1. September 18, 2014 Lynne Hall GAPP COACHING CALL PROCEDURAL HARM WORKING SESSION

2. Successes  Doctors Specialty Hospital consistently uses the surgical checklist on all surgical cases to reduce procedural harm.  The AORN Comprehensive checklist is working properly for the Crisp Regional Medical staff. The same assessment will be moved to SDC.  Ty Cobb Regional Medical Center is successfully completing the Safe Surgery checklist for surgical patients.  Floyd Medical Center is working with the OR team including physicians, staff and educators to incorporate the WHO surgical checklist into their OR. 2 HOSPITAL SHARING

3. Roadblocks –  All hospitals are working on Procedural Harm and have hard-wired the OR checklist into their systems. Solution: They will need to drill down into their data in order to decrease their numbers with the appropriate PSI data HOSPITAL SHARING 3

4. FAILURE TO RESCUE (FTR) Failure to rescue is shorthand for failure to rescue (a patient) from a complication of an underlying illness or a complication of medical care. Failure to Rescue - AHRQ Patient Safety Network psnet.ahrq.gov/popup_glossar...Agency for Healthcare Research and Quality

5. PARTNERSHIPS INCLUDE: Agency for Healthcare Research and Quality (AHRQ) National Quality Forum (NQF) The Joint Commission Josie King Foundation (Condition Help) Robert Woods Johnson Foundation FAILURE TO RESCUE – BOLD LEAPT AIM

6. FTR – NATIONAL IMPLICATIONS As many as 159,000 patients died from in- hospital cardiac arrest in 2013 15,900 – 31,800 Nationally, the potential number of Lives SAVED! (based on 10-20% reduction) Rapid Response Teams respond to the spark before it becomes a fire!!

7.  Provide Mentor Support and monthly coaching calls/webinars  Leadership Buy-in and Champion to assist with spread throughout the organization  Formation of Rapid Response Team (RRT)  Most common “Failure to Rescue” event…..Sepsis related FTR – KEY LEARNINGS

8.  Standardize RRT policy and protocols  Education of entire staff AND Patients and Families about when and who to call  Analyze data and give feedback to entire hospital on regular basis  Establish mock drills and practice! FTR – KEY LEARNINGS

9.  Participate in Drills and Simulations  RRT call simulations  Code Blue Grand Rounds  Identify at risk populations early  Obese  People with significant comorbidities and the elderly with or without comorbidities:  COPD  CAD  CHF  HTN  Diabetes FTR – RAPID CYCLE INNOVATIONS

10.  Use of Early Warning systems  Rothman Index  MEWS  Open Safety huddles  Review all codes  GaHEN hospitals have adapted an RRT Bundle to include:  Sepsis Screens  Blood glucose within 5 minutes on all RRT calls  Adding lactic acid levels to ABG’s done during RRT calls FTR – RAPID CYCLE INNOVATIONS

11. FTR RESULTS

13. FTR – A HOSPITAL STORY

14.  Continue spread nationally by  Encouraging the use of RRT’s by identifying at-risk patients  Getting patients and families involved  Using PSI-4 as one measurement indicator  Couple that with mortality rate, RRT and Code review, and patients moved to a higher level of care FTR – FUTURE OBJECTIVES

15. PROCEDURAL HARM

16.  Procedural Harm-related harm includes all coded complications directly related to medical and surgical procedures.  We have focused on surgical procedures WHAT IS PROCEDURAL HARM

17.  Working on Procedural Harm leads to  Decrease in mortality rate  Decrease in injuries related to surgery  Accidental Puncture or laceration  Foreign bodies left in surgery  Iatrogenic Pneumothorax  Perioperative Hemorrhage or Hematoma  Postoperative Respiratory Failure Rate  Postoperative Wound Dehiscence  Overall patient harm ADVANTAGES

18.  The Patient  The Healthcare Worker  The Environment  Look at activity in the OR at a minimum 3 INFECTIOUS PATHOGEN TRANSMISSION

19.  Aseptic practices  Surgical Attire  Surgical hand antisepsis  Skin antisepsis  Maintaining a sterile field  Traffic Patterns  Watch who and how many times the circulator goes in and out of the OR suite HOW?

20. 5 steps 1.Pre-op brief – what is the operation? Who is the patient? Any issues? 2.Sign-in – Introduction of staff; operation being performed; site marked; Any issues? 3.Time-out – Stop! 4.Sign-out – Final counts correct? Blood loss? Any issues? 5.Post-op Debrief – Anything to improve on? What could be improved THE WHO CHECKLIST

21.  http://www.youtube.com/watch?v=6- myLENTBO4 – Correct Surgical Checklist http://www.youtube.com/watch?v=6- myLENTBO4  http://www.youtube.com/watch?v=REyers2A AeI - How not to do a surgical Checklist http://www.youtube.com/watch?v=REyers2A AeI VIDEO

22.  Correct use of the surgical checklist  Observation  How often do people come in and out of OR during the procedure?  What surgeries are causing the most problems and how do you address?  Do not disturb signs for OR doors/phones??  Break out the Surgical checklist to make sure each piece is being done “TESTS OF CHANGE”

23. GRAPHS

36. TRANSPARENCY CRITERIA FOR LEAPT 3 Ways to be Transparent 1.Put LEAPT data on Website 2.Put LEAPT data in a public area in the hospital 3.Possibly put on GHA website Important: Please let us know how you make your data public 36

37. GAPP UPDATES  Mandatory Meeting Attendance  If you miss a call you can listen to the recording within 1 week. Complete eval, and notify topic lead that you listened to get credit.  Data Submission:  Due 3 rd or each month – send to Lynne Hall (lhall@gha.org)lhall@gha.org  TOC (1 for sepsis and 1 for additional topic area)  Checklist (1 per hospital)  Worker Safety Data (if in WS group) Send to Jean Allred (jallred@gha.org)jallred@gha.org  due 15 th of month (about 45 days after end of reporting month).  Next Coaching Call  Workers Safety Working Session October 23 rd, 2014 1 -2 pm 37