2018)
○ Interprofessional attitudes (Liaw et al., 2020)

Image: https://resources.nurse.com/image/3733082.1544805129000
Literature Synthesis

● Communication
○ Positive relationships between clinical team members can lead to better team performance in an acute care setting (Lee & Doran, 2017)
○ Studies in a variety of settings have concluded that communication affects the quality of patient care, team satisfaction, and nursing
turnover rates (Khan et al., 2021)
○ Medication errors were decreased by 93% with the implementation of a medication reconciliation process (Khan et al., 2021)
○ Failures in many different communication processes in hospitals can lead to medical errors and patient harm (Khan et al., 2021)
● Simulation
○ Simulation and virtual reality both give rise to positive communication and attitudes working with teams (Granheim, Shaw, & Mansah,
2018)
○ Simulation provides the opportunity to try and fail and improves skills without putting patients at risk (Lee & Doran, 2017)
● Team
○ Working together can help improved job satisfaction (Khan et al., 2021)
○ Team training can be completed using communication tools (Liaw et al., 2020)
○ The hierarchy that is present in healthcare systems (doctor, nurse, CNA, etc) inhibits communication and collaboration efforts (Lee &
Doran, 2017)
Connection to To Err is to Human

● Failure communication in health care can lead an impact on the

patient and the family
- In the documentary a 45 year-old men died from cancer
● Some things are easily missed; therefore, we must advocate for our
patients even when everyone believes everything is fine

(Eisenberg, et. al., 2019)

Patient-Centered Concept Map
(Kreitzer & Koithan, 2019)
- Donabedian Model
- Structure
- The people, units, and organizations
- Process
- The workflow, protocols, and guideline
- Outcome
- Resulting factors from the process
- Each component works together
How do the systems
within the systems
interact?
Outcome

Donabedian
Model

Process Structure (Ayanian, J. Z., & Markel, H., 2016)

Topic Selection Rationale

Potential Safety and Quality Issues Integrative Nursing Principles

INP 1- The Whole System is
inseparable from its environment
- Failure to Educate INP 6- The Health and Well-being of
- Failure to Assess Patient carers and care-recipients

- Lack of Open Communication

(Kreitzer & Koithan, 2019)
How to Improve with the Model for
Improvement (MFI)
Model for Improvement Overview

• A Model for Improvement (MFI) is about

setting aims, establishing measures and
deciding what needs to change
• What are we trying to accomplish?
• How will we know that a change is an
improvement?
• What change can we make that will result
in improvement?
Improving communication between hospital care team members
through team role play simulation in order to prevent MRSA

What do we want to learn from this PDSA cycle?

What questions do we intend to answer?

Quantitative
Qualitative

Healthcare issue recommended for improvement:

Improving interprofessional communication
PDSA-Plan

● The effect of interprofessional

role-play communication ● Prediction
simulations ○ Quantitative
● Health educators ○ Qualitative
● Post-op Unit
● Banner Desert Medical Center
● November 7th 2021 -
December 12, 2021
● Day shift 7AM - 7 PM
PDSA- Plan the Test of Change Data Collection Plan

▪ Process measure ▪ Data collection

▪ Qualitative data needed
▪ Analyze the data
▪ Quantitative data needed
PDSA- Do -> Results!

Enhanced communication
Hesitant to participate
Decreased rates in MRSA!
Analyze Run Chart
PDSA-Study

Prediction Outcome

The effect of interprofessional role-play There was a decrease in the rates of MRSA
communication simulations will decrease MRSA over the course of implementing role-play
rates. simulation to improve communication.  

The interprofessional role-play communication Based on feedback from healthcare team

simulations will enhance communication and members their role-play simulation
hesitancy of participation could hinder enhanced communication and perspective-
communication. taking but felt hesitant to participate in the
simulation.
PDSA- Act

What we would like to do differently next time

-Qualitatively
-Quantitatively
Summary, Discussion Questions,
Reflections, and Pearls of Wisdom
Summary

PDSA QI Project process overall IN principles incorporated throughout

the PDSA
❖ Completed IHI PDSA tracker aided with
extra support for final project INP 1- The Whole System is inseparable from its
environment
❖ Relatable topic found in our current INP 6- The Health and Well-being of carers and care-
clinicals- easier to comprehend subject of recipients
project

❖ Further evaluations of simulation work to (Kreitzer & Koithan, 2019)

show increased communication
Discussion Q

❖ Would the use of simulations be more effective to reduce HAIs,

specifically with MRSA, with the use of robotics mannequins as
patients or actors playing the role of patients?

❖ Would the use of a self-centering activity (5 mins meditation)

before simulations increase the effectiveness of communication
within a healthcare team?
 Reflections, and Pearls of Wisdom:

Facilitators: Pearls of Wisdom:

Course Content References
❖ Schedule team meetings early in the
Second project week - early planning and progress
Topic Selection Easily Understood
❖ Incorporate IN #5 and use evidenced-
Barriers: informed recommendations in our
project
Schedule Conflicts
Short Deadline
Closing Mindful Moment
Image: https://pbs.twimg.com/media/CfYF-wmUUAAwH8U.jpg
 References
Ayanian, J. Z., & Markel, H. (2016). Donabedian's lasting framework for health care quality. The New England Journal of Medicine, 375(3), 205–207.
https://doi.org/10.1056/NEJMp1605101
Eisenberg, M., Wu, A., Jha, A., Keysar, B., Wachter, B., Sheridan, C., Clancy, C., Gravitas, & Kanopy. (2019). To Err is Human.
Granheim, B. M., Shaw, J. M., & Mansah, M. (2018). The use of interprofessional learning and simulation in undergraduate nursing programs to address interprofessional communication
and collaboration: An integrative review of the literature. Nurse Education Today, 62, 118–127. https://doi.org/10.1016/j.nedt.2017.12.021
Institute for Healthcare Improvement. (n.d.). Q1 104. Interpreting data: Run charts, control charts, and other measurement tools.
https://education.ihi.org/topclass/topclass.do?CnTxT-196611987-contentSetup-tc_student_id=196611987-item=3261-view=1
Institute for Healthcare Improvement. (n.d.). Q1 104. The life cycle of a quality improvement project.
http://www.ihi.org/education/ihiopenschool/Courses/Documents/SummaryDocuments/QI%20104%20SummaryFINAL.pdf
Khan, A., Spector, N. D., Baird, J. D., Ashland, M., Starmer, A. J., Rosenbluth, G., Garcia, B. M., Litterer, K. P., Rogers, J. E., Dalal, A. K., Lipsitz, S., Yoon, C. S., Zigmont, K. R., Guiot,
A., O’Toole, J. K., Patel, A., Bismilla, Z., Coffey, M., Langrish, K., Landrigan, C. P. (2018). Patient safety after implementation of a coproduced family centered communication
programme: Multicenter before and after intervention study. The British Medical Journal. https://doi.org/10.1136/bmj.k4764
Kreitzer, M. J., Koithan, M., & Oxford University Press. (2019). Integrative nursing (Second edition.).
Lee, C. T.-S., & Doran, D. M. (2017). The role of interpersonal relations in healthcare team communication and patient safety: A proposed model of Interpersonal process in teamwork.
Canadian Journal of Nursing Research, 49(2), 75–93. https://doi.org/10.1177/0844562117699349
Liaw, S. Y., Ooi, S. W., Rusli, K., Lau, T. C., Tam, W., & Chua, W. L. (2020). Nurse-physician communication team training in virtual reality versus live simulations: Randomized
controlled trial on team communication and teamwork attitudes. Journal of Medical Internet Research, 22(4), e17279. https://doi.org/10.2196/17279
Partnering to heal. U.S. Department of Health and Human Services. (2017). Retrieved October 24, 2021, from https://health.gov/hcq/trainings/partnering-to-heal/index.html.
University Hospital Southampton NHS Foundation Trust. (n.d.). Healthcare associated infections.
https://www.uhs.nhs.uk/PatientsAndVisitors/Yourstayinhospital/Makingyourstaywithussafe/Preventinginfection/Healthcare-associated-infections-(HCAI).aspx
Image: Slide 6- https://resources.nurse.com/image/3733082.1544805129000
Image Links

Slide 6- https://resources.nurse.com/image/3733082.1544805129000
Slide 28- https://pbs.twimg.com/media/CfYF-wmUUAAwH8U.jpg