MISSOURI SAFE SURGERY SAVES LIVES DASH

1. MISSOURI SAFE SURGERY SAVES LIVES DASH April 24 and 29, 2009 Missouri Hospital Association Missouri Center for Patient Safety

2. 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/Campaign/mentor_registry_ssc.htm

3. FAQs • See also FAQs on IHI website • QDoes this substitute for the Universal Protocol? AThe 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 don’t have to document completion of the WHO checklist but you do the UP. • QHow can I incorporate core measures, hospital-specific initiatives and the Universal Protocol into the checklist? ALook at modified checklists on the SafeSurgery web site and the guidelines for modifying on the IHI Web site.

4. FAQs • QWho needs to be present at the sign in phase before induction of anesthesia? AIdeally 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. • QWhat is the patient’s reaction when you ask about EBL while the patient is still awake? AGenerally patients are comforted by the process. There should be appropriate language developed. • QHow can we monitor improvement as a result of the checklist? ALook at what you already measure: SSIs, mortality rate, retained objects, compliance with SCIP measures, AHRQ PSI indicators.

5. FAQs • QWho reads the checklist? AIdeally it should be the surgeon but the circulating nurse is most likely to be the one to do it. You don’t have to actually check it off; it is just a safety tool not a documentation tool. Don’t change your current documentation process. • QIs the checklist comprehensive enough? Should we review meds for the risk of bleeding? AThe 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. • QHow do you get the surgeons on board? AHave a surgeon talk to the surgeons using a short video clip and presentation about 10 minutes in length.

6. FAQs • QWhat do you do about the surgeon who refuses to wait for the checklist to be done? • AYou 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. • QDoes 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, couldn’t remember the scrub nurse’s 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.

7. RESOURCES • http://www.ihi.org/IHI/Programs/ImprovementMap/WHOSurgicalSafetyChecklist.htm • Starter kit • Blog, brochure, webinars • FAQs • http://www.who.int/patientsafety/safesurgery/en/WHO | Safe Surgery Saves Lives • Dr. Gawande's lecture • ER episode • http://www.safesurg.org/ • Learn More Tab – Examples of modified checklists especially Brigham and Women’s Hospital, Children’s Hospital – Boston • Implementation Tab – PowerPoint • Video tab

8. RESOURCES • http://www.scoap.org/checklist/ Surgical Care Outcomes Assessment Program SCOAP modified checklists • http://www.jointcommission.org/PatientSafety/UniversalProtocol/ Universal Protocol • http://www.mocps.org/docs/Missouri_Safe_Surgery_Saves_Lives_DASH.pdf Missouri DASH

9. 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

10. NEXT STEPS • Register commitment to test at • www.who.int/patientsafety/safesurgery/hospital_form/en/index.html • Report results/experience with your commitment at • www.surveymonkey.com/s.aspx?sm=v5PfRnrcnAQlX44n9H02EQ_3d_3d • Share stories with Becky or Sharon • bmiller@mocps.org or sburnett@mail.mhanet.com • Share stories with your community! • The State Map Coming

11. 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

12. IHI IMPROVEMENT MAP • Prevent Catheter-Associated Urinary Tract Infections • http://www.ihi.org/IHI/Programs/ImprovementMap/PreventCatheterAssociatedUrinaryTractInfections.htm • Guides, videos, bundles, articles, compendiums • HACs

13. 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/LinkQualityandFinancialManagement.htm • Adverse Events Prevented Calculator • Building the Business Case for Quality