1. Michelle George, RN MSN CASC 1

2. A. Efficiency & Accuracy (Pit Crew) B. Patient Safety through Effective Communication (SBAR-Patient Hand Offs) C. Infection Control (ASC Infection Control Audit worksheet) D. Survey Readiness (Bag O’ Tricks)

3.  Describe strategy for achieving perioperative efficiency and accuracy through implementation of a Pit Crew.  Influence patient safety through the implementation of effective patient hand- offs using the SBAR approach.  Describe methods for successful use of the CMS Infection Control Worksheet.  List and discuss tools for engagement of clinical team in ongoing accreditation and CMS survey readiness using the Bag of Tricks strategy. 3

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5. Benefits  Patient satisfaction  Physician satisfaction  Staff pride and satisfaction  Eliminates redundancy of efforts  Ensures consistent outcomes  Prevents errors  Prevents patient harm Cool Tool: Pit Crew Model

6.  “F1 Pit Crews can change all 4 tires and refuel the car in 7 seconds.” 6

7.  Developed by the Formula 1 team in 1994  A tire came off during impact causing head injury to the driver and subsequent death  Assigned and trained for specific roles  Developed checklists  Drilled for perfection  Assigned team leader (known as the lollipop man)  Results: No deaths from 1994 to 2011 7

8. Healthcare themes:  historical working practice;  problems during transfer;  poor awareness of handover protocols;  poor team coordination;  time pressure;  lack of consistency in handover practice;  poor communication of important information;  awareness that handover was a potential threat to patient safety. 8

9. F1 PIT CREW 13-member pit crew in which each member has a unique role that is defined by competencies. Team performance is rehearsed thousands of times. Failure on any members part to deliver can result in driver’s death. SURGICAL TEAM Each member of the surgical/procedure team has a specific role. Each role has specific competencies that members are trained to perform. Patient injury and death can result with failures. 9

10. Pit Crew practices involve checklists, training for competence, individual role accountability and a leader to ensure thorough and accurate performance. 10

11. Each member of the team has to work in coordination with the other team members. Timing, accuracy and competence are all essential elements. Every member must successfully complete their job to prevent errors and patient harm. 11

12.  Each members role is defined  Use of checklists: Pre-op checks, Safe Surgical Checklist  Anesthesia Providers leads in OR-PACU hand-off  Healthcare studies show 2/3 ’s fewer technical errors with Pit Crew model 12

13. Safety Theme Formula OneOld Medical Practice New Medical Practice LeadershipThe “lollipop man” coordinates the pit stop Unclear who was in charge Anesthesiologist given coordination responsibility for hand off to PACU Task SequenceClear rhythm, order to events Inconsistent & non- sequential Defined phases of equipment/technology handoff, information handoff, discussion & plan ChecklistsWell established culture of using checklists NoneChecklists designed and used by team members TrainingFanatical approach to training & repetition of pit stop No Training existedFormal training on protocols 13

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15. CDC Study reports key findings:  Hand hygiene & personal protective equipment  Injection safety & medication handling  Equipment reprocessing  Environmental cleaning  Handling of blood glucose monitoring

16.  Required to use the ASC Infection Control Audit  Cited for deficient practices with required plan of corrections  CMS & CDC have provided in-depth training for surveyors  Surveyors must use IC tracer method for a least one patient  Updated standards; one breach constitutes a breach in the standard 16

17. Multiple regulatory agencies and standards Interwoven into all patient care activities Involves all caregivers— employees and non-employees A single breach results in a survey deficiency Time & knowledge constraints Takes a special interest to be really good 17

18.  Find the right leader  Committee responsibility vs. individual responsibility  Make it personal  Involve the team in investigations & Root Cause Analysis  Share results  Interactive & creative approach to education Cool Tool: ASC Infection Control Audit 18

19.  Use the actual ASC Infection Control Audit tool  Assign Audit sections to Medication Safety Nurse  Conduct regular rounds and observations  Use both observation and interview techniques  Invite patient care nurses to join IC rounds  Formal reports to Quality Committee and MEC/GB 19

20. Page 8 of Survey Tool

21. Page 7 of Survey Tool

22.  Assign to the IC Preventionist or clinicians  Use actual standards from the ASC Infection Control Audit tool  Immediate education/invention for breaches  Formal reports to Quality Committee/MEC/GB 22

23.  Focus on key survey findings—after removal of gloves and with medication administration  Report and educate at every meeting  Rotate signage and posters  Hold contests/reward for longest period of no breaches 23

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25.  Communication breakdown key in near- misses and RCAs  JC National Patient Safety Goal  Promotes patient safety Cool Tool: SBAR Communication Model 25

26. 26  Provides structure to communication  Shared model ensures consistency  Ensure that key information is shared  Can be used to improve performance  Requires staff education and practice

27. SSituationComplaint, diagnosis, treatment plan and patient’s wants and needs BBackgroundVital signs, mental and code status, list of medications and lab results AAssessmentCurrent provider’s assessment of the situation RRecommendationIdentify pending lab results and what needs to be done over the next few hours and other recommendations for care

28.  Implemented following Wrong Site Surgery  Establishing a Baseline Measure  Implementation Challenges  SBAR in March  Training  Posters  Accountability  Results 28

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30.  Accreditation Surveys  CMS Recertification and Validation Surveys  Life Safety Surveys  Board of Pharmacy Inspections  OSHA Inspections  Fire Marshall Inspections

31. Every Day Challenges:  Multiple priorities  Multiple keepers of the process  Staff turnover  Moving parts 31

32.  Formal Plan  Survey Committee  Quality Council  Assign Responsibility  Medication Safety Nurse  Safety Officer  Infection Control Preventionist  Chapter/Section Leaders  Regular Rounding  Mock Surveys  Total Team Engagement Cool Tool: Bag O’ Tricks 32

33.  Identify center-specific challenges  Medication management  Infection control  Life safety  Set up the “Tricks”  Shop at Dollar Stores  Number of items determined by need/team size  Make up the instructions for each item  Determine the rules, timelines and rewards  Staff education  Revise as needed 33

34. Engage across departments Establish a regular cadence Extends the survey team Creative education model Make it your own 34

35. 35 ItemStandardStaff Responsibility Mop SpongeInfection ControlAssess Mop Buckets: Using same one for OR and Lounge? Silt in the bottom? Single mop head use per turnover? ClapperNational Patient Safety Goal Observe patient care hand-offs: Are they happening? All departments? Critical information? RulerLife SafetyCheck Fire Safety Plan: 18” rule observed with sprinklers? Fire exits blocked? Fire extinguishers checked? Star/LeafPatient SafetyAssess Fall Prevention Program: Are patients being assessed for fall risk? Are the high risk patients identified? Dot StickersMedication Management Assess Look-alike, sound-alike med system: Is look-alike, sound-alike list posted? Is the “system” in use everywhere that meds are stored?

36.  Engage the entire team  Ensure safe patient care through standardization, competence and consistent practice  Prevent healthcare harm through better communication and structured hand-offs  Use proven best practice tools and make them work for you  Turn the hard-to-achieve into fun and creative methods 36

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