Presentation Transcript

1. Webinar 4: Checklist Modification/Customization

2. W S C U
3. Summary of Last Week’s Call Nuts and bolts of administering the culture survey. Administering the culture survey is important to your implementation. You may be surprised by what you find when see the culture survey results. The survey can give us valuable information to measure your progress with putting the checklist into place.
4. Administering the Culture Survey
5. Email Research Participants Only This is offered to hospitals that have indicated that they are part of the research. Complete the provided template that asks for names, titles, and email addresses for anesthesia providers, nurses, surgeons, and techs and send it to us. Modify a cover letter that will accompany the survey. Provide the name and email address of the person from whom you would like the invitation to originate.
6. IntranetResearch Participants Only If you have a hospital intranet we can provide you a link to the survey that you can post. Complete the provided template that asks for names, and titles for anesthesia providers, nurses, surgeons, and techs and send it to us. (No Need to Provide Email Addresses) Send us an email requesting this option.
7. Paper BasedAll Hospitals The paper based version of the survey is available on our website. Complete the provided template that asks for names, and titles for anesthesia providers, nurses, surgeons, and techs. If you are part of the research send us your spreadsheet. (No need to provide email addresses). You will also send us completed surveys for analysis. If you are not part of the research use the spreadsheet to monitor the response rate.
8. Survey MonkeyHospitals Not Participating in Research Use your own survey monkey account and analyze your results.
9. Excel Template
10. Advertising the Survey Posters Announce the survey at staff meetings Advertise in the surgeon’s lounge

11. How Did the Homework Go?

12. Homework to Date Gather an implementation team Schedule a time and venue for a meeting to take place in 8-10 weeks Read background materials on the checklist and look at safesurgery2015.org website Create a list using the excel template provided to you of all of the OR staff, physicians, and techs. This template asks for names, titles, and email addresses Send us a picture of your checklist implementation team Designate if your hospital will be participating in the research portion of this project Review instructions for the culture survey and administer based on the previous discussion. Review the checklist modification guide and South Carolina Checklist Template.
13. The Checklist as a Documentation Tool How many of you want to use the checklist as an auditing tool? When you discussed the checklist with your colleagues, did they have concerns about including the checklist in the medical record? If you are already using the checklist, do you keep it as part of the medical record?
14. Using the Checklist As a Documentation Tool SCIP Measures Electronic Medical Record Patient Chart Signatures Malpractice issues
15. This Checklist Is Not . . . An algorithm. A tool to train people how to do their jobs. A “tick boxing” exercise.
16. This Checklist is . . . A reminder for the surgical team to perform/discuss critical safety steps for every patient every time. Performed as a team and read aloud.

17. Origin of Checklist Items

18. Universal Protocol/Standard of Practice SCIP SC Checklist
19. Universal Protocol/Standard of Practice SCIP SC Checklist
20. Universal Protocol/Standard of Practice SCIP SC Checklist
21. Universal Protocol/Standard of Practice SCIP SC Checklist
22. Checklist Modification 101 Make Me Your Own
23. The Basics One size doesn’t fit all. Every hospital should modify the checklist. Checklist modification creates buy-in and ownership. The checklist is designed to promote teamwork and communication . . . don’t remove teamwork/communication items.

24. Things to Keep In Mind When Modifying the Checklist

25. Brief Each section (Before Induction of Anesthesia, Before Skin Incision, and Before the Patient Leaves the Room) should take < 1 minute. The checklist should never take longer than the procedure. The checklist should fit on one page.
26. When Adding and/or Removing Items Ask Yourself . . . . Is this a critical safety step and in great danger of being missed? Examples: Known Allergies, Essential Imaging, Antibiotic Prophylaxis Is this adequately checked by other mechanisms? Examples: Anesthesia safety checklist has been completed, Sterility including indicator results Is this actionable, with a specific response? Example: Monitoring blood pressure Is this item discussed at a time when all relevant team members are present and when something can be done to fix it? Examples: Essential equipment and expected blood loss Will this item help anybody here?

27. Alternative Wording for Particular Items

28. Modifying Blood Loss Are blood products required and available? What is the EBL? Blood (or cross-match) available if needed. Is there a need for blood products? Blood availability confirmed. EBL/Blood Plan
29. Modifying Team Introductions We will start by introducing ourselves by name and role. Team introductions to patient, including name and role. Are there any unfamiliar staff in the room? Please introduce yourself by name and role.
30. What If We Already Know Each Other? We recommend that even if you know each other that everybody says something before the procedure starts. Check-off with everybody in the room Surgeon says, “Mary, are you ready to go?” etc.
31. Modifying the Safety Statement Surgeon says: “If anyone on the team sees something that the team should know about, please speak up” Surgeon declares: “If anyone on the team sees something that the team should know about, please speak up anytime during the procedure.” Surgeon states, “If you see, suspect, or feel that patient care is compromised, will you speak up?” Surgeon states, “Remember that all are free to voice any concerns at any time throughout the procedure” Surgeon states, “Does anyone have concerns? If you think there is a problem, please speak up”
32. Is the Checklist the Best Way to Take Care of This? Glycemic Control Fire Risk Assessment Hair Removal Checking Pressure Points

33. Examples of Modified Checklists

34. Process to Follow When Modifying the Checklist

35. This Week Modify the checklist with your implementation team. Discuss each item on the checklist using the guidelines that we previously discussed. Ensure that the checklist follows your current flow in the OR. Add your hospital logo to the checklist. Once it is modified, practice using the checklist in a “table top simulation”.
36. “Table-Top” Simulation S Anes. Machine CN A SN Conference Room or an Empty OR
37. This Week Debrief, how did it go? What needs to be changed to fit the flow in your ORs? If you are happy with your checklist try using it in the OR in one case. Only use it with the implementation team that built the checklist.
38. This Week’s Homework Start/Continue to administer the culture survey Modify the checklist with your implementation team. Use your modified checklist in a “table top simulation”. Then use the checklist in one case for one day. Only do this with the implementation team. Send us your hospital’s modified checklist before next week’s call.
39. ? Questions
40. Ask Us a Question By Using the Raise Hand Button

41. Next Week’s Call:Checklist Modification Cont. and Small Scale Testing

42. Resources Website: www.safesurgery2015.org Email: safesurgery2015@hsph.harvard.edu