2012 WEBINAR SERIES. ASC Knowledge Share SAFE SURGERY CHECKLIST: TOOLS TO SUPPORT COMPLIANCE WITH THE NEW CMS REPORTING REQUIREMENT.

Transcription

1 2012 WEBINAR SERIES ASC Knowledge Share SAFE SURGERY CHECKLIST: TOOLS TO SUPPORT COMPLIANCE WITH THE NEW CMS REPORTING REQUIREMENT February 23, 2012

2 Welcome ASC Knowledge Share is a new webinar series designed to address infection prevention related topics of interest to Oregon ASCs Each webinar will have 20 to 30 minutes of educational content presented by various speakers, followed by time for questions and answers 2/23/2012 2

3 Networking The remaining 10 to 15 minutes of the webinar will be available for participants to network with each other by asking questions or addressing concerns on any infection prevention related topic The goal of the webinar is to share knowledge and experience with other ASCs 2/23/2012 3

4 Webinar Speakers Oregon Patient Safety Commission (Host) Valerie Van Buren, MPH, Patient Safety Consultant Northwest Ambulatory Surgery Center, LLC Kecia Rardin, RN, CNOR, CASC, Administrator, Director of Nursing Debbie Spain, RN, BSN, CNOR, Clinical Director 2/23/2012 4

5 Webinar Speakers (cont.) Oregon Eye Surgery Center Cheri Van Bebber, RN, BSN, Operating Room Manager Oregon Patient Safety Commission Leslie Ray, PhD, RN, Patient Safety Consultant 2/23/2012 5

6 Valerie Van Buren, MPH, Patient Safety Consultant Oregon Patient Safety Commission SAFE SURGICAL CHECKLIST: THE NEW ASC MEASURE & HOW IT CAN IMPACT PATIENT OUTCOMES 2/23/2012 6

7 ASC Quality Reporting Program Five quality measures: 1. Patient burn 2. Patient fall 3. Wrong site, side, patient, procedure, implant 4. Hospital admission/transfer 5. Prophylactic IV antibiotic timing Two structural measures: 1. Safe surgery checklist use in Volume of certain procedures in /23/2012 7

8 Safe Surgery Checklist Structural Measure Measure Measurement Period Reporting Period Payment Affected Safe Surgery Checklist Use CY 2012* July 1 Aug 15, 2013 CY 2015* *CY: calendar year 2/23/2012 8

9 Annual Global Statistics 234 million operations One operation for every 25 human beings Known surgical complications 3-16% At least seven million disabling complications Known death rates % About one million deaths World Health Organization: 2/23/2012 9

10 Eight Checklist Pilot Sites Seattle, USA Toronto, Canada London, UK Amman, Jordan New Delhi, India Manila, Philippines Ifakara, Tanzania Auckland, New Zealand 2/23/

11 Checklist Pilot Results Reduced rate of postoperative complications and death by more than one-third Similar effect in high and low/middle income country sites Income Level Change in Complications Change in Death High 10.3% -> 7.1%* 0.9% -> 0.6% Low/Middle 11.7% -> 6.8%* 2.1% -> 1.0%* * p<0.05 William Berry. Harvard School of Public Health. December 7, Oregon IHI Network Webinar. Haynes, et al. (2009). A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population. New England Journal of Medicine. 360: /23/

12 A recent study showed when a safe surgical checklist was used: Surgical complications reduced by one-third Mortality reduced by nearly half De Vries, E.N., Prins, H.A., Crolla, RM, et al. (2010). Effect of a comprehensive surgical safety system on patient outcomes. New England Journal of Medicine. 363: /23/

13 Three Crucial Phases 1. Before induction of anesthesia 2. Before skin incision 3. Before the patient leaves the operating room The WHO Surgical Safety Checklist: Adaptation Guide ptation_guide.pdf 2/23/

14 World Health Organization: 2/23/

15 Correct Patient, Operation & Operative Site wrong site surgery incidents every year in the US¹ 1050 hand surgeons surveyed, 21% reported performing at least one wrong-site surgery in career² Before induction of anesthesia: Before skin incision: Before patient leaves operating room: ¹ Seiden. Archives of Surgery ² Joint Commission. Sentinel Event Statistics /23/

16 Safe Anesthesia and Resuscitation Study in Australia: Of 1256 general anesthesia incidents, pulse oximetry on its own would have detected 82% of them Before induction of anesthesia: Before skin incision: Webb. Anaesthesia and Intensive Care /23/

17 Infection Risk Reduction Antibiotics within one hour before incision reduces risk of surgical site infection by 50% At pilot sites, failure to give antibiotics on time occurred in almost half of patients who would benefit from timely administration Before skin incision: Bratzler. The American Journal of Surgery Classen. New England Journal of Medicine /23/

18 Effective Teamwork Communication A root cause of 70% of events reported to the Joint Commission ( ) 1 Preoperative team briefing Enhanced prophylactic antibiotic choice and timing Appropriate maintenance of intraoperative temperature and glycemia 2,3 Before skin incision: Before patient leaves operating room: ¹ Joint Commission. Sentinel Event Statistics ² Makary. Joint Commission Journal on Quality and Patient Safety ³ Altpeter. Journal of the American College of Surgeons /23/

19 Survey: Attitudes Among Clinicians Attitudes About Checklist Use Among Clinicians N = 229 The checklist was easy to use 78.6% The checklist improved operating room safety 79.0% Communication was improved through checklist use 84.3% The checklist took a long time to complete 18.3% The checklist helped prevent errors in the operating room 78.2% If I was having an operation, I would want the checklist to be used 92.6% 2/23/

20 Information & Resources Safesurg.org (Book) The Checklist Manifesto: How to Get Things Right, Atul Gawande 2/23/

21 Kecia Rardin, RN, CNOR, CASC, Administrator, Director of Nursing Debbie Spain, RN, BSN, CNOR, Clinical Director Northwest Ambulatory Surgery Center, LLC ASC EXPERIENCE 2/23/

22 Northwest Ambulatory Surgery Center Multi-specialty surgery center established in 2005 Located in northwest Portland 3,100 procedures per year: Orthopedics, ENT, Podiatry, Hand Surgery, Gynecology and Pain Management Joint venture with 17 surgeons, USPI and Legacy Health Systems 35 employees 2/23/

23 Surgery Checklist Implementation This current checklist was developed by USPI Corporate and replaced our original Surgical Site Verification Checklist Our staff was presented with this new form at our monthly staff meeting The new form is more user-friendly making its implementation seamless 2/23/

24 Key Successes The new checklist is an evolution of our original checklist which primarily focused on preventing a wrong site surgery The previous form involved multiple departments tracking the patient from scheduling until the OR Time Out looking for any discrepancies specifically related to wrong site prevention 2/23/

25 Key Successes (continued) The previous form also included many of the required elements, but lacked the three distinct critical points: prior to administering anesthesia, prior to skin incision, and prior to patient leaving the operating room The updated form includes these areas and a few additional RED Alert areas our center felt were beneficial At our center we are particularly concerned about pain procedures and anesthesia blocks so those became RED Alert areas for us 2/23/

26 Key Challenges The key to staff participation is understanding how it applies to them; through the use of our original form, it became apparent how frequently cases were scheduled incorrectly; wrong site surgeries can occur anywhere The staff wasn t thrilled about more paperwork, but understood that mistakes happen everyday and the checklist is a safety mechanism to protect the patient The new form is more efficient and easier to use; it s important that the staff realizes you are trying to make their jobs easier 2/23/

27 Key Learnings Even experienced staff make mistakes Checklists are only effective if they are actually read thoroughly and followed; we had several cases in which staff members completed the checklist, but the information wasn t actually in the chart We have to learn from our mistakes 2/23/

28 Cheri Van Bebber, RN, BSN, Operating Room Manager Oregon Eye Surgery Center ASC EXPERIENCE 2/23/

29 Oregon Eye Surgery Center We are an Ophthalmic Physician-owned ASC, opened in 1988 Located in Eugene, Oregon 2,000 to 2,500 surgeries per year Procedures include: cataracts, cornea, retina, plastics, glaucoma, lasers, and Lasik 12 MDs, 3 operating rooms, no general anesthesia 25 employees 2/23/

30 Developing the Checklist Started with WHO s Implementation Manual for the Surgical Safety Checklist Sources: WHO, AORN, National Patient Safety Agency, SCOAP, current Time Out Input from the people who would use list Considered what is useful/relevant to our setting Emphasized that it is a No pressure worksheet meant to help not hinder care 2/23/

31 Key Successes Found that it is a good communication tool We caught missing or inconsistent information More complete/thorough patient care Promotes MD marking surgical site Slows work flow down, yet does create efficiency 2/23/

32 Key Challenges More work, another piece of paper, duplication, slows down the flow, staff resistance, hard getting it done How we ve dealt with challenges: It s the law! It is a helpful communication tool In our EMR world, serves as a quick visual Assigned personnel to check for list completion More effective chart organization makes easier Listen to feedback and stay positive 2/23/

33 Key Learnings We ve caught missing and inconsistent information Why didn t we do this sooner-like pilots? It is a consistent approach Feels like better patient care; patients like seeing their doctor before surgery Expands time out: reception through postop care gpecora@oregoneyeassociates.com 2/23/

34 Leslie Ray, PhD, RN, Patient Safety Consultant Oregon Patient Safety Commission MAKING CHECKLISTS EFFECTIVE 2/23/

35 An Effective Safe Surgery Checklist The checklist is a tool to help you provide the best possible care 2/23/

36 Lessons Learned Use the right checklist the right way Start small and modify Clinician support and practice changes Policy revisions 2/23/

37 Right Checklist/Right Way 3 Phases Team Participation Critical Elements 2/23/

38 Start Small & Modify Consider each use a trial Incorporate recommended changes Re-try on smaller scale 2/23/

39 Clinician Support & Practice Changes Checklist focus Respond to concerns Give it time 2/23/

40 Policy Revisions Last step Avoid too much detail Build in revisions 2/23/

41 Helpful Tips Have the checklist reflect reliable processes, not personal preferences Avoid multiple checklists Team focus is on the checklist during each pause other tasks stop Include only the most critical elements Post a big, laminated checklist in each OR Check off items as reviewed, then erase at end Notice and share good catches 2/23/

42 SAVE THE DATE Date: Topic: Next ASC Knowledge Share Thursday, April 19, 2012, 2:00-3:00p.m. PST Biological Indicator Failures: Updated Processes Speaker: Joseph F. LeBouef, RST, CST, CRCST, CHL Regional Sterile Processing Educator Kaiser Foundation Health Plan of the Northwest 2/23/