Transdisciplinary training promotes better care
Transdisciplinary training promotes better care
All staff expand their skills
At Horton Medical Center in Middletown, NY, everyone who provides patient care can take vital signs, adjust a buzzing hearing aid, and recognize when an amputee’s stump bandage needs to be rewrapped.
Their knowledge is the result of a transdisciplinary competency program designed to promote better patient care.
Under the program, every member of the rehab staff has to learn to do two tasks that are crucial to each discipline.
Disciplines involved in the project include physical therapy, occupational therapy, speech and audiology, neuropsychology, nursing, and case management.
The program is expanding to include nutrition, recreation therapy, infection control, and the ostomy nurse.
Following the competency program, patient surveys showed patients felt more satisfied that they were getting care in a timely manner, says Carmella Pistone, RN, MA, CRRN, nurse manager for rehab, who spearheaded the competency training program.
"But more importantly, staff satisfaction increased. It has broadened the skills of everyone in the department and has given everyone pride in their own area of expertise," Pistone says.
The competency program grew out of the staff’s preparation for accreditation from CARF, the Rehabilitation Accreditation Commission, which now requires competency testing.
Each discipline has its own professional competencies to pass but the hospital management thought the transdisciplinary competencies would help the staff work as a team, Pistone explains.
Sharing expertise
Each discipline’s manager polled staff to identify two components of their practices that everyone in the rehab department should be able to carry out to make the unit more quality oriented.
Among the tasks covered were swallowing assessment, infection control, radiation safety, skin assessment, stump wrapping, transfer techniques, bowel management, stroke behavior, and dealing with agitated patients.
"We’ve increased the quality of our care by promoting better team communication and improving the accuracy of the information that is passed among the team members," says Ann Keane, RN, MSN, MA, CCRN, manager of education.
Here are some examples of how the transdisciplinary competency training has helped:
• If a patient becomes dizzy during a physical therapy session, the PT can take vital signs and give nursing accurate information about the patient’s condition. The nurse has the information needed to decide if it is a true emergency in order to give the therapist proper guidance on what to do until the nurse can check on the patient.
In the past, the therapist would call the unit nurse who would drop everything and come to the therapy gym in case it was an emergency.
• If a patient is being discharged at night or on weekends and it is determined at the last minute that the patient needs home oxygen, the nursing staff knows what to do.
In the past, nursing would have contacted the case manager who was on call, and the patient may have waited several hours until the oxygen could be arranged.
• If an amputee’s stump becomes unwrapped during speech therapy, the therapists can rewrap it, rather than calling nursing in and interrupting therapy.
"We emphasized that this is not cross-training. We did not expect anyone to perform the duties of other disciplines. Everyone here is an advocate for the patient. Everyone’s goal is to promote quality care," Pistone says.
Understanding the patient
By doing some competencies, such as getting dressed with assistive devices as part of the OT training, staff also gained a better understanding of what they expected from patients, she adds.
Staff also got a better idea of what their counterparts in other departments do each day, Pistone says.
"Everybody learned that others’ jobs were harder than they thought," she adds.
About three months before testing, the managers of each participating discipline created a videotape demonstrating the skills their discipline had chosen to teach. Each manager developed a packet of supporting articles and descriptive instructions to go along with the videotape.
Several copies of the videotape were available. Staff were responsible for viewing the videotape on hospital time and studying the supporting information.
The staff had a chance to practice with the equipment being used for the competency testing and ask questions.
Everyone, from aides and therapists up to management staff, had to pass the competencies. Those who didn’t pass the first time could go through a remediation process and receive one-on-one instruction by a manager.
24-hour testing
For the testing, the staff created a carnival atmosphere with stations for each discipline’s testing in the hospital auditorium.
"We wanted it to be professional, but we didn’t want to create an intimidating environment. We wanted them to get the most out of it they could and enjoy it," Pistone says.
The competency testing took place on a 24-hour basis during a three-day period so all staff could be tested during their regular shifts.
This meant that the management staff had to be at the hospital during all three shifts and on a weekend.
"The people who were doing the validation got a true appreciation of what it’s like to be here all hours of the day," Keane adds.
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