1. Ensuring Patient Safety in Operating Room: Improving Time-Out Compliance (Quality Improvement Project)
Presenter:
Shukrullah Ahmadi, BSN (Aga Khan University, Pakistan)
Assistant Head Nurse
French Medical Institute for Children, Kabul, Afghanistan
MPH candidate (EHESP, France)

2. A project by Multidisciplinary Team of Operating Room (OR)
Team Leader
Shukrullah Ahmadi, AHR, OR
Members
HOD, Anesthesia, Peads Cardiac Surgery, General Surgery, Orthopedic Surgery Resident, ENT Surgeon, HN- OR, AHN, surgical unit of FMIC
Facilitators
Administrator, FMIC Nursing Division

3. Background
Wrong patient, wrong procedure and wrong site surgeries are concerns of patient safety in operating rooms worldwide. In the United States (US) these errors happen up to 40 times per week (Institute for Healthcare Improvement, 2014), leading to estimated 1300 to 2700 wrong procedures annually in the United States (S. Dupree, 2014).
To just present you the background of our project, first, safe and quality…second, IPSG.

4. What is Timeout?
Time-out occurs just before surgery is recognized as an effective methodology to reduce the risk of wrong patient, wrong site and wrong procedure surgeries. Time-out takes place just before the start of a surgical procedure to verify the completeness and accuracy of patient identification, assessment, and site-marking, readiness of equipment and availability of required materials.

5. Time Out Components Correct Patient Correct Procedure
Correct Site and Side, and team consensus to perform surgery
Correct Position
Availability of necessary special equipment
As I discussed time out occurs before surgery and these are the components of time out

6. Time-out contd..
Time-Out is an universally applicable methodology to improve patient safety even in low-income countries like Afghanistan.

7. Project Purpose
This quality project analysis the compliance at the French Medical Institute for Children with defined Time-Out processes and evaluates the strategies for its improvement.

8. To prevent wrong procedure, wrong site and wrong patient surgery in OR and to minimize the risk of errors and delays during procedure
To improve pre surgical Time-Out practices and compliance among health care workers in Operating Room (OR).
Project Aim

9. Utilization of Quality Improvement Methodology and Tools
Juran,s CQI Methodology
Fishbone Diagram
CQI: Continuous quality improvement
Juran’s Methodology was selected because it is aimed at buisness transformation and process improvement.
Work on Transparency

10. Activity Plan Sr # 1. Quality Circle team formation 2. Theme selection
Task
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov 1.
Quality Circle team formation 2.
Theme selection 3.
Current analysis 4.
Plan / Target 5.
Problem analysis 6.
Intervention 7.
Evaluation 8.
Summary
Planned:……….
Actual: ________

11. Diagnostic Journey

12. Problem Analysis

13. Previous Time out checklist
“Correct surgical site and side” missing

14. Data Collection Methodology
Spot Checks
Observational audits
To review effect of implementation
A qualitative data collection tool was developed based on Joint Commission International Accreditation (JCIA) guidelines of Time-out to explore baseline compliance of Time-out.

15. Data Analysis
The baseline data was collected by conduction silent observations in OR and using an audit tool between April and June A random sample of 100 surgeries was included in the assessment. The result showed an average compliance of 60% to the Time-out process

16. Remedial Journey

17. Goal and Target setting
Timeout Compliance

18. Implementation The project implementation was divided in two phases:
Phase I:
Phase II:

19. Implementation and Intervention
Awareness Sessions
Hands on Supervision
Checklist reviewed and approved
Policy on Time out drafted and approved (MD-P0L-11)
Interdisciplinary Collaboration
PHASE I:

20. Drafted and approved policy
Time-out flyer
Educational sessions
Continuous educational sessions and awareness were conducted for OR team
Well, this is just a picture of the policy here however it dint got approved overnight. It did took a lot of efforts and time

21. Reviewed checklist
Old checklist

22. Implementation contd.. Hands on Supervision Spot Checks Audits
PHASE II:
Ensuring compliance

23. Timeout Compliance Post Intervention Results
(September to October 2014)

24. Conclusion
Compliance to the Time-out process has been found in 60% of the surgical procedures during three months between April and June 2014 at the French Medical Institute for Children.
After the interventions to improve compliance to the process the compliance resulted in 95% of surgical interventions in October 2014.
Even in low income countries such as Afghanistan patient safety methodologies can be implemented and improved by coordinated team work.

25. Project Sustainability

26. Continuous Reinforcement
Team Work from all multidisciplinary team
Compliance Audits
Exploration in Processes
Besides different explorations are being made in order to simplify documentation of time out process.

27. References
1. Continous Quality Improvement. (n.d.) Retrieved on April 6th 2015from academicdepartments.musc.edu/fm_ruralclerkship/curriculum/cqi.htm
2. S. Dupree, E. (2014). 10 Years In, Why Time Out Still Matters. Association of Perioperative Registered Nurses, 99(6), Retrieved September 25, 2014, from text/PDF/s pdf?issn= &full_text=pdf&pdfName=s pdf&spid= &a rticle_id=
3. Institute for Healthcare Improvement. Patient Safety. (19th of January 2014). Retrieved on 25th of August 2014 from
4. Joint Commission International. (2013). International Patient Safety Goals. Joint Commission International Standards for Hospitals (5th ed.). Illiniois: Joint Commission International.

28. Acknowledgements
This quality improvement project couldn’t have been possible with out the support of following people.
Quality Assurance, FMIC
Mr. Abdul Qayum, former Head Nurse ICU, FMIC
FMIC Surgeons
FMIC Anesthesiologists
FMIC OR Nursing Team
And other list of colleagues

29. Take 60 Seconds to get it right [or left]…
Thank you !
Take 60 Seconds to get it right [or left]…