Team training program's impact on medication administration, teamwork and patient safety culture in an ambulance service (TEAM-AMB): a longitudinal multimethod study protocol.

INTRODUCTION: Medication administration errors (MAEs) have the potential for significant patient harm, and the frequency of MAEs in the ambulance services is not well known. Effective teamwork is paramount for providing safe and effective patient care, especially in a time-sensitive, high-risk environment such as the ambulance services. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based team training programme that, to our knowledge, has not been studied in the ambulance services previously. TeamSTEPPS is based on the five principles: team structure, communication, leadership, situation monitoring and mutual support. This study aims to advance the knowledge of the medication administration process in the ambulance services and study the impact of a team training programme on the frequency of MAEs, and the perception of teamwork, and patient safety culture. METHODS AND ANALYSIS: This study uses a longitudinal multimethod design to evaluate medication administration and the implementation of the team training programme TeamSTEPPS in an ambulance service. A review of electronic patient journals 6 months prior to the intervention, and 12 months after the intervention will provide data on the frequency of MAEs. Focus group interviews and questionnaires will be carried out before and after the intervention to describe the perception of teamwork and patient safety culture among ambulance professionals. Observations, individual interviews and a review of guidelines will be conducted in the first and second quarters of 2022 to study the medication administration process in ambulance services. ETHICS AND DISSEMINATION: The study protocol was reviewed by the Regional Committees for Medical and Health Research Ethics Central Norway and approved by the Hospital Trust data protection officer, and the head of the Prehospital Division at the Hospital Trust. The data material will be managed confidentially and stored according to regulations. The results will be disseminated through scientific papers, reports, conference presentations, popular press, and social media. TRIAL REGISTRATION NUMBER: NCT05244928.

Longitudinal team training program in a Norwegian surgical ward: a qualitative study of nurses' and physicians' experiences with implementation.

BACKGROUND: Team training interventions to improve team effectiveness within healthcare are widely used. However, in-depth knowledge of how healthcare professionals experience such team training curricula and their implementation processes, as well as how contextual factors impact implementation, is currently missing. The aim of this study is therefore to describe healthcare professionals' experiences with the implementation of a longitudinal interprofessional team training program in a surgical ward. METHODS: A descriptive design was applied based on qualitative semi-structured focus group interviews with 11 healthcare professionals. A convenience sample of physicians (n = 4), registered nurses (n = 4), and certified nursing assistants (n = 3) was divided into three professionally based focus groups, which were interviewed at three time intervals over a period of 1 year. INTERVENTION: The validated and evidence-based team training program Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) was implemented in a surgical ward at a hospital between January 2016 and June 2017. The team training program included three phases: 1) assessment and planning, 2) training and implementation, and 3) sustainment. RESULTS: Healthcare professionals' experiences with the content of the team training program varied from valuing the different elements of it to seeing the challenges in implementing the elements in clinical practice. A one-day training course was found to be especially beneficial for interprofessional collaboration at the ward. Over time, the nursing staff seemed to maintain their motivation for the implementation of the tools and strategies, while the physicians became less actively involved. Contextual ward factors influenced the adoption and utilization of the tools and strategies of the program both positively and negatively. The healthcare professionals' experienced the implementation of the team training program as positive for the patient safety culture at the ward in the forms of increased awareness of teamwork and open communication. CONCLUSIONS: The study suggests that the implementation of a team training program in a surgical ward is dependent on a set of factors related to content, process, context, and impact. Knowledge on how and why a team training program work supports the transferability to clinical practice in further planning of team training measures. TRIAL REGISTRATION: The study is part of a larger research project with a study protocol that was registered retrospectively on 05.30.17, with the trial registration number ISRCTN13997367 .

Longitudinal team training programme in a Norwegian surgical ward: a qualitative study of nurses' and physicians' experiences with teamwork skills.

OBJECTIVES: Teamwork and interprofessional team training are fundamental to ensuring the continuity of care and high-quality outcomes for patients in a complex clinical environment. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based team training programme intended to facilitate healthcare professionals' teamwork skills. The aim of this study is to describe healthcare professionals' experiences with teamwork in a surgical ward before and during the implementation of a longitudinal interprofessional team training programme. DESIGN: A qualitative descriptive study based on follow-up focus group interviews. SETTING: A combined gastrointestinal surgery and urology ward at a hospital division in a Norwegian hospital trust. PARTICIPANTS: A convenience sample of 11 healthcare professionals divided into three professionally based focus groups comprising physicians (n=4), registered nurses (n=4) and certified nursing assistants (n=3). INTERVENTIONS: The TeamSTEPPS programme was implemented in the surgical ward from May 2016 to June 2017. The team training programme included the three phases: (1) assessment and planning, (2) training and implementation and (3) sustainment. RESULTS: Before implementing the team training programme, healthcare professionals were essentially satisfied with the teamwork skills within the ward. During the implementation of the programme, they experienced that team training led to greater awareness and knowledge of their common teamwork skills. Improved teamwork skills were described in relation to a more systematic interprofessional information exchange, consciousness of leadership-balancing activities and resources, the use of situational monitoring tools and a shared understanding of accountability and transparency. CONCLUSIONS: This study suggests that the team training programme provides healthcare professionals with a set of tools and terminology that promotes a common understanding of teamwork, hence affecting behaviour and communication in their daily clinical practice at the surgical ward. TRIAL REGISTRATION NUMBER: ISRCTN13997367.

A qualitative study of how inter-professional teamwork influences perioperative nursing.

Aim: To explore Norwegian operating room nurses' perceptions of how team skills in the inter-professional operating room team influence perioperative nursing in relation to patient safety. Design: A qualitative, descriptive study based on interviews. Methods: Ten operating room nurses (N = 10) employed in four Norwegian hospitals were interviewed individually. A qualitative inductive content analysis was conducted. The study was reported adhering to the Consolidated Criteria for Reporting Qualitative Research Checklist. Results: Three generic categories, containing three subcategories each, were identified illuminate the operating room nurses' perceptions. The operating room team's team skills influence on (a) the quality of perioperative nursing, about task performance, result for the patient and learning; (b) the progress of perioperative nursing, by keeping focus on the task, being prepared and task distribution and (c) the operating room nurses' work environment in the operating room, including confidence, stress and energy use and irritation or job satisfaction.

"Teamwork in hospitals": a quasi-experimental study protocol applying a human factors approach.

BACKGROUND: Effective teamwork and sufficient communication are critical components essential to patient safety in today's specialized and complex healthcare services. Team training is important for an improved efficiency in inter-professional teamwork within hospitals, however the scientific rigor of studies must be strengthen and more research is required to compare studies across samples, settings and countries. The aims of the study are to translate and validate teamwork questionnaires and investigate healthcare personnel's perception of teamwork in hospitals (Part 1). Further to explore the impact of an inter-professional teamwork intervention in a surgical ward on structure, process and outcome (Part 2). METHODS: To address the aims, a descriptive, and explorative design (Part 1), and a quasi-experimental interventional design will be applied (Part 2). The study will be carried out in five different hospitals (A-E) in three hospital trusts in Norway. Frontline healthcare personnel in Hospitals A and B, from both acute and non-acute departments, will be invited to respond to three Norwegian translated teamwork questionnaires (Part 1). An inter-professional teamwork intervention in line with the TeamSTEPPS recommend Model of Change will be implemented in a surgical ward at Hospital C. All physicians, registered nurses and assistant nurses in the intervention ward and two control wards (Hospitals D and E) will be invited to to survey their perception of teamwork, team decision making, safety culture and attitude towards teamwork before intervention and after six and 12 months. Adult patients admitted to the intervention surgical unit will be invited to survey their perception of quality of care during their hospital stay before intervention and after six and 12 month. Moreover, anonymous patient registry data from local registers and data from patients' medical records will be collected (Part 2). DISCUSSION: This study will help to understand the impact of an inter-professional teamwork intervention in a surgical ward and contribute to promote healthcare personnel's team competences with an opportunity to achieve changes in work processes and patient safety. TRIAL REGISTRATION: Trial registration number (TRN) is ISRCTN13997367. The study was registered retrospectively with registration date 30.05.2017.

The association between patient safety culture and burnout and sense of coherence: A cross-sectional study in restructured and not restructured intensive care units.

OBJECTIVES: To study the associations between registered nurses' (RNs) perception of the patient safety culture (safety culture) and burnout and sense of coherence, and to compare the burnout and sense of coherence in restructured and not restructured intensive care units (ICUs). DESIGN: Cross-sectional study. PARTICIPANTS/SETTING: RNs employed at seven ICUs in six hospitals at a Norwegian Hospital Trust. One to four years before the study, three hospitals merged their general and medical ICUs into one general mixed ICU. METHOD: The safety culture, burnout and sense of coherence were measured with the questionnaires Hospital Survey on Patient Safety Culture, Bergen Burnout Indicator and Sense of Coherence. Participant characteristics and working in restructured and not restructured ICUs were registered. RESULTS: In total, 143/289(49.5%) RNs participated. A positive safety culture was statistically significantly associated with a low score for burnout and a strong sense of coherence. No statistically significant differences were found in burnout and sense of coherence between RNs in the restructured and not restructured ICUs. CONCLUSIONS: In this study, a positive safety culture was associated with absence of burnout and high ability to cope with stressful situations. Burnout and sense of coherence were independent of the restructuring process.

Changes in patient safety culture after restructuring of intensive care units: Two cross-sectional studies.

OBJECTIVES: Compare changes in registered nurses' perception of the patient safety culture in restructured and not restructured intensive care units during a four-year period. METHODOLOGY/DESIGN: Two cross-sectional surveys were performed, in 2008/2009 (time 1) and 2012/2013 (time 2). During a period of 0-3 years after time 1, three of six hospitals merged their general and medical intensive care units (restructured). The other hospitals maintained their structure of the intensive care units (not restructured). SETTING: Intensive care units in hospitals at one Norwegian hospital trust. OUTCOME MEASURE: The safety culture was measured with Hospital Survey on Patient Safety Culture. RESULTS: At times 1 and 2, 217/302 (72%) and 145/289 (50%) registered nurses participated. Restructuring was negatively associated with change in the safety culture, in particular, the dimensions of the safety culture within the unit level. The dimensions most vulnerable for restructuring were manager expectations and actions promoting safety, teamwork within hospital units and staffing. CONCLUSION: In this study, the restructuring of intensive care units was associated with a negative impact on the safety culture. When restructuring, the management should be particularly aware of changes in the safety culture dimensions manager expectations and actions promoting safety, teamwork within hospital units and staffing.