The document summarizes the first 18 months of a patient safety program called Caring Safely at an organization. The program had four main objectives: reduce serious safety events by two-thirds, improve staff safety by reducing injuries by 20%, reduce hospital-acquired conditions significantly, and enhance the safety culture by following high reliability principles. To achieve these, the program utilized strategies like reliability bundles, a high reliability culture, error prevention, leadership methods, investigation of issues, and system redesign. Benchmarking data showed reductions in various hospital-acquired conditions and improvements in the safety culture through initiatives like daily safety briefings and training programs for staff.
Overcoming Barriers to Risk-Based MonitoringBioclinica
Risk-Based Monitoring offers an amazing opportunity, but there are many companies that are hesitant to undertake such an initiative. In this on demand webinar, experts Mireille Zerola and Courtney McBean will discuss common challenges organizations face when transitioning to risk based monitoring and ways to overcome these obstacles.
Healthcare Got Personal in 2016... Top 12 Trends of the Year SAP
2016 was a huge year for the healthcare industry. Vice President Joe Biden's Cancer Moonshot initiative, wider adoption of genome sequencing, electronic medical records... we grow closer to the adoption of precision care each day.
What has enabled the revolution? Big Data analytics and high speed technology. Check out how.
HealthXL is the global clearing house for innovation in healthcare. We catalyse collaboration between leading brands in healthcare and the most exciting tech companies to improve the lives of millions of people.
Together with our partners we establish audacious goals (Moonshots) to work towards within healthcare. Then we search for innovators in digital health that can work with us and our partners to achieve those Moonshots. We help them find each other, create business partnerships and facilitate their relationship through collaboration.
Our partners are Bupa, Cleveland Clinic, Becton Dickinson, IBM, ICON, ResMed, Janssen Healthcare Innovation, Linde Healthcare, Novartis, Partners HealthCare, Silicon Valley Bank, EY, SoftServe, and Hermitage Medical Clinic.
Recently, a study published in the Journal of the American Dental Association shows a growing trend among U.S. dentists to incorporate EDR technology into their practice. Learn about how technology adoption has changed over the last decade among dentists, as well as how they are using the technology in their practices.
Overcoming Barriers to Risk-Based MonitoringBioclinica
Risk-Based Monitoring offers an amazing opportunity, but there are many companies that are hesitant to undertake such an initiative. In this on demand webinar, experts Mireille Zerola and Courtney McBean will discuss common challenges organizations face when transitioning to risk based monitoring and ways to overcome these obstacles.
Healthcare Got Personal in 2016... Top 12 Trends of the Year SAP
2016 was a huge year for the healthcare industry. Vice President Joe Biden's Cancer Moonshot initiative, wider adoption of genome sequencing, electronic medical records... we grow closer to the adoption of precision care each day.
What has enabled the revolution? Big Data analytics and high speed technology. Check out how.
HealthXL is the global clearing house for innovation in healthcare. We catalyse collaboration between leading brands in healthcare and the most exciting tech companies to improve the lives of millions of people.
Together with our partners we establish audacious goals (Moonshots) to work towards within healthcare. Then we search for innovators in digital health that can work with us and our partners to achieve those Moonshots. We help them find each other, create business partnerships and facilitate their relationship through collaboration.
Our partners are Bupa, Cleveland Clinic, Becton Dickinson, IBM, ICON, ResMed, Janssen Healthcare Innovation, Linde Healthcare, Novartis, Partners HealthCare, Silicon Valley Bank, EY, SoftServe, and Hermitage Medical Clinic.
Recently, a study published in the Journal of the American Dental Association shows a growing trend among U.S. dentists to incorporate EDR technology into their practice. Learn about how technology adoption has changed over the last decade among dentists, as well as how they are using the technology in their practices.
Behavioural change presentation from Mobile World Congress 2016Ross Taylor
How industry and agency needs to collaborate with the best of academia in order to create behavioural change programmes that are rooted in robust, validated techniques as well as creative inspiration.
Anaesthesia Surgical Procedures in COVID19 for safety precautions | Dr Shivan...Dr Shivani Sachdev Gour
Modifications due to covid19 in surgical procedures for safety precautions by Dr. Shivani Sachdev Gour and Dr. Rahul at SCI International Hospital. Tips to surgical procedures for safety precautions due to covid19: Modifications due to covid19 in surgical procedures for safety precautions.
Forever Autumn is a Falls Awareness and Falls Prevention initiative being developed in St Mary's Hospital, Phoenix Park, Dublin Ireland.
It builds on the Bone Health Education Programme which was launched in May 2011.
The project team comprises of clinical and non clinical members of staff from the hospital. The project is being led by Daragh Rodger, CNS in Health Promotion and Assessment of the Older Adult, and Anne Spencer, Clinical Educational Technologist.
HealthXL is the global clearing house for innovation in healthcare. We catalyse collaboration between leading brands in healthcare and the most exciting tech companies to improve the lives of millions of people.
Our partners are Bupa, Cleveland Clinic, Becton Dickinson, IBM, ICON, ResMed, Janssen Healthcare Innovation, Linde Healthcare, Novartis, Partners HealthCare, Silicon Valley Bank and EY.
Together with our partners we establish audacious goals (Moonshots) to work towards within healthcare. Then we search for innovators in digital health that can work with us and our partners to achieve those Moonshots. We help them find each other, create business partnerships and facilitate their relationship through collaboration
Listening to the Lonely Voice of Autoimmune Patients At Stanford MedicineXDrBonnie360
There is a large and growing incidence of autoimmune diseases in young adults. We need to work together to better understand the underlying cause of these diseases and develop collaborative and complimentary approaches to care.
Introduction to a panel of architects, public heath professionals, and civic leaders about designing for health. Hosted by American Institute of Architects, Washington, DC, on October 8, 2014
Beyond Cancer: Precision Medicine Needed to Take on Autoimmune DiseaseDrBonnie360
Judy Jetson reimagines diagnosis and treatment of autoimmune disease.
Precision medicine is emerging in cancer therapy: biomarkers are enabling stratification of patients for better study designs and clinicians are matching treatment to disease and patient to improve outcomes. Increasing ability to mine data (genomic, metabolomic, etc.) to develop targeted therapies and improved diagnostics is making possible the use of precision medicine against other disease states. The knowledge from using data and digital tools to personalize cancer treatment can and should be applied to the growing needs of the autoimmune community. With more than 50M Americans suffering from 90+ different autoimmune diseases, this is a large and growing market. NIH estimates that $100 billion is spent annually (compared to $57 billion in cancer), but treating symptoms, rather than curing diseases. This talk explores how we can begin to use big data and digital tools to ignite precision medicine in autoimmune disease for Judy Jetson.
A review of some of the pitfalls in planning local practice development programmes, and a suggestions for how to produce a comprehensive and coherent plan that will achieve meaningful goals
BioAgilytix and ATCC Partner to Develop Cell-Based Assay SolutionsTerrell Herring
Possessing extensive experience in the pharmaceutical industry, Terrell Herring operates as the president of Alamo Pharma Services, Inc., in Doylestown, Pennsylvania. Terrell (“Terry”) Herring also serves on the Advisory Board of BioAgilytix, a contract testing services provider.
How employers can take control of unmanaged chronic disease health costs, and drive productivity across the whole workforce through better eyecare integrated into benefits packages
Territoris digitals. Les ciutats, el seu entorn i el Big dataMarca Ciutat
Diapositives corresponents a la ponència “Territoris digitals. Les ciutats, el seu entorn i el Big data”, a càrrec de Genís Roca, president de Roca Salvatella.
Behavioural change presentation from Mobile World Congress 2016Ross Taylor
How industry and agency needs to collaborate with the best of academia in order to create behavioural change programmes that are rooted in robust, validated techniques as well as creative inspiration.
Anaesthesia Surgical Procedures in COVID19 for safety precautions | Dr Shivan...Dr Shivani Sachdev Gour
Modifications due to covid19 in surgical procedures for safety precautions by Dr. Shivani Sachdev Gour and Dr. Rahul at SCI International Hospital. Tips to surgical procedures for safety precautions due to covid19: Modifications due to covid19 in surgical procedures for safety precautions.
Forever Autumn is a Falls Awareness and Falls Prevention initiative being developed in St Mary's Hospital, Phoenix Park, Dublin Ireland.
It builds on the Bone Health Education Programme which was launched in May 2011.
The project team comprises of clinical and non clinical members of staff from the hospital. The project is being led by Daragh Rodger, CNS in Health Promotion and Assessment of the Older Adult, and Anne Spencer, Clinical Educational Technologist.
HealthXL is the global clearing house for innovation in healthcare. We catalyse collaboration between leading brands in healthcare and the most exciting tech companies to improve the lives of millions of people.
Our partners are Bupa, Cleveland Clinic, Becton Dickinson, IBM, ICON, ResMed, Janssen Healthcare Innovation, Linde Healthcare, Novartis, Partners HealthCare, Silicon Valley Bank and EY.
Together with our partners we establish audacious goals (Moonshots) to work towards within healthcare. Then we search for innovators in digital health that can work with us and our partners to achieve those Moonshots. We help them find each other, create business partnerships and facilitate their relationship through collaboration
Listening to the Lonely Voice of Autoimmune Patients At Stanford MedicineXDrBonnie360
There is a large and growing incidence of autoimmune diseases in young adults. We need to work together to better understand the underlying cause of these diseases and develop collaborative and complimentary approaches to care.
Introduction to a panel of architects, public heath professionals, and civic leaders about designing for health. Hosted by American Institute of Architects, Washington, DC, on October 8, 2014
Beyond Cancer: Precision Medicine Needed to Take on Autoimmune DiseaseDrBonnie360
Judy Jetson reimagines diagnosis and treatment of autoimmune disease.
Precision medicine is emerging in cancer therapy: biomarkers are enabling stratification of patients for better study designs and clinicians are matching treatment to disease and patient to improve outcomes. Increasing ability to mine data (genomic, metabolomic, etc.) to develop targeted therapies and improved diagnostics is making possible the use of precision medicine against other disease states. The knowledge from using data and digital tools to personalize cancer treatment can and should be applied to the growing needs of the autoimmune community. With more than 50M Americans suffering from 90+ different autoimmune diseases, this is a large and growing market. NIH estimates that $100 billion is spent annually (compared to $57 billion in cancer), but treating symptoms, rather than curing diseases. This talk explores how we can begin to use big data and digital tools to ignite precision medicine in autoimmune disease for Judy Jetson.
A review of some of the pitfalls in planning local practice development programmes, and a suggestions for how to produce a comprehensive and coherent plan that will achieve meaningful goals
BioAgilytix and ATCC Partner to Develop Cell-Based Assay SolutionsTerrell Herring
Possessing extensive experience in the pharmaceutical industry, Terrell Herring operates as the president of Alamo Pharma Services, Inc., in Doylestown, Pennsylvania. Terrell (“Terry”) Herring also serves on the Advisory Board of BioAgilytix, a contract testing services provider.
How employers can take control of unmanaged chronic disease health costs, and drive productivity across the whole workforce through better eyecare integrated into benefits packages
Territoris digitals. Les ciutats, el seu entorn i el Big dataMarca Ciutat
Diapositives corresponents a la ponència “Territoris digitals. Les ciutats, el seu entorn i el Big data”, a càrrec de Genís Roca, president de Roca Salvatella.
Victoria Brazil - Putting the Patient into Patient SafetySMACC Conference
Patients are at risk – from the moment they begin their healthcare journey.
They are at risk of bad outcomes (as defined by us) and of bad experience (as can only be defined by them).
Patient safety experts like James Reason, and groups like the Institute for Healthcare Improvement (IHI) have prompted us to think about systems and complexity as sources of error – and supported strategies to remove predictable human fallibility as far as possible. This is important to make healthcare safer.
Vic Brazil’s talk suggests there is also a human face to patient safety - in the behaviour and attitude of healthcare practitioners and patients themselves......
We think too little of patients. We feel affronted if patient takes a different view of ‘evidence’ or of ‘risk’.
…and they think too much of us....! Every day patients allow nurses (and doctors) to inject drugs into their IV line without asking “whats in that syringe”....
This combination of our subconscious paternalism and patients’ blind faith is a heady mix……but ripe for us to make a difference.
Vic suggests there are are small, human ways we can involve patients in safer healthcare, of better quality and with an improved patient experience.
We can ask them.
We often do involve patient advocates at the ‘strategic end’, but when was the last time you invited a real patient to your departmental teaching or consultant meeting (or smacc conference...!)
Presentations from the patient safety conference held at Teesside University on 1 and 2 September 2014 - Students at the forefront of continuing and improving our culture of safe care
Free book on patient safety by Dr Aniruddha Malpani
Medical errors can be a nightmare – both for patients, and for doctors. However, this is one of those topics which we prefer to sweep under the carpet, because it can be so emotionally charged.
This book provides a holistic overview of medical errors from multiple perspectives. Doctors, nurses, pharmacists, other healthcare providers, pharmaceutical companies, insurers and patients themselves all need to work together to promote patient safety.
Starting with the basics as to why medical errors are still so common, this book highlights what needs to be done to keep patients safe. Reading this book may help to save your life, or that of a loved one. If you are a patient, please read it before you go to the doctor . If you are a doctor, please read it before you see your next patient !
patient safety and staff Management system ppt.pptxanjalatchi
Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
patient safety and staff Management system ppt.pptxanjalatchi
What is Patient Safety? Patient Safety is a health care discipline that emerged with the evolving complexity in health care systems and the resulting rise of patient harm in health care facilities. It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care.
Introducing the Next-Gen Patient Safety OrganizationHealth Catalyst
Eliminating avoidable harm is a problem that we can and should solve. The journey to become highly reliable at producing meaningful and sustainable outcomes improvements requires organizations to maximize their investments in safety.
Safety improvements are the result of people, and process changes with data-driven insights as the underlying secret ingredient, but most PSOs are missing this tight integration between the three. Does your PSO?
View this webinar announcing the next generation Health Catalyst Patient Safety Organization (HC PSO) and learn why coupling it with the Health Catalyst Patient Safety Monitor™ Suite—built by patient safety experts for patient safety experts—is such an important differentiator. Leading in this product announcement are two experts in patient safety, Michael Barton and Elaine St. James. In this webinar they share the following:
- Importance of active safety surveillance and analysis to discover safety vulnerabilities that are often overlooked.
- Operational efficiency and organizational risk avoidance available by hosting together the safety analytics and HC PSO.
- Effective safety governance and application of safety best practices that will improve outcomes in a measurable, and sustainable way.
- Integration of analytics, and benchmarking from a health care Data Operating System (DOS).
Implementation of an active trigger surveillance tool into your existing system is just one step on your safety journey. Eliminating preventable harm requires commitment to change, organizational buy-in and a number of key components that will be discussed in this webinar. We hope that you will view the webinar.
The implementation of Risk management in a health care organisation ensure safe health care,increased patient satisfaction , improved bottom line and brand value.
Objectives:
By the end of this call, you will be able to:
•Describe the processes of Root-Cause Analysis (RCA) and Multi-Incident Analysis (MIA) and their role in quality improvement
•Compare and contrast the different approaches to collecting hospital-acquired VTE data
•Identify an approach suitable for improving patient safety at your institution
Simple and Safe Approaches Towards Patient SafetyEhi Iden
A conference presentation on simple approaches and steps in achieving and managing patient safety in health. It talks about team approach, mutual support, just system, leadership commitment, complications of blame game and case study of the popular Kimberly Hiatt story.
We held an improvement collaborative with 19 NHS providers earlier this year to help improve the management of falls in an inpatient setting.
This resource shows case studies of the providers involved in the collaborative.
Objectives:
1.Introduce the Measuring and Monitoring of Safety Framework to a Canadian healthcare audience
2.Describe how the framework would work in Canada
Oct 25 CAPHC Concurrent Symposium - Sleep Disorders - Dr. Penny Corkum and ...Glenna Gosewich
CAPHC Concurrent Symposium
Sleep Disorders in Canadian Children: What Can We Do to Ensure Better Nights and Better Days for Children and their Families?
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
4. Four Objectives of Caring Safely*
1. Reduce the incidence of Serious Safety Events (SSEs)
by two-thirds
2. Improve Staff Safety by reducing lost time injury count,
frequency rate and/or severity by 20%
3. Reduce the incidence of the seven
Hospital Acquired Conditions (HACs) significantly
4. Enhance our Safety Culture by adhering to the
principles of High Reliability Organizations
* April 2015 – March 2018
5. Taking on all patient and staff harms simultaneously
•Central line infections
•Surgical site infections
•Pressure Injuries
•Catheter-associated
Urinary tract Infection
•Ventilator associated
pneumonia
•Falls with significant
harm
•(Adverse Drug Events)
Bundle reliability:
Set teach audit
the standard
• Delayed recognition/response to
deterioration, e.g. sepsis
• Failure to respond to results of
investigations
• Errors in decision-making
• Failure to use expertise
High Reliability Culture:
Error prevention strategies
Leadership methods
RCA
System redesign
16
6. Hospital Acquired Condition Network Center Line SickKids Center Line
Adverse Drug Event 0.03/1000 pt days
Catheter Associated Urinary Tract
Infections
1.35/1000 catheter
days
Central Line Associated Blood
Stream Infections
1.52/1000 line days
Falls (Moderate or Greater Injury) 0.02/1000 pt days
Pressure Injuries (formerly ulcers) 0.11/1000 pt days
Surgical Site Infections 1.71/100 procedures
Ventilator Associated Pneumonia 0.54/1000 vent days
Benchmarking against Network data helps to identify priorities of focus and
accomplishments to celebrate and sustain
10. HOW CAN WE PREVENT THIS?SUMMARY OF EVENT
Capturing Events
The Case of the: <title>
<Date>
WHY DID THIS EVENT HAPPEN?
The story presented above is an example of patient safety events
occurring in hospitals across the country. As a learning
organization, telling these stories is intended to generate dialogue
among frontline caregivers who may be able to prevent a similar
occurrence. For internal use only.
HOW CAN WE SUPPORT THE CULTURE OF
SAFETY?
14. ‘We’re not going to compete on safety’: Canadian paediatric health centres
collaborate on journey to eliminating preventable harm
Clinical and operational leaders from SickKids, CHEO, and IWK came together to
share ideas and key learnings about the journey to reducing preventable harm.
SPS is the only HEN to focus not just on HACs but also on SSEs
Error Prevention- The interactive session sets the stage for understanding how errors occur and discusses the error prevention strategies to be adopted in order to meet the expected behaviors for Caring Safely. These practical strategies are aligned with high reliability organization principles, and audience participation is encouraged in the exercises to develop insight, confidence and competence in enacting these strategies for error prevention.
ARCC
QVV
Stop & Resolve
STAR
Leadership Methods- Learn, adopt and practice leadership skills for building and sustaining a culture of safety and performance excellence. The role then of leaders at all levels is to effectively influence behaviors to achieve performance expectation.
Rounding to Influence
Safety Huddles
Organizational Safety Brief
Top 10 Problem List
Safety Coach Program- Safety coach program is a tool for reinforcing the safety training techniques for a sustainable safety culture.
Observe the performance of a group or individuals to determine if practice meets our Safe Behavior expectations
Provide real time feedback to reinforce good practices and correct unsafe practices
Time: 1 min
Key Point: Introduction to trainers.
Introduce yourself as the trainers for today’s session., and that you are a part of a team of 54 Caring Safely trainers for the hospital. My name is……, and I work …..
Definitions in our Management of Serious Patient Safety Incidents policy
Critical incident (relates to Public Hospitals Act): “Any unintended event that occurs when a patient receives treatment in the Hospital that results in a) death or serious disability, injury, or harm and b) does not result primarily from the patient’s underlying medical condition or from a known risk inherent in providing treatment” (this leaves a lot of discretion to the hospital - policy states that decision is made by Risk, with Chief, EVP Clinical, VP Medical, and Clinical Director if applicable – practical experience is that Risk has most influence on what is called)
Serious Patient Safety Incident (relates to Canadian Incident Analysis Framework) “an event or circumstance which could have resulted or did result in severe unnecessary harm to a patient, including death and permanent loss of function, that does not result primarily from the patient’s underlying condition”
Main difference between these and SSE is that these require severe/permanent loss of function
Serious Safety Events are deviations in best-practice care that result in:
Death
Severe permanent harm
Moderate permanent harm
Severe temporary harm: Detectable harm, lasting for a limited time only, resulting in no permanent injury, yet causing great discomfort, injury, and/or distress. For example, resuscitation required or additional procedure/surgery.
Precursor Events
Near-Miss Events