MISSOURI SAFE SURGERY SAVES LIVES DASH

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MISSOURI SAFE SURGERY SAVES LIVES DASH

• April 24 and 29, 2009
• Missouri Hospital Association
• Missouri Center for Patient Safety

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HOSPITALS EXPERIENCE

• Citizens Memorial Hospital Linda Harris
• Community Hospital Fairfax Rhonda Evans
• Others?
• Freeman Health System Mona Caylor
• IHI Mentor Hospitals www.ihi.org/IHI/Programs/Camp
  aign/mentor_registry_ssc.htm

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FAQs

• See also FAQs on IHI website
• Q Does this substitute for the Universal
  Protocol?
• A The two are not in conflict but use of the WHO
  checklist does not ensure compliance with UP. TJC
  is reviewing the UP to determine if refinements
  are needed.
• The WHO checklist does not include the
  following verification of required implant and
  devises, properly labeled diagnostic and
  radiology results, correct position.
• You dont have to document completion of the WHO
  checklist but you do the UP.
• Q How can I incorporate core measures,
  hospital-specific initiatives and the Universal
  Protocol into the checklist?
• A Look at modified checklists on the SafeSurgery
  web site and the guidelines for modifying on the
  IHI Web site.

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FAQs

• Q Who needs to be present at the sign in phase
  before induction of anesthesia?
• A Ideally the entire team, but at a minimum the
  anesthesia provider and the scrub or circulating
  nurse need to be present. Not an expectation that
  the surgeon be there but it would be ideal. The
  more staff present, the better the process will
  be.
• Q What is the patients reaction when you ask
  about EBL while the patient is still awake?
• A Generally patients are comforted by the
  process. There should be appropriate language
  developed.
• Q How can we monitor improvement as a result of
  the checklist?
• A Look at what you already measure SSIs,
  mortality rate, retained objects, compliance with
  SCIP measures, AHRQ PSI indicators.

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FAQs

• Q Who reads the checklist?
• A Ideally it should be the surgeon but the
  circulating nurse is most likely to be the one to
  do it. You dont have to actually check it off
  it is just a safety tool not a documentation
  tool. Dont change your current documentation
  process.
• Q Is the checklist comprehensive enough? Should
  we review meds for the risk of bleeding?
• A The checklist is not designed to be totally
  comprehensive. It is designed for the greatest
  risk factors. Reviewing meds for risk of
  bleeding etc. is not widely applicable. If you
  add too much, the list becomes unruly.
• Q How do you get the surgeons on board?
• A Have a surgeon talk to the surgeons using a
  short video clip and presentation about 10
  minutes in length.

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FAQs

• Q What do you do about the surgeon who refuses to
  wait for the checklist to be done?
• A You could tie compliance with privileging.
  Scrub techs in one hospital left all starting
  instruments (scalpel, speculum, cope, etc) on the
  back table until the checklist was completed.
• Q Does the OR team really need to introduce
  themselves?
• A If people speak at the beginning they are much
  more likely to speak up during the surgery if
  there is a problem. One surgeon who worked with
  the same team for years, couldnt remember the
  scrub nurses name and was glad they did
  introductions.
• Q What do we do about surgeons complaining that
  the hospital across town does something
  different?
• A Work with area hospitals to create a
  community-wide standardization of checklists.

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RESOURCES

• http//www.ihi.org/IHI/Programs/ImprovementMap/WHO
  SurgicalSafetyChecklist.htm
• Starter kit
• Blog, brochure, webinars
• FAQs
• http//www.who.int/patientsafety/safesurgery/en/WH
  O Safe Surgery Saves Lives
• Dr. Gawande's lecture
• ER episode
• http//www.safesurg.org/
• Learn More Tab Examples of modified checklists
  especially Brigham and Womens Hospital,
  Childrens Hospital Boston
• Implementation Tab PowerPoint
• Video tab

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RESOURCES

• http//www.scoap.org/checklist/ Surgical Care
  Outcomes Assessment Program SCOAP modified
  checklists
• http//www.jointcommission.org/PatientSafety/Unive
  rsalProtocol/ Universal Protocol
• http//www.mocps.org/docs/Missouri_Safe_Surgery_Sa
  ves_Lives_DASH.pdf Missouri DASH

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SHARING BEST PRACTICES

• Please contact Sharon or Becky to share
• modified checklists especially for ambulatory
  surgery and OP procedures
• policies and procedures
• our experiences
• or to be a national IHI mentor or a Missouri
  Mentor

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NEXT STEPS

• Register commitment to test at
• www.who.int/patientsafety/safesurgery/hospital_for
  m/en/index.html
• Report results/experience with your commitment at
• www.surveymonkey.com/s.aspx?smv5PfRnrcnAQlX44n9H0
  2EQ_3d_3d
• Share stories with Becky or Sharon
• bmiller_at_mocps.org or sburnett_at_mail.mhanet.com
• Share stories with your community!
• The State Map Coming

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IHI IMPROVEMENT MAP

• WHO Surgical Safety Checklist
• Prevent Catheter-Associated Urinary Tract
  Infections
• Link Quality and Financial Management Strategies
  to Engage the Chief Financial Officer and Provide
  Value for Patients

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IHI IMPROVEMENT MAP

• Prevent Catheter-Associated Urinary Tract
  Infections
• http//www.ihi.org/IHI/Programs/ImprovementMap/Pre
  ventCatheterAssociatedUrinaryTractInfections.htm
• Guides, videos, bundles, articles, compendiums
• HACs

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IHI IMPROVEMENT MAP

• Link Quality and Financial Management
• Strategies to Engage the Chief Financial Officer
  and Provide Value for Patients
• http//www.ihi.org/IHI/Programs/ImprovementMap/Lin
  kQualityandFinancialManagement.htm
• Adverse Events Prevented Calculator
• Building the Business Case for Quality