Transcript Starting the Journey: Gather a Checklist Implementation Team

Call 2: Background of the
WHO Surgical Safety Checklist
Last Week’s Call
• Overview of the Safe Surgery 2015: South
Carolina Initiative and call series.
• MUSC’s checklist journey.
Today’s Topics
• Building an implementation team.
• Poll
• The background of the WHO Surgical
Safety Checklist.
• Website Overview.
Meeting the Team
Lorri Gibbons, RN, BSN, CPHQ
Vice President
Quality & Patient Safety
SCHA
Starting the Journey:
Building a Checklist
Implementation Team
Build an Implementation
Team
• Administrator/Quality Improvement Officer
• Anesthesiologist and/or CRNA
• Circulating Nurse
• Scrub Tech
• Surgeon
• Others (Perfusionists, PA’s, Biomedical
Engineers, Anesthesia Techs, Pre-op nursing,
etc)
Find Clinical Champions
• The nurses will know.
• Pick those who are respected and who will
be supportive.
• The support of “formal” leadership is
absolutely necessary but those leaders
are often not the ones who should guide
this effort directly.
Recommendations on How Often
and When to Meet as a Team
• Meet regularly.
• Choose someone to organize the meeting
schedule and be a point of contact for
people in your hospital and our team.
• An opportune time to meet together would
be following each webinar.
• It is better to meet with part of the group
than not at all.
Poll 1:
Pick the most important thing that
makes you feel like a case went well.
•
•
•
•
•
•
•
Respected
My concerns were heard
We had all of the necessary equipment
There were not any delays
All of the paperwork was in order
There were no wasted resources
I had all of the information that I needed to know to take
care of the patient
• The team worked well together
• The case ended on time
Poll 2:
Pick all of the things that make a case
go well.
•
•
•
•
•
•
•
•
Respected
My concerns were heard
We had all of the necessary equipment
There were not any delays
All of the paperwork was in order
The patient did well
There were no wasted resources
I had all of the information that I needed to know to take
care of the patient
• The team worked well together
• The case ended on time
Development of the WHO
Surgical Safety Checklist
The Problem
The 3 Central Problems in Surgical
Safety Throughout the World
• Unrecognized as public health issue
• Lack of data on surgery and outcomes
• Even though we know what to do, but we
don’t do it consistently
Global Annual Procedure Rates
Source: WHO, 2008
Four Categories for Surgical
Standards:
CONTROL OF
INFECTION AND
CONTAMINATION
ANESTHESIA AND
PATIENT
MONITORING
SURGICAL
OPERATOR
QUALITY
ASSURANCE
The Safe Surgery Saves Lives
Program
Guiding Principles
• Simple
• Widely applicable
• Measurable
• Address serious and avoidable surgical
complications
• Zero harm from the Checklist
Pilot Study
International Pilot Study
8 Evaluation Sites - Nearly 8,000 Patients
PAHO I
Toronto, Canada
EURO
EMRO
London, UK
Amman, Jordan
WPRO I
Manila, Philippines
PAHO II
Seattle, USA
WPRO II
AFRO
Ifakara, Tanzania
SEARO
New Delhi, India
Auckland, NZ
Results – All Sites
Baseline
Checklist
P value
Cases
3733
3955
-
Death
1.5%
0.8%
0.003
Any Complication
11.0%
7.0%
<0.001
SSI
6.2%
3.4%
<0.001
Unplanned Reoperation
2.4%
1.8%
0.047
Survey of Attitudes to Checklist Use Among
Clinicians at Study Site (n=229)
The checklist was easy to use
78.6%
The checklist improved operating room
safety
79.0%
The checklist took a long time to complete
18.3%
Communication was improved through
use of the checklist
The checklist helped prevent errors in the
operating room
If I were having an operation, I would
want the checklist to be used
84.3%
78.2%
92.6%
The Checklist – September 2006 to
December 2009
Quite a trip
SURPASS Checklist
The Netherlands
• 100 item checklist implemented in 6 high
performing hospitals
• Compared to controls the test hospitals
had a greater than one-third reduction in
complications and achieved an almost
50% reduction in deaths (from 1.5% to
0.8%)
(N=7,580)
de Vries EN, et al. Effect of a Comprehensive Surgical Safety System on Patient Outcomes. N Engl J Med 2010; 363:1928-1937
Veterans Health Affairs
• Implemented a surgical team training program
incorporating a modified version of a surgical
checklist in the operating theatres of 74
facilities
• Experienced a mortality reduction of 18%
Neily J, Mills PD, et al. Association Between Implementation of a Medical Team
Training Program. JAMA. 2010 Oct 20;304(15):1693-700
Teamwork
&
Communication
Site C
Baseline
(n=524)
Checklist
(n=598)
Abx Given 0-60 Mins
Except Dirty Cases
98.1%
96.9%
Adherence to All Six
Safety Indicators
94.1%
94.2%
4%
1.0%
2.0%*
0.0%*
11.6%
7.0%*
SSI
Death
Any Complication
*p<0.05
JC/Standard of Practice
SCIP
WHO/SC Checklist
Safe Surgery 2015 Website
Tour
www.safesurgery2015.org
Homework
• Build an implementation team.
• Schedule a time and a venue for a
meeting to take place after January
23rd. This meeting is where the
implementation team will be able to talk
to as many OR physicians and staff as
possible about the checklist at your
hospital.
Questions
Next Week’s Topic:
Measuring the Culture in
Your Operating Rooms
Office Hours:
Cancelled
Happy Veterans Day
Resources
Website:
www.safesurgery2015.org
Email:
[email protected]