Using TeamSTEPPSŪ Methodology to Improve Quality in Pressure Ulcer Management, Communication, and Documentation

TeamSTEPPS® is an evidence based teamwork system designed to improve quality, safety, and efficiency in healthcare by improving communication and team skills. It was developed by the Department of Defense's Patient Safety Program in collaboration with the Agency for Healthcare Research and Quality. TeamSTEPPS® Methodology utilizes specific tools for Planning (Briefs), Problem Solving (Huddles), and Communication (SBAR).

Pressure Ulcers signify a serious complex patient care issue. Prevention and management of pressure ulcers involve an interdisciplinary team approach for early recognition and intervention. Communication between the team members is imperative to provide quality care and prevent legal ramifications.

TeamSTEPPS® methodology was implemented at the unit level to improve communication, early intervention, and documentation of pressure ulcers. Patients with pressure ulcers are identified at each intershift "briefing". Interdisciplinary team "huddles" using SBAR (S= Situation, B=Background, A = Assessment, R= Recommendations and Request) are held at the time that the hospital acquired pressure ulcer(s) are identified or deteriorate. The interdisciplinary team’s assessments and recommendations are documented in the EMR.

Data was collected for six (6) months on”Pressure Ulcer Huddles".  The percent of time team members participated in the huddles included: Nurse Manager (82%), Registered Nurse (100%), Skin Care Nurse (90%), Physician (80%), Dietitian (40%), and PCA (60%). Frequency of documentation in EMR on the Interdisciplinary Note included: PU Assessments: Location, Stage, Measurements (100%), Braden (100%), Support Surfaces (95%), Positioning(90%), Heel Elevation (70%), Chair Cushion (50%), Dietary Consult (93%), Moisture Management (68%).

In summary, pressure ulcer incidence was identified as an opportunity to use TeamSTEPPS® strategies including Briefs, Huddles, and SBAR. These strategies have improved (1) interdisciplinary team collaboration and communication related to pressure ulcer assessment, management and documentation, (2) Improved timely implementation of measures to treat pressure ulcers, prevent deterioration and promote healing, and (3) Improved documentation in the medical record.