1. Check-In Call June 21 st, 2012

2. Welcome Back

3. Today’s Topics A series of polls Common barriers Checklists for special needs Monitoring your progress How do you know when you are done? Looking forward, what is to come with the Safe Surgery 2015: South Carolina Initiative

4. Poll 1: Where Are You? 1.What is the percentage of cases that now use the South Carolina Checklist? –< 50% –> 50% –Every team uses the checklist for every case 2.What have you worked on since our last call? (Please check all that apply) –Modified the checklist –Trained surgical teams on how to use the checklist –Conducted one-on-one conversations with surgical team members –Observed how the checklist is used –Coached in the OR –Mandated that the checklist be used in every case

5. Poll 2: How Do You Feel About Where You Are? Our hospital is: still making progress done and we use the checklist routinely stalled and we don’t know how to move forward stalled and we have a plan to move this work forward not using the checklist as much as we were a couple of months ago

6. Poll 3: What Are The Barriers That You Have Faced Since the Last Call? Misuse of the checklist Surgical teams have a lack of interest in using the checklist Pushback Improvement Fatigue Problems with teams doing the debriefing consistently

7. Pushback “When or if we should mandate using the checklist”

8. Improvement Fatigue

9. Checklist Rebound Checklist Implementation End of Checklist Implementation

10. Doing the Checklist “Right” In order for the Checklist to work well it has to be used “right”. Improving communication between all members of the OR team is critical to successful implementation. Virginia Mason, 2010 Annual Meeting of the American Society Anesthesiologists

11. Checklists for Special Needs Rapid Turnover & Complex Cases

12. Special Needs for Short Cases

14. Before Skin Incision ASCMain OR

15. Before Patient Leaves the OR ASCMain OR

16. The Checklist In Complex Cases

17. Monitoring Your Progress

18. These results include 114 Observation Tools from Five South Carolina Hospitals Preliminary Results

19. Using the Checklist Helps Our Patients In 7% of cases an error was prevented by the use of the checklist. Preliminary Results

20. We Still Have Work To Do Checklist Item Number of Times the Item Was NOT Performed Percentage of Time the Item Was NOT Performed Did the surgeon discuss the operative plan? 3329% (N=114) Were all of the checklist items read aloud, without reliance on memory? 4943% (N=114) Did the team discuss key concerns for patient recovery and post-op management? 2827% (N=104) Preliminary Results

21. Poll 4: Will You Use the Observation Tools To See Where You Are? Yes No

22. How Do We Know When We Are Done? Have members of your surgical teams complete a document that we call, “Are we a Safe Surgery 2015 Hospital”. (Questions on the next two slides) Ask people from all disciplines to complete this form. If anybody answers “no” you are not done with this work.

23. Are We a Checklist Hospital? 1. Does your surgical checklist have three phases, before induction of anesthesia, before skin incision, and before the patient leaves the room? 2. Are the items on the checklist read aloud, without reliance on memory, so all members of the team can hear them? 3. Are all three phases of the checklist performed for every patient undergoing a surgical procedure in your hospital’s operating rooms? 4. Does every person that is present in the operating room say something before skin incision, at a minimum they introduce themselves by name and role or state that they are ready to proceed? (This includes perfusionists, surgical assistants, PAs, residents, observers, manufacturer representatives, and other observers)

24. Are We A Checklist Hospital Continued 5. Does the surgeon share an operative plan and discuss: anticipated blood loss, expected duration of the procedure, possible difficulties, and implants or special equipment needed for the case with the entire team before skin incision? 6. Do nurses and surgical techs discuss with the entire team their concerns about the patient? 7. Do the anesthesia providers discuss with the entire team the anesthetic plan and airway or other concerns? 8. Does the surgeon ask the entire team to speak up if they have any concerns during the case? 9. Before the patient leaves the OR do ALL members of the surgical team discuss equipment problems that need to be addressed, key concerns for recovery and management, and anything that could have been done better to make the case safer or more efficient?

25. Safe Surgery 2015: South Carolina Surgical Teamwork Collaborative “Bringing It Home To Our Patients”

26. South Carolina Surgical Teamwork Collaborative Fall 2012 – Spring 2013 In-person meetings + webinars Mark your calendars –First in person meeting is October 17 th, 2012 It is for everybody, the goal is to improve checklist performance.

27. What Is This Part Of The Work About Coming together as a state to make our patients safer. Hospitals helping hospitals. Sharing the lessons that we have all learned with one another. Creating a model for the nation.

28. South Carolina Surgical Teamwork Collaborative Goals Have a modified version of the Surgical Safety Checklist used for every patient undergoing surgery in the state by 2013. Build stronger surgical teams through a team training program and the use of a surgical checklist that promotes teamwork and communication.

29. We Need Your Help

30. A Quick Reminder SCHA Site Visits –Ashley Childers will be reaching out to many of you over the next couple of weeks to schedule a time visit your hospital. –If she hasn’t reached out to you and you want her to visit, please contact Ashley Childers at: childer@clemson.edu.

31. ? ? Questions

32. Resources Website: www.safesurgery2015.org Email: safesurgery2015@hsph.harvard.edu