North Texas Research Forum 2024



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North Texas


Medical City Fort Worth


Family Medicine

Document Type


Publication Date



skilled nursing facilities, long-term care, TeamSTEPPS, shift change


Family Medicine | Medicine and Health Sciences


Background: Skilled Nursing Facilities (SNFs) play a crucial role in long-term care for a progressively frail patient demographic. Surveys of SNF staff reveal poorer levels of safety culture compared to their hospital counterparts. Quality of clinical care delivery in SNF remains inconsistent and insufficient evidence-based process of care. Studies demonstrate that team functioning and communication are crucial in changing the clinical practice methods in SNF. TeamSTEPPS is a curriculum designed to enhance team performance in healthcare settings by addressing patient safety issues and improving safety culture. In this study, we implemented the TeamSTEPPS curriculum at two SNFs and obtained staff feedback and perceptions of the training. Methods: The TeamSTEPPS Fundamentals Course for Long-Term Care comprises 7 modules, each lasting 45-50 minutes. We adapted the training to address our setting's specific needs, focusing on creating the "Shift Change Checklist." After implementing training, SNF staff were surveyed on tool perception, the training program, safety culture, and feedback. Post-training focus group questions were derived from literature reviews. Answers were assessed for common themes by three independent reviews to identify categories. Results: Both facilities were able to successfully completed TeamSTEPPS training curriculum. 57 staff participated in training at Facility A, with 25 engaging in focus groups. At Facility B, 62 participiated, with six in focus groups. Facility A has beds of 122 while facility B has 46. Facility B reported successful shift change checklist implementation. Identified themes included communication, accountability, leadership, training, buy-in, and burnout. Discussion: Differences between the two facilities revealed factors influencing success or failure. Facility B's success may be attributed to consistently meeting basic staffing needs, a smaller patient population facilitating program implementation, and an assistant director of nurses driving the initiative. Despite Facility A's challenges, feedback indicated a staff community eager to enhance patient safety. The issues stemmed from external system factors rather than TeamSTEPPS curriculum limitations. Our data suggests TeamSTEPPS can be effectively implemented in an SNF, with external conditions influencing outcomes. Future studies involving diverse SNFs will clarify successful implementation factors. In summary, SNFs are integral in long-term care, and implementing TeamSTEPPS can enhance safety culture. Adapting the curriculum to specific needs, such as creating the "Shift Change Checklist," proved effective. Factors influencing success included staffing adequacy, patient population size, and leadership involvement. External conditions, not curriculum limitations, impacted implementation challenges. Despite difficulties, our findings support the promising implementation of TeamSTEPPS in SNFs, encouraging further research for targeted success in varied environments.

Original Publisher

HCA Healthcare Graduate Medical Education

Identifying Critical Factors in Facilitating the Application of the Team STEPPS Curriculum for Improved Patient Safety in Two Area Skilled Nursing Facilities



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