1. A Multi-Faceted Progress Evaluation of the Use of the Surgical Safety Checklist SQAN November 16, 2012 Quality and Patient Safety

2. But Before I Begin….

3. Yes this is for Movember….

4. But Before I Begin…. Yes….I know it is creepy….

5. Why use the Surgical Safety Checklist? Interactive tool Structures team communication Ensures that all team members possess accurate and explicit information regarding the patient and procedural plan Gives team members the same context (situational awareness)

6. Surgical Safety Checklist

8. 39 different versions!!!!

9. Objectives of the Surgical Safety Checklist Evaluation Assessment of the Surgical Safety Checklist post implementation Quantify the use of the Surgical Safety Checklist in procedures across the region Qualify how the tool is being used: –Pieces that provide beneficial information, –Areas that need improvement Reconcile documented use to actual use Identify good catches

10. Evaluation Tools 1.Observations of surgical procedures 1.Surgical cases by 5 observers 2.Facilities include VGH, UBCH, LGH, RH, SPH & MSJ 2.An electronic survey 1.All surgical staff members across VCH received an invitation to participate 3.Interviews of front line staff 1.At minimum, 3 nurses, 3 surgeons, and 3 anesthesiologists from each facility. 2.Nursing graduate student and Human Factors Specialist interviewers

11. How did we do? EvaluationActual Interviews25 Observations47 Electronic Survey162

12. Observations Each observer paired up with our HF Specialist to observe 2 – 4 cases Observations were compared after each case to ensure our they were “reliable” and then we were set free Goal was about 6 – 8 observations per site

13. What were we looking for? A distinct pause for each component Did it flow with the work Who was in the room and were all team members paying attention How did the team interact with each other Where was the patient

14. Surgical Safety Checklist Completion Evaluation TypeOverallBriefingTime-OutDebriefing Observations (n=47) 70.7%StandardAbove Standard Standard

15. Observations n=47 Question Overall - Average Score (0-3) Ranking Overall, the use and completion of the Safety Checklist was: 2.34 Standard The completion of the briefing section was: 2.16 Standard The completion of the time-out section was: 2.55 Above Standard The completion of the debriefing section was: 2.08 Standard (Scoring included 0 = not complete, 1 = below standard, 2 = standard, 3 = above standard)

16. What parts of the Surgical Safety Checklist have been working well? Antibiotic prophylaxis administration DVT prophylaxis considerations Availability of appropriate implants and equipment Allergies awareness and confirmation Overall increased communication in the OR

17. Good Catches (Electronic Survey Responses)

18. What parts of the Surgical Safety Checklist have NOT been working well? Briefing and Debriefing Lack of awareness and understanding of the purpose Attention Responsibility and accountability Designates

19. Areas for Improvement Minor changes to the briefing & debriefing section of the Surgical Safety Checklist Awareness and education on the value of team communication Supporting leadership, responsibility, and accountability Celebrate the ‘good catches’

20. Recommendation: Minor changes to the Briefing and Debriefing Section of the Surgical Safety Checklist Identify the components involved in a meaningful briefing and debriefing conversation Refining the essential components to be discussed –Briefing: Focus on process –Debriefing: Focus on process and content Ensuring all team members are present Ensure the timing of the debriefing occurs at an appropriate (non-critical) time for all team members –Ex: Not during emergence for anaesthesia

21. Recommendation: Awareness and education on the value of team communication Comprehensive verses Prescriptive Emphasis on the team having a conversation for each phase of the checklist and talk about “critical” items for the surgery Awareness and education on the value of team communication

22. Recommendation: Supporting leadership, responsibility, and accountability Reinforce the use of the checklist as acceptable practice in our surgical suites Positive role-modeling in safety conversations with the checklist Celebration for those teams who have incorporated the checklist successfully in their cases. Accountability of those team members who choose not to participate in the checklist

23. Recommendation: Celebrate the ‘good catches’ “Good catches are great as front line staff are identifying places where the safety checklist has helped improve upon patient and staff safety. Looking at antibiotics, allergy awareness, and equipment availability are issues where systems within our organization can be improved.”

24. More than just a checklist!

25. Questions?