Transcript Document

Michelle George, RN MSN CASC
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A.
Efficiency & Accuracy (Pit Crew)
B.
Patient Safety through Effective Communication
(SBAR-Patient Hand Offs)
C.
Infection Control (ASC Infection Control Audit
worksheet)
D.
Survey Readiness (Bag O’ Tricks)
 Describe
strategy for achieving perioperative
efficiency and accuracy through
implementation of a Pit Crew.
 Influence patient safety through the
implementation of effective patient handoffs using the SBAR approach.
 Describe methods for successful use of the
CMS Infection Control Worksheet.
 List and discuss tools for engagement of
clinical team in ongoing accreditation and
CMS survey readiness using the Bag of Tricks
strategy.
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Benefits
Patient satisfaction
Physician satisfaction
Staff pride and satisfaction
Eliminates redundancy of efforts
Ensures consistent outcomes
Prevents errors
Prevents patient harm
Cool Tool: Pit Crew Model
 “F1
Pit Crews can change all 4 tires and
refuel the car in 7 seconds.”
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 Developed
by the Formula 1 team in 1994
 A tire came off during impact causing head
injury to the driver and subsequent death
 Assigned and trained for specific roles
 Developed checklists
 Drilled for perfection
 Assigned team leader (known as the lollipop
man)
 Results: No deaths from 1994 to 2011
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Healthcare themes:
historical working practice;
problems during transfer;
poor awareness of handover protocols;
poor team coordination;
time pressure;
lack of consistency in handover practice;
poor communication of important
information;
awareness that handover was a potential
threat to patient safety.
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F1 PIT CREW
13-member pit crew in which each
member has a unique role that is
defined by competencies. Team
performance is rehearsed thousands of
times. Failure on any members part to
deliver can result in driver’s death.
SURGICAL TEAM
Each member of the surgical/procedure
team has a specific role. Each role has
specific competencies that members
are trained to perform. Patient injury
and death can result with failures.
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Pit Crew practices involve checklists, training for
competence, individual role accountability and a leader to
ensure thorough and accurate performance.
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Each member of the team has to work in coordination with the
other team members. Timing, accuracy and competence are all
essential elements. Every member must successfully complete
their job to prevent errors and patient harm.
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Each members role is
defined
Use of checklists:
Pre-op checks, Safe
Surgical Checklist
Anesthesia Providers
leads in OR-PACU
hand-off
Healthcare studies
show 2/3’s fewer
technical errors with
Pit Crew model
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Safety
Theme
Formula One
Old Medical
Practice
New Medical
Practice
Leadership
The “lollipop man”
coordinates the pit
stop
Unclear who was in
charge
Anesthesiologist given
coordination
responsibility for hand
off to PACU
Task Sequence
Clear rhythm, order to
events
Inconsistent & nonsequential
Defined phases of
equipment/technology
handoff, information
handoff, discussion &
plan
Checklists
Well established
culture of using
checklists
None
Checklists designed
and used by team
members
Training
Fanatical approach to
training & repetition of
pit stop
No Training existed
Formal training on
protocols
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CDC Study reports key findings:
Hand hygiene & personal protective
equipment
Injection safety & medication handling
Equipment reprocessing
Environmental cleaning
Handling of blood glucose monitoring
 Required
to use the ASC Infection Control
Audit
 Cited for deficient practices with required
plan of corrections
 CMS & CDC have provided in-depth training
for surveyors
 Surveyors must use IC tracer method for a
least one patient
 Updated standards; one breach constitutes a
breach in the standard
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Multiple regulatory agencies
and standards
Interwoven into all patient care
activities
Involves all caregivers—
employees and non-employees
A single breach results in a
survey deficiency
Time & knowledge constraints
Takes a special interest to be
really good
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 Find
the right leader
 Committee responsibility vs. individual
responsibility
 Make it personal
 Involve the team in investigations & Root
Cause Analysis
 Share results
 Interactive & creative approach to education
Cool Tool: ASC Infection Control Audit
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Use the actual ASC
Infection Control Audit
tool
Assign Audit sections to
Medication Safety Nurse
Conduct regular rounds
and observations
Use both observation and
interview techniques
Invite patient care nurses
to join IC rounds
Formal reports to Quality
Committee and MEC/GB
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Page 8 of
Survey Tool
Page 7 of
Survey Tool
 Assign
to the IC Preventionist or clinicians
 Use
actual standards from the ASC Infection Control
Audit tool
 Immediate
 Formal
education/invention for breaches
reports to Quality Committee/MEC/GB
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Focus on key survey
findings—after
removal of gloves and
with medication
administration
 Report and educate at
every meeting
 Rotate signage and
posters
 Hold contests/reward
for longest period of
no breaches
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 Communication
breakdown key in nearmisses and RCAs
 JC National Patient Safety Goal
 Promotes patient safety
Cool Tool: SBAR Communication Model
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Provides structure to
communication
 Shared model ensures
consistency
 Ensure that key
information is shared
 Can be used to
improve performance
 Requires staff
education and
practice
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S
Situation
Complaint, diagnosis, treatment plan and
patient’s wants and needs
B
Background
Vital signs, mental and code status, list of
medications and lab results
A
Assessment
Current provider’s assessment of the
situation
R
Recommendation Identify pending lab results and what
needs to be done over the next few hours
and other recommendations for care
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Implemented
following Wrong Site
Surgery
Establishing a
Baseline Measure
Implementation
Challenges
SBAR in March
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Training

Posters
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Accountability
Results
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 Accreditation
Surveys
 CMS Recertification and Validation Surveys
 Life Safety Surveys
 Board of Pharmacy Inspections
 OSHA Inspections
 Fire Marshall Inspections
Every Day Challenges:
Multiple priorities
Multiple keepers of the process
Staff turnover
Moving parts
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
Formal Plan
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Survey Committee
Quality Council
Assign Responsibility
Medication Safety Nurse
 Safety Officer
 Infection Control Preventionist
 Chapter/Section Leaders
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Regular Rounding
 Mock Surveys
 Total Team Engagement
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Cool Tool: Bag O’ Tricks
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 Identify
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
Medication management
Infection control
Life safety
 Set
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center-specific challenges
up the “Tricks”
Shop at Dollar Stores
Number of items determined by need/team size
 Make
up the instructions for each item
 Determine the rules, timelines and rewards
 Staff education
 Revise as needed
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Engage across departments
Establish a regular cadence
Extends the survey team
Creative education model
Make it your own
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Item
Standard
Staff Responsibility
Mop Sponge
Infection Control
Assess Mop Buckets:
•Using same one for OR and Lounge?
•Silt in the bottom?
•Single mop head use per turnover?
Clapper
National Patient
Safety Goal
Observe patient care hand-offs:
•Are they happening?
•All departments? Critical information?
Ruler
Life Safety
Check Fire Safety Plan:
•18” rule observed with sprinklers?
•Fire exits blocked?
•Fire extinguishers checked?
Star/Leaf
Patient Safety
Assess Fall Prevention Program:
•Are patients being assessed for fall risk?
•Are the high risk patients identified?
Dot Stickers
Medication
Management
Assess Look-alike, sound-alike med system:
•Is look-alike, sound-alike list posted?
•Is the “system” in use everywhere that
meds are stored?
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 Engage
the entire team
 Ensure safe patient care through
standardization, competence and consistent
practice
 Prevent healthcare harm through better
communication and structured hand-offs
 Use proven best practice tools and make
them work for you
 Turn the hard-to-achieve into fun and
creative methods
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