One step at a time: a mountain to climb?

One step at a time: a mountain to climb?

A brief background to Latvian health service Identify Latvian Quality Regulations Patient safety in children s hospital

Background Population approximately 2.1 million 45.8% male 54.2% female 350,000 children Independence from Russia in 1991 2011 established a National Health Service (type System) dependent on user payments / co payments

Member of European Union Network for patient safety and quality of care (PaSQ) Responsible to facilitate exchanges of member states to improve patient safety and quality of care Examples are: Alcohol based hand rub to improve hand hygiene Safety in surgical procedures by introduction of surgical checklists Latvian Health Service Quality Awards

Regulate compliance of regulation No 60 Minimum requirements for the medical institutions and their structural units Regular quality control of medical services provided Consideration of patients complaints and recommendations Analysis of results of medical services Quality improvement of medical services

The development of a quality management system and quality standards for health are officially claimed to be important It is known that there is a lack of leadership, staff knowledge and organisational structures to promote quality safe patient care Lack of tools to gather and analyse the risk in health care that will inform strategic direction

Valmiera Kuldīga RĪGA Jelgava Central offices of region Daugavpils

Ventspils Valmiera Kuldīga RĪGA Jelgava Liepāja Central offices of region Hospital / health centres we visit Daugavpils

Emergency rooms Pharmacy Out patient Primary care/ home care Diagnostic departments Operating rooms Transfusion service SAFETY AREA Infecction control Medication policy Patient identification and checklist Triage Record keeping Staff training Reporting adverse event

Patient Safety Team Patient safety manager Patient safety trainer / facilitator Auditor development of clinical guidelines Member of the hospital board Clinical leaders from different departments (surgeons / physicians) Head Nurses

Roles and Responsibilities Development of strategic policy on patient safety Evaluate safety improvement projects Analysis of adverse event reporting / root cause analysis Ongoing clinical audit Risk management

Departmental visits to talk to frontline staff Workshops / focus groups brainstorming learning from industrial models of change Staff training from Patient Safety team adverse event reporting Analysis of event fish bone, 5 whys no blame culture Audit lead by Head Nurses clinical guidelines

Surgery group discussing operating checklists Emergency room triage of patients Patient identification? Use of ID bracelets Record keeping Patient registration

Process Focus group with relevant professionals Use of models from industry ie lean principles Identifying areas of improvement

Registration for attendance Current system administrators by default allocate patient to speciality First come first seen Staffing area for triage nurse No dedicated / suitable area with visible sight of patients Triage system needed to be identified

Emergency room reception area

Training of staff Adminstration staff change in practice Nursing / medical staff understanding of triage system Immediate attention Observation but will need attention soon Observation but can wait Wait to be seen Other / can wait

Some remodelling of Reception Area Nurses station not suitable for triage area

Latvian Health Service is committed to provide quality safe care for their patients There is evidence of systems and processes to introduce change and improve quality Staff very enthusiastic and ready to promote change Renovated areas have given staff motivation to accept change