USING FRAM IN A CHILDREN S SURGICAL UNIT

Transcription

1 USING FRAM IN A CHILDREN S SURGICAL UNIT TO UNDERSTAND WORKFLOW AND DESIGN SOLUTIONS TO DAMPEN VARIABILITY Dr Danielle Franklin BM BSc FRCA Safety- II in Practice June 2018 Supported by Ernest Leach RCOA Grant

2 WHO AM I? Full time Doctor, Consultant Paediatric Anaesthetist working 1 in 6 on-call Plymouth University Hospitals Trust Q fellow Association of Paediatric Anaesthetist QI lead I have been given 0.25PA a week for this work June

3 PROJECT MSc in Patient Safety and Simulation Ethics granted by university - deemed service evaluation by the NHS Children are 20% of the population June

4 CHILDREN S THEATRES 5000 procedures a year Range of specialities: ENT, Orthopaedics, Plastics, Max fax, Trauma, General surgery, Oncology, Dental, Gynaecology, Ophthalmology, Paediatric medicine, Urology, Radiology, Endoscopy Elective and emergency work Theatres open 08:00-20:00 Monday to Friday Emergency cover 24/7 Specialist staff ODP, anaesthetists, nurses, surgeons June

5 HOW DO YOU GET YOUR OPERATION? UNDERSTANDING THE SYSTEM June

6 UNDERSTANDING THE SYSTEM Drawn by Danielle Franklin Take a guided tour June

7 HOW? FRAM Interviews (n=12) Observed practice (20hrs) Learning from Excellence(6 months) Workshops (x2) June

8 FUNCTIONS IDENTIFIED OVER 30 IDENTIFIED June

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12 Before arrival Finalise theatre list Child scheduled Create work schedule Medications Physical space Culture Child arrival Guidelines Admit patient Coordinate patient flow Coordinate clinician flow Consult with surgeon Consult with perioperative practitioner Mark off theatre list Attend team brief Consult with anaesthetist Weigh child Deliver sedative medication Collecting first patient Patient ready for theatre Provide competent staff IT support Provide equipment Apply TED stockings Deliver premed Put on Book bed appropriate clothing June

13 MARK OFF THEATRE LIST A CORE FUNCTION IDENTIFIED FOR SMOOTH RUNNING OF LISTS June

14 Mark off theatre list I just know how to do it June

15 Mark off theatre list June

16 VARIABILITY Everyone marked off on the theatre list in a different way Identified that this was a keep step Not all team members understood importance of this list Not identified clearly Anaesthetist Surgeon Nurse Weight Order Premedication TEDS Pregnancy June

17 HOW DO WE GET A THEATRE LIST? June

18 SCHEDULE CHILD June

19 Finalise theatre list IMPACT OF CHANGES TO PLANNED WORK June

20 LOOSING THE TACIT KNOWLEDGE OF THE SYSTEM Example of theatre scheduler for planed period off Limited planning for training up the temp Use example of late booking We can use the FRAM to show the consequences of actions and predict Review way work done Predict the issues Couldn t deliver this at this time to the management Need facilitator Need engagement at operational level June

21 PROVIDE COMPETENT STAFF June

22 IDENTIFYING STAFF SKILLS Tasks to be completed Prepare child and family Premedication Wrist bands Ametop Observations Patient weight TEDS Pregancy test Gown Pre-operative checklist Allergies identified Pre-operative assessment Starvation status Patient needs June

23 CHANGES June

24 CHANGE IDEAS Staff tabards Competencies List coordination VTE Gowns Labelled rooms Moved pre-op rooms June

25 UNEXPECTED CONSEQUENCES June

26 Nursing culture Threatened WAD exposed Scheduling issues These are all big issues above where I sit in the organisation. June

27 WHERE NEXT? Staff are resource Lots of knowledge Pre-admission FRAM Lack of knowledge of actual WAD Management June

28 1. How do you present this back to the non expert? 2. What should we measure? Leading indicators June

29 THANK YOU Thank you to all of the staff at Plymouth Children s Theatres Thank you to Laura Pickup and Su Smith as my supervisors daniellefranklin@nhs.net #PlymFRAM June