Webinar 4: Checklist Modification/Customization

W S C U

Summary of Last Week’s Call• Nuts and bolts of administering the culture

survey.

• Administering the culture survey is important to your implementation.

• You may be surprised by what you find when see the culture survey results.

• The survey can give us valuable information to measure your progress with putting the checklist into place.

Administering the Culture Survey

Email Research Participants Only

• This is offered to hospitals that have indicated that they are part of the research.

• Complete the provided template that asks for names, titles, and email addresses for anesthesia providers, nurses, surgeons, and techs and send it to us.

• Modify a cover letter that will accompany the survey.

• Provide the name and email address of the person from whom you would like the invitation to originate.

IntranetResearch Participants Only

• If you have a hospital intranet we can provide you a link to the survey that you can post.

• Complete the provided template that asks for names, and titles for anesthesia providers, nurses, surgeons, and techs and send it to us. (No Need to Provide Email Addresses)

• Send us an email requesting this option.

Paper BasedAll Hospitals

• The paper based version of the survey is available on our website.

• Complete the provided template that asks for names, and titles for anesthesia providers, nurses, surgeons, and techs.

– If you are part of the research send us your spreadsheet. (No need to provide email addresses). You will also send us completed surveys for analysis.

– If you are not part of the research use the spreadsheet to monitor the response rate.

Survey MonkeyHospitals Not Participating in

Research• Use your own survey monkey account and

analyze your results.

Excel Template

Advertising the Survey• Posters

• Announce the survey at staff meetings

• Advertise in the surgeon’s lounge

How Did the Homework Go?

Homework to Date• Gather an implementation team

• Schedule a time and venue for a meeting to take place in 8-10 weeks

• Read background materials on the checklist and look at safesurgery2015.org website

• Create a list using the excel template provided to you of all of the OR staff, physicians, and techs. This template asks for names, titles, and email addresses

• Send us a picture of your checklist implementation team

• Designate if your hospital will be participating in the research portion of this project

• Review instructions for the culture survey and administer based on the previous discussion.

• Review the checklist modification guide and South Carolina Checklist Template.

The Checklist as a Documentation Tool

• How many of you want to use the checklist as an auditing tool?

• When you discussed the checklist with your colleagues, did they have concerns about including the checklist in the medical record?

• If you are already using the checklist, do you keep it as part of the medical record?

Using the Checklist As a Documentation Tool

• SCIP Measures

• Electronic Medical Record

• Patient Chart

• Signatures

• Malpractice issues

This Checklist Is Not . . .• An algorithm.

• A tool to train people how to do their jobs.

• A “tick boxing” exercise.

This Checklist is . . .

• A reminder for the surgical team to perform/discuss critical safety steps for every patient every time.

• Performed as a team and read aloud.

Origin of Checklist Items

Universal Protocol/Standard of Practice

SCIP

SC Checklist

Universal Protocol/Standard of Practice

SCIP

SC Checklist

Universal Protocol/Standard of Practice

SCIP

SC Checklist

Universal Protocol/Standard of Practice

SCIP

SC Checklist

Checklist Modification 101

Make Me Your Own

The Basics• One size doesn’t fit all. Every hospital should

modify the checklist.

• Checklist modification creates buy-in and ownership.

• The checklist is designed to promote teamwork and communication . . . don’t remove teamwork/communication items.

Things to Keep In Mind When Modifying the

Checklist

Brief• Each section (Before Induction of

Anesthesia, Before Skin Incision, and Before the Patient Leaves the Room) should take < 1 minute.

• The checklist should never take longer than the procedure.

• The checklist should fit on one page.

• Is this a critical safety step and in great danger of being missed?Examples: Known Allergies, Essential Imaging, Antibiotic Prophylaxis

• Is this adequately checked by other mechanisms?Examples: Anesthesia safety checklist has been completed, Sterility

including indicator results• Is this actionable, with a specific response?

Example: Monitoring blood pressure• Is this item discussed at a time when all relevant team

members are present and when something can be done to fix it?Examples: Essential equipment and expected blood loss

• Will this item help anybody here?

When Adding and/or Removing Items Ask Yourself . . . .

Alternative Wording for Particular Items

Are blood products required and available?

What is the EBL?

Blood (or cross-match) available if needed.

Is there a need for blood products?

Blood availability confirmed.

EBL/Blood Plan

Modifying Blood Loss

Modifying Team Introductions We will start by introducing ourselves

by name and role.

Team introductions to patient, including name and role.

Are there any unfamiliar staff in the room? Please introduce yourself by name and role.

What If We Already Know Each Other?

• We recommend that even if you know each other that everybody says something before the procedure starts.– Check-off with everybody in the room Surgeon says, “Mary, are you ready to go?”

etc.

Modifying the Safety StatementSurgeon says: “If anyone on the team sees something that the team should know about, please speak up”

Surgeon declares: “If anyone on the team sees something that the team should know about, please speak up anytime during the procedure.”

Surgeon states, “If you see, suspect, or feel that patient care is compromised, will you speak up?”

Surgeon states, “Remember that all are free to voice any concerns at any time throughout the procedure”

Surgeon states, “Does anyone have concerns? If you think there is a problem, please speak up”

Is the Checklist the Best Way to Take Care of This?

• Glycemic Control• Fire Risk Assessment• Hair Removal • Checking Pressure Points

Examples of Modified Checklists

Process to Follow When Modifying the Checklist

This Week• Modify the checklist with your

implementation team. – Discuss each item on the checklist using the

guidelines that we previously discussed.– Ensure that the checklist follows your current

flow in the OR.– Add your hospital logo to the checklist.

• Once it is modified, practice using the checklist in a “table top simulation”.

“Table-Top” Simulation

Anes.Machine

ACN

SN

S

Conference Room or an Empty OR

This Week• Debrief, how did it go? What needs to be

changed to fit the flow in your ORs? • If you are happy with your checklist try

using it in the OR in one case. Only use it with the implementation team that built the checklist.

This Week’s Homework• Start/Continue to administer the culture

survey• Modify the checklist with your implementation

team.• Use your modified checklist in a “table top

simulation”.• Then use the checklist in one case for one

day. Only do this with the implementation team.

• Send us your hospital’s modified checklist before next week’s call.

?Questions

Ask Us a Question By Using the Raise Hand Button

Next Week’s Call:

Checklist Modification Cont. and Small Scale Testing

Resources

Website:www.safesurgery2015.org

Email: safesurgery2015@hsph.harvard.edu