Transcript Slide 1
An Endoscopy Checklist: Patient story, implementation of tool, and measuring success Jacky Watkins RN PG. Dip, MN, Erehi Tua RN, Linda Jackson CNM Contents Background Methodology • • • • • Process observation Identification process Time out Checklist Implementation Results Background Two patients with similar Names Patient A for gastroscopy, Patient B for bronchoscopy • Dr called for A, B responded, consented and had a gastroscopy. Bronchoscopy was rescheduled • Elderly, confused patient for inpatient gastroscopy Follow up post bleeding gastric ulcer • NJ tube was removed (standard practice) • Wrong sticker on referral form • Perforation during procedure to replace NJ tube • Methodology Root Cause Analysis Observational study • • • • • Review sticky label process Review identification process Theatre time out development Develop standard operation procedures/ Role descriptions Review consenting process Identify Actions Plan do check act interventions Observation The different areas of patient travel were analyzed which identified four processes, namely: The reception admission Process. • The clinical admission Process. • The procedure Process. • The recovery Process. • This analysis helped us to develop a Near Miss Template that captured data Gastro Out Patient Procedure Process Registration Admission Procedure Admission Co-ord/ Nurse check PiMS for next Pt based on time Start Patient report at Gastro reception Check patient’s name in PiMS No Pt. ok Notes passed on to Doctor when free for reading Yes Patient identified Pt. discharged Try to adjust the pt in the list Staff prepared the necessary medication Nurse ask questions and complete the form Staff collect the patient from recovery room Confirm the procedure Patient for Col Check Pt. information on PiMS Yes No Yes Complete/update the info by asking Take the patient to recovery room for change No Patient waits Doctor speaks to the patient in procedure room and complete consent form Doc explains the process Patient waits in Bed Luer required Yes Admit the Pt. in PiMS Patient recovers in recovery room Nurse collects and check all the equipments as per notes & checklist Patient taken to admission room Pt in right location Is information complete / updated Pt transferred to Recovery room Nurse collects the Pt notes from outside the room Acquire the pt. clinical notes Post procedure Nurse identifies the procedure room# from manual sheet Nurse insert Luer Procedure Send the Pt. to waiting area Update the sheet with colour coding Doctor updated the Pt. notes Place the notes outside the procedure room No Identification process Current practice – close ended questions • Change to open ended question • Before procedure room At each stage Script used to embed change in practice. • Entire team Script PATIENT LABEL TIME OUT BEFORE ANY PROCEDURE/SEDATION CHECKLIST (FORM TO BE COMPLETED BY THE HEAD OF PATIENT NURSE PLEASE) Question Write the actual response that the patient gives What is your full name? What is your date of birth? What is your understanding about what we are going to do today? If the Patient does not understand OR is unsure STOP Have you signed the consent form for what you are having today? Do you have any allergies? WHO Checklist Gastro Checklist AFFIX PATIENTS ID LABEL PROCEDURE SAFETY CHECKLIST – Generic V. 3 CHECK IN TIME OUT CHECK OUT (On arrival /hand over to the department) (prior to procedure beginning) (Prior to patient leaving the room/dept.) Nurse confirms with Patient Endoscopist confirms Nurse confirms What is your full name Identity Procedure performed ________________________________ Indication Specimen correctly labelled/presented What is your date of birth ______________________________________ Procedure & Reason for procedure Key concerns for hand over e.g. sedation What are we doing today? _______________________________________ Consent Obtained and Signed Follow-up instructions recorded e.g. drugs Allergies Critical events recorded Staff Check Discuss Have you signed consent for this procedure? Do you have any allergies? Set up – equipment medications required available Monitoring in place (pulse-oximeter, BP cuff) CHECK IN signature: _____________________ Anticipated or potential adverse events Speciality specific requirements Antibiotics IV fluids TIME OUT signature: _____________________ CHECK OUT signature: _____________________ PDCA Combined team meeting to establish purpose Trialed 1 list, 1 endoscopist, nursing team Altered until consensus reached Rolled one consultant at a time Support for all staff in use of form Commitment from Heads of Department Results No misidentification 3 years Incorrect patient highlighted – harm prevented Ongoing support to maintain standards Education for new staff • Updates for existing staff • Thank you Any questions?