Patient Safety Advocate Dr. Karen J. Panzarella

Dr. Karen J. Panzarella is an Associate Professor at D’Youville, in Buffalo NY and a Certified Healthcare Simulation Educator and TeamSTEPPS(Team Strategies and Tools to Enhance Performance and Patient Safety) master trainer. Her research focuses on the use of healthcare simulation for collaborative practice.

Dr. Heather Ferro is a Clinical AssistantProfessor of Occupational Therapy and a TeamSTEPPS master trainer. She has beenan OT for 23 years and has worked interprofessionally across the continuum ofhealth care.

James Cypert is the Director ofInterprofessional Education and Simulation. A master trainer in TeamSTEPPS, hebrought 25 years’ experience in information technology and education and hasbecome an innovative voice in the pursuit of integrating technology intoclassrooms.

Dr. Kirsten Butterfoss is a ClinicalAssociate Professor, D'Youville School of Pharmacy and is a clinical pharmacistat a skilled nursing facility in Buffalo, NY. She is a member of the D'YouvilleCollege Interprofessional Education Committee and is a TeamSTEPPS mastertrainer. Her involvement with the interprofessional education committeeincludes curricular development and debriefing.

Colleen Koszelak is a Clinical AssistantProfessor and Director of Nursing Simulation. She specializes in neonatalintensive care and was instrumental in establishing the School of Nursingsimulation program and is a master trainer in TeamSTEPPS.

Nominated for their outstanding work asPatient Safety Advocates, the nominator said: “These individuals are championsfor patient safety. They devote time and energy into training over 500 healthprofessional students per year from eight different disciplines in simulationgroups of 12-14 with eight different professions. They are master trainers inTeamSTEPPS and are currently conducting a research study that trained 27 healthprofessional students (from eight disciplines) in TeamSTEPPS and developed anadditional two hour “Targeted Team Strategies” for active practice ofTeamSTEPPS strategies and are looking at this effect in their performance ininterprofessional simulation scenarios. This is their story.

Interprofessional students participating in Targeted Team Strategies. All Images: D'Youville Simulation.

TheBenefits of Training Health Professional Students in TeamSTEPPS Prior toGraduation

The D’Youville master trainers useTeamSTEPPS to enhance collaboration across curricula.

Patient safety should be at the forefrontof an institute of higher education that graduates over 500 health careproviders each year. D’Youville is noted for offering degrees in eight healthprofessional programs on a small urban campus in Buffalo, New York. The adventof a school of pharmacy at D’Youville brought accreditation standards forinterprofessional education. To address these standards, a team of fiveinterdisciplinary faculty attended the inaugural InterprofessionalCollaborative in Dulles, Washington in 2012. During the event, the team decidedthe best approach for students from different disciplines to learn togetherwould be participating in something fun, meaningful and applicable to real lifeclinical care. They started by using medical simulation.

A small grant was secured and used to buildtwo simulation rooms at D’Youville’s chiropractic clinic and provide facultytraining in the areas of curriculum writing, facilitating, and debriefing.During a two-day summer retreat a dozen faculty came together from the varioushealth profession programs and created four simulation scenarios about apatient, “Chris Dulles.” During the simulations, learners from each of thehealth profession programs followed Chris for a year across his continuum ofcare. The faculty wrote embedded challenges into the curriculum for thelearners to problem solve and respond, including: drug seeking behavior, signsof a new stroke, an overbearing spouse, and discharge planning concerns(Panzarella et. al, 2013). This set of scenarios was implemented in the springinterprofessional education (IPE) curriculum in 2013 and has been delivered toover 500 health profession students (‘learners’) each year since. Studentlearners attend an evening four-hour simulation experience and represent eightdifferent health profession programs: chiropractic, dietetic, nursing, nursepractitioner, occupational therapy (OT), pharmacy, physical therapy (PT), andphysician assistant (PA) (DeMarco et. al, 2015). Excitement from faculty andpositive feedback from the student learners led to the recruitment anddevelopment of 25 faculty from the eight health profession programs tofacilitate the spring curriculum.

In 2015, a second grant was secured andused for a second retreat of additional faculty to create a fall IPE simulationcurriculum, “Tom” and “Martha,” which has been delivered to over 300interprofessional students each year since 2015. Tom, a Vietnam veteran, andMartha, a retired nurse, are simulated patients who are undergoing electivesurgery. In the scenario, Tom is having a lumbar laminectomy in one week andMartha is scheduled for a total hip replacement. Students meet in theirinterprofessional groups on three occasions (seven hours of contact time)throughout the semester. The first two hour meeting is called the “RoundRobin.” During this event, learners pair up with a student from a differenthealth profession and meet Tom and Martha preoperatively in an outpatientsetting to conduct an interview. In addition, learners participate in a skillsdemonstration commonly used within (and unique to) their profession. The secondmeeting, a four-hour simulation session, learners meet Martha and Tom the dayafter their surgeries in an acute care hospital and deal with embeddedchallenges of medication changes, detoxification and domestic violence.Although D’Youville does not have a medical school, the curricular team createda simulated physician and medical student role. During the simulation, studentlearners also interact with Martha in a home care setting and deal withchallenges of infection control and dietary/digestive concerns (Butterfoss et.al, 2018). The final simulation event (one contact hour) is offered at the endof the fall semester. All learners who participated in the IPE program throughoutthe semester come together as one united team to meet Tom and Martha “one yearlater” and ask about the patients’ successes, challenges, and current needs.Student learners also listen to real life stories from a community veteran anda survivor of domestic violence. Currently over 30 faculty, from the eighthealth profession programs, participate in facilitating and debriefing the falland spring curriculum.

Both fall and spring interprofessionalcurricula challenge learners to communicate with their healthcare team.Communication challenges are embedded throughout the scenarios to have learnersdisplay collaborative care with their colleagues, patient, and the patients’family members. Although many opportunities are presented, it is rare that learnerscommunicate with their healthcare team optimally as evidenced on videorecordings. Only after targeted debriefing to address performance gaps, is someimprovement demonstrated in subsequent scenarios. Learners have heardcommunication strategies such as ‘SBAR’ or ‘Handoffs’ in a didactic lecture,but many are not familiar with and none have had opportunities to practicethese strategies in a simulated setting.

In spring of 2018, five key players in IPEbecame master trainers in TeamSTEPPS. Following this training, the core teampresented the material at a rehabilitation symposium at a local trauma hospitaland were convinced that TeamSTEPPS is an effective program that needs to beimplemented at D’Youville in conjunction with the existing IPE curricula.Through this added training, the goal is to prepare students to becomeassertive leaders of collaborative practice. Following the symposium, themaster trainers made a strong effort to gain buy-in across the D’Youvillecampus and presented customized one-hour overview of TeamSTEPPS at facultymeetings, staff development days, and to the president’s council. Theexcitement around the topic grew quickly across the campus as people heard thepresentation. In the summer of 2018, the five master trainers planned aresearch study to collect data that would provide evidence regarding the valueof this training for students.

The study, “Enhancing InterprofessionalSimulation Utilizing Targeted Team Strategies” was conducted fall of 2018 andexamined the effects of TeamSTEPPS training in addition to the existing fallIPE simulation curriculum “Tom and Martha”. The experimental group of 27student learners (three PA, six OT, four PT, four pharmacy, six nursing, twodietetic and two chiropractic) was split into two groups. Each group completedeight hour online training of TeamSTEPPS. In addition, they participated in twohours of targeted team strategies that master trainers had created to providepractice with team building and use of key strategies from TeamSTEPPS. Thisgroup was compared to a random selection of matched students who alsoparticipated in the fall IPE simulation curriculum and served as the controlgroup.

The experimental and control groups arebeing analyzed via the video recordings of the four-hour IPE simulationsessions for achievement of learning objectives related to the TeamSTEPPScompetencies by counting how many times the student learners utilized the toolsand strategies of TeamSTEPPS. The experimental groups completed a pre- and post-assessmenton teamwork knowledge, attitudes, and skills. Levels of patient satisfactionwere compared via feedback from the simulated patients for both groups. Initialanalysis shows a positive trend toward the groups that received TeamSTEPPStraining and targeted team strategies in addition to the IPE simulationcurriculum.

D’Youville is planning construction of a50,000 square foot health professions HUB to open in the fall of 2020 and willinclude a community clinic, workforce development, and simulation. The initialplanning committees seemed segregated in their utilization of space andprograming, prompting an urgent need to get everyone on the same page with thevision of the HUB and the future of D’Youville. The core team of mastertrainers presented the idea of using TeamSTEPPS as a platform to unify thevision and suggested a retreat, similar to the retreats that were used to buildthe IPE simulation curricula. D’Youville’s president, Dr. Lorrie Clemo,endorsed the team’s idea and empowered the team to plan the retreat. The eventwas planned and had 50 committed volunteers (staff, faculty, andadministrators) to attend the two-day “mystery” retreat. The mystery retreatrequired each participant to read “Our Iceberg is Melting” by John Kotter andto reflect on several key questions prior to attending.

Participants in the “Save Our Iceberg” retreat, Dr. Karen Panzarella out-stretched arms.

On December 11 & 12, 2018 the D’Youville “Save Our Iceberg” retreat was held in Niagara Falls, Canada. With the goal of creating a sense of urgency, the retreat opened with a simulation, unbeknownst to the participants, that had D’Youville’s president announcing that spring enrollment was lower than expected and although 50 participants were scheduled to attend the retreat, the budget could only support 30 participants and therefore 20 volunteers were needed to stay back and would be given the opportunity to attend a future retreat. The realism was powerful as participants asked, “can we hold it here on campus so we all can participate”. This was the first experience debriefing 50 people at once during a D’Youville simulation and it was a huge success! From here the participants were taken on an exhilarating jet boat ride through the lower rapids of Niagara Falls. The remainder of the retreat was devoted to a customized version of TeamSTEPPS training called, “D’You TEAM” and included didactic, videos and targeted team strategies. The retreat culminated with implementing change through culture transformation and design work with the architects of the HUB project. At the closing ceremony, each participant was awarded a penguin pin and empowered to be a change agent (this was accomplished once again through a planned simulation). During the simulation, one of the faculty who attended was wearing her penguin pin and another employee of D’Youville asked about it. The focus of the interaction was communication about the shared vision generated through the retreat, including the faculty member revealing that her mystery roommate was President Clemo! The preliminary feedback is very positive and as one participant reported, “The retreat brought together a diverse group of individuals from across the D'Youville campus. I enjoyed meeting people that I do not normally have the opportunity to interact with and hearing their different perspectives.”

References

1. Butterfoss, K, Panzarella, K, Whelan,M., Ferro, H., Dunn, B., Case, A., Stewart, M., Verni, C.,Duszkiewicz, A.,Cieri, N., and DeMarco, L. “Transitions of Care From Pre-Operative to CommunityCare through Interprofessional Simulation, Journal of interprofessional care,resubmitted November 2018.

2. DeMarco L, Panzarella K, Ferro H,Pownall L, Case A, Nowakowski, P, Stewart M, Duszkiewicz A, Verni C, Kennedy M,Cieri N, Dowd C, Dunford D. Outcomes of an Interprofessional SimulationCurriculum. Journal of Applied Research in Higher Education 2015:7(2)453-468.

3. Panzarella K, Rivers L, Brigh, B, Whelan M, Butterfoss K, Russ L, Case A, Brian S, Ferro H, DeMarco L, Dunford D, Schmitz K, Kittleson H, Kennedy M, Brzykcy D, Pownall L, Reddington M. Using Actors as Simulated Patients for Interprofessional Education. Medical Science Educator 2013:October23(3S).

Originally published in  Issue 1, 2019 of MT Magazine.