TeamSTEPPS® Toolkit: Check-Back

The first time learners use Bodyswaps, an onboarding sequence familiarises them with the features of the app, takes them through an avatar selection and embodiment activity, and prepares them for the experience to come. 

In the onboarding, learners will: 

• Find out how this training is different from the rest
• Select their avatar
• Discover their virtual journal
• Learn how to navigate and use the tools and settings

In this introduction, the learner meets their virtual coaches, Nurse Sam and Nurse Carlos, in the tutor room of Summerview Hospital.

It opens with Sam asking Carlos whether he’s ever made a mistake as a nurse, to which he responds: “Of course!” Everyone has at some point in their careers, and in a fast-paced environment like healthcare, the risk of miscommunications is high. But that can negatively impact patient outcomes, so preventive systems are important.

Sam shares a story about a medication error her team made in the past, which helped them realize the need for a verification process. Since then, she’s become an advocate for the TeamSTEPPS® tool Check-Back, which she and Carlos are going to explore with the learner throughout this training.

Before the learner begins their first activity, they’re invited to complete a short, likert-style self-reflection survey, to indicate how confident they feel about the following key learning points:

• Identify when and how you should use Check-Back
• Apply Check-Back in action to confirm a patient’s details

When giving and receiving clinical information in healthcare, it’s easy to assume the message is accurate and clear. But if both people involved don’t verify that they’re on the same page as one another, there’s a risk of errors slipping through the cracks. Sam and Carlos discuss this challenge, before inviting the learner to think about how they currently verify clinical information.

In this activity, Sam and Carlos start by describing three scenarios that involve receiving patient information, and ask the learner to choose from a three option MCQ how they would respond to each situation.

After answering all three, the learner discovers whether their responses aligned with Check-Back, which helps them self-reflect on how it can aid their communication.

The coaches then proceed to walk the learner through how Check-Back helps care providers catch mistakes when exchanging information – it creates what’s known as a ‘closed loop’ that leaves no room for errors.

In the next activity, the learner has an opportunity to see the benefits of the technique in action, when nurses Kayla and Peter use it to verify a patient’s blood transfusion. 

To develop their understanding of Check-Back, the learner watches a conversation between two virtual nurses, Kayla and Peter. Kayla is preparing to administer a blood transfusion for a patient, Jamie, but a 2-nurse verification is needed to confirm the information as a safety check, so she’s asked Peter to help.

In this activity comprising three conversation exchanges, Kayla shares some information with Peter, such as Jamie’s name and date of birth, his pre-medications, and details about the blood product. Peter then uses Check-Back to confirm and verify its accuracy.

The learner’s goal is to pay attention to Peter’s use of the technique in each exchange, and then answer a three-option MCQ to say whether they think Peter’s Check-Back verified all the details, if it caught any errors, or if he overlooked checking something back.

When the learner chooses an incorrect option, text feedback encourages them to rethink the exchange between Kayla and Peter, before they try again. They must eventually select the right answer to progress through the conversation. Each correct choice also provides text feedback, reinforcing the learning point about how Peter used Check-Back.

In the final exchange, the learner discovers that Kayla and Peter’s Check-Back has uncovered an error: the blood type on the product doesn’t match Jamie’s. Overlooking this mistake would pose a serious patient risk, so the two of them are relieved that their thorough verification process caught it.

The activity ends with virtual coach Nurse Sam sending the learner a text message. She says it’s their turn to put what they’ve learnt about Check-Back into action, gearing them up for their next activity. 

Check-Back is a simple verification technique; the challenge is overcoming the initial awkwardness of repeating back information to others, and making it into a habit. So, in this LLM-powered freeform conversation, the learner has a chance to actively put the technique into action and start building that habit.

In the central nursing station, virtual Charge Nurse Tala assigns the learner a new patient, Linda. Over three exchanges, Tala then verbally shares some details about Linda and her surgery, and invites the learner to check if what she just shared matches the patient’s chart. Throughout the activity, the learner can see Linda’s chart on a virtual computer screen.

The learner’s goal is to use Check-Back in each exchange, speaking aloud in their own words, to verify all the information. LLM AI evaluates whether or not they did, and branches to different responses from Tala and text feedback from the coaches accordingly. They can repeat an exchange as many times as they like, but must succeed before they can progress the conversation.

For example, if they simply say something like “Got it, that matches my records.” Tala seems hesitant to move on, and text feedback encourages them to think about whether there’s more they can do to verify the details.

Each time the learner succeeds, a tick is added to a checklist on a clipboard next to the computer, providing them with visual feedback on their progress verifying Linda’s information.

Once they complete all three exchanges, an error on Linda’s medical record comes to light, demonstrating the power of the Check-Back technique for preventing miscommunications. Tala heard that Linda’s NPO should begin at 12 AM, but the records say 2 AM.

If the learner decides to move on before verifying everything, they receive an alternative ending, where Linda’s surgery is majorly delayed due to the discrepancy never being spotted. After receiving this ending, they can try the activity again, if they wish.

The learner rejoins Sam and Carlos in the hospital tutor room. They receive one of two possible outcomes, depending on whether or not they successfully checked back all of Linda’s details with Nurse Tala.

If the learner was successful, Sam and Carlos congratulate them for using the Check-back technique to verify the information and catching the NPO discrepancy.

If the learner struggled and had to move on from the activity, the coaches offer reassurance and encourage the learner to keep practicing. They explain that, even though Check-Back is a straightforward technique, it can take time to get in the habit of checking back.

The coaches then offer some closing thoughts about the technique, encouraging the learner to continue applying it in their daily lives. Then, they ask them to complete the same confidence survey from the start.

Before the learner leaves the module, they are asked to complete a short survey about their experience.

This survey is not compulsory, but the data helps us to assess the effectiveness of our product and identify any areas that need improvement. Clients also find it beneficial when assessing ROI.

They are asked to mark whether they agree or disagree with the following statements, on a 10 point scale:

• I would recommend this experience to others.
• The experience helped me identify how to reduce the chance of errors when receiving patient information.
• I now have a better understanding of how to use the TeamSTEPPS® tool Check-Back to verify patient information.