C2 Rapid Fire: Operation(al) Integrity A. Muniak

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  • Many industries: Aviation and Aerospace, Energy (hydro, nuclear, petro-chemical), Heavy Construction Military
  • Different interpretation of a completed checklist Resistance from some team members in participating Difficulty in completing the debriefing Complexity Distraction
  • Provide an assessment of the use of the checklist in surgical procedures throughout Vancouver Coastal Health and Providence Health
  • What is the compliance n value
  • occurring appropriately and timely – teams are introducing everyone in the room to the patient, visitors are introduced to the surgical team
  • Not taking the checklist ‘seriously’, focusing or stopping what they are doing to have the conversation. Team members are often not present (in person or by phone for the conversation). Assigning a designate that does not know the patient ’s history or have a complete understanding of the patient
  • Ensuring everyone is involved Conversation is comprehensive and increases situational awareness Empowers the team to ‘critically think’, is flexible, and uses their expertise. Who initiates the checklist and when? Support from leaders throughout the HA on the importance of the checklist conversation Support for surgical teams when individuals do not participate A few surgeons had not heard of the surgical safety checklist Timing of when the briefing, time-out, and debriefing are. Assigning a designate Making the checklist your “own”
  • C2 Rapid Fire: Operation(al) Integrity A. Muniak

    1. 1. A Multi-Faceted Progress Evaluation ofthe Use of the Surgical Safety Checklist Allison Muniak (nee Lamsdale), M.A.Sc Human Factors Specialist Quality & Patient Safety Quality Forum 2012 March 8th, 2012
    2. 2. Authors• Allison Muniak• Claire O’Quinn• Dermot Kelly• Meghan MacLeod• Kelle Payne• Linda DempsterWork completed by Vancouver Coastal Health andProvidence Healthcare
    3. 3. BackgroundSafety Checklists: Communication tools to empower teams by increasing situational awareness, teamwork and cooperation, problem-solving and decision- making, and leadership and management in complex environments
    4. 4. Surgical Safety Checklist• Designed an interactive tool using Human Factors principles to structure team communication and assist in ensuring that all team members possess accurate and explicit information regarding the patient and procedural plan, to give team members the same context (situational awareness).
    5. 5. Surgical Team in Action
    6. 6. Progress Assessment
    7. 7. Objectives of the Surgical Safety Checklist Assessment• Assessment of the Surgical Safety Checklist post implementation• Quantify the use of the Surgical Safety Checklist in procedures across the region• Qualify how the tool is being used: – Pieces that provide beneficial information, – Areas that need improvement• Reconcile documented use to actual use• Identify good catches
    8. 8. Methods• A multi-faceted evaluation of the Surgical Safety Checklist will occur to collect: – A comprehensive understanding – The effectiveness – Highlight personal experiences
    9. 9. Evaluation Tools• Observations of surgical procedures – A minimum of 65 surgical cases by 5 observers – Facilities include VGH, UBCH, LGH, RH, SPH & MSJ• An electronic survey – All surgical staff members across VCH receive an invitation to participate• Interviews of front line staff – At minimum, 3 nurses, 3 surgeons, and 3 anesthesiologists from each facilities. – Nursing graduate student and Human Factors Specialist interviewers
    10. 10. Assessment Status (February 24th, 2012)Evaluation ActualInterviews 24Observations 35Electronic Survey 162
    11. 11. Overall Findings1. Differences in the compliance rate verses perceived completion of the checklist.2. Every facility observed has incorporated the checklist into their workflow differently.3. Surgical teams value the checklist4. Concerns around the entire team ‘buying-in’, increased leadership, responsibility, and simplification of content?
    12. 12. Surgical Safety Checklist CompletionEvaluation Type Overall Briefing Time-Out DebriefingInterviews 84.8% 71.4% 93.4% 54.4%(n=24)Observations 76.3% Standard Above Standard(n=35) StandardElectronic Survey 88.1% 68.6% 93.3% 59.2%(n=162)Compliance 72.8% -- -- --Score (P9 report)Average Total 80.5%(all 4 methods)
    13. 13. Q3. What parts of the Surgical Safety Checklist have been working well?Strongest themes:• Antibiotic prophylaxis administration• DVT prophylaxis considerations• Availability of appropriate implants and equipment• Allergies awareness and confirmation• Overall increased communication in the OR
    14. 14. Q4. What parts of the Surgical SafetyChecklist have NOT been working well?Strongest themes:• Briefing and Debriefing• Lack of awareness and understanding of the purpose• Attention• Responsibility and accountability• Designates
    15. 15. Best Surgical Safety Checklists Observed to date:• Dr. Bas Masri (Ortho): Ownership of checklist• Dr. Ryan Patterson (Urology): Empowering residents• Dr. Houston (General RH): Conversation Involvement• Dr. Thompson (Spine LGH): Involvement of patient
    16. 16. Good Catches (Electronic Survey Responses)53 Good Catches / Close Calls (n=162)Summary of themes:• Antibiotics **• Surgical site and side• Wrong patient• DVT prophylaxis• Equipment, Implants• Blood type and product availability
    17. 17. Q8. Would you want the Surgical SafetyChecklist used if you were having surgery?
    18. 18. Areas of Improvement• Empowering teams to think “critically”• Supporting leadership, responsibility, and accountability• Awareness and education on the value of team communication• Logistics in implementation
    19. 19. Next Steps• Provide final report and findings to surgical staff and leadership• Develop recommendations with the team• Further refine the checklist conversation for improved use• Complete implementation and assessment of procedural checklists throughout VCH / PHC
    20. 20. ContactAllison Muniak (nee Lamsdale), M.A.Sc – Human Factors SpecialistQuality and Patient Safety, Vancouver Coastal HealthContact:Email: allison.muniak@vch.caPhone: 1-604-875-4111 extension 66096Rm 380, Centennial Pavilion855 West 12th Avenue,Vancouver, BC, V5Z 1M9Canada

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