IMPLEMENTATION OF THE SURGICAL CHECKLIST AT REGIONAL LEVEL

IMPLEMENTATION OF THE SURGICAL CHECKLIST AT REGIONAL LEVEL Josefa González Pastrana Co-Coordinator of the Project Castilla y León Health Service Webinar www.pasq.eu 27 June 2014

Castilla y León Regional Health Service. Implementation of patient safety initiatives Situation before starting with the project Our objective and our participation in the PaSQ Project Critical points for implementation Implementation steps in the regional and local level First outcomes

2.500.000 Citizens 14 Hospitals 246 Primary Care Centers

Implementation of patient Safety initiatives PION PATIENT SAFETY INITIATIVES AWHO SURGICAL SAFETY CHECKLIST TION F IMPLEMENTATION OF PATIENT

CASTILLA Y LEON REGIONAL HEALTH SERVICE. SITUATION BEFORE STARTING WITH THE PROJECT % Hospitals using checklist % surgeries with checklist

Objective of the Project To start and/or to improve the practice implementation 1. Knowledge transfer: sharing information, experience, good practices, 2. Designing and sharing implementation tools Implementation guides Information leaflets Indicators for monitoring the project.

2013-2014. PASQ PROJECTasq Project Pasq Project. Spanish participation Health regions: 7 Health care organizations: 31 31 Hospitals 3 Primary healthcare organizations CAU León H. Bierzo HCU Valladolid HU Rio Hortega- AI Valladolid oeste 3 3 4 15 1 2 3

Before to start,. Beforehand it seems to be a quite simple project...but it is important to take into account some factors to ensure successful implementation

Critical points CRITICAL POINTS OF IMPLEMENTATION 2 To support or to expand the project 1. Show its usefulness 2. Feed back to the professionals To start with implementation 1. Start small 2. Leaders support 3. Multidisciplinary team 4. Local adaptation and test of the checklist 5. Guidelines to use the checklist 6. Design a checklist coordinator 7. Educate Professionals 1

Implementation steps at REGIONAL level STEP 1. Invitation to hospitals including some recommendations STEP 2. Design of implementation tools STEP 3. Meetings to discuss and reach consensus on different questions STEP 4. Share experiences and good practices STEP 5. Monitoring indicators

Implementation tools and indicators Tools Planning of the implementation steps in the hospital level Information leaflet to the leaderships Questionnaire PPT presentations for sensitizing and training professionals Indicators and incidents registration Networking collaborative group Common Indicators % surgeries with checklist (NHS) % Checklits in which a problem is detected (NHS) Mortality (NHS), infection

Implementation steps in the HOSPITAL level STEP 1. Local adaptation of the checklist STEP 2. Develop guidelines to use the checklist STEP 3. Staff training STEP 4. Monitoring and feed-back

Step 1. Local Adaptation of the checklist 1. Collaborative adaptation of the checklist 2. Simple checklist 3. Check antibiotic prophylaxis before induction of anaesthesia 4. Items to keep 5. Items to incorporate It is possible to develop a checklist at institutional level and specially specific ones (for cataract surgery, heart surgery, )

6. Use a check box for the registration of the practices introduced into the operating room after the checking ANTES DE LA INDUCCION ANESTESICA ENTRADA (enfermera y anestesiólogo) Step 1. Local Adaptation of the checklist El paciente ha confirmado su identidad el sitio de intervención el procedimiento su consentimiento Yes Si Yes, Si, after tras correction correccion NA No procede Sitio de intervención marcado Why to use it? Pulsioxímetro funcionando en el paciente 1. To know the problems that needed to be corrected to identify Instrumental/ which equipo are quirúrgico/prótesis the usual problems and study why they happen disponible 2. Equipo To show de anestesia its usefulness preparado Medicación anestésica preparada

The guidelines to use the checklist should explain: Step 2. Guidelines to use the checklist 1. How to check each item 2. What to do if a problem is detected 3. How to do the registration

Training Session To educate staff in the surgical area Step 3. Staff training

Monitoring and evaluation of the outcomes and the feed-back to the professionals Step 4. Feedback Incidents detected % surgeries with incidents detected Prevalent problems Decrease of adverse events (infections,..)

First outcomes 1. Other hospitals interested on this practice Go to start Previous experience Starting 5 Hospitals Already using, want to extend 2 Hospitals Advanced develope in use it 2 Hospitals 3 hospitals No experience 2 Hospitals

First outcomes Difficulties Driver: Multimodal strategy 2. Identification of most prevalent difficulties and the improvement strategy 1. Professionals don t see its usefullness 2. It is not used in an appropriate way 3. Monitoring 4. To support the project 1. Staff Training 2. Remind why to use it 3. Monitoring tool to make easy the feedback to professionals 4. To have a local coordinator 5. Include it as an objective in the

First outcomes 3. Good practices implemented in the regional and local level Review of antibiotic prophylaxis in some departments,.. Standarization of the surgery process in the regional level Develop a computer programme for the management of the surgery area

My special greetings to all the professionals that with their work make possible this project Regional and local Teams Cesar Aldecoa Alvarez- Santullano Yolanda Carrascal Hinojal Mario Castaño Ruiz Elisa Gil-Carcedo Sañudo Jose Ignacio Gómez Herrera Marta Eva González Pérez Maria Heredia Rodríguez Cristina Hernan Garcia Genoveva López Relea Jose Miguel Marcos Vidal Jose Manuel Meijome Sánchez Mª Nieves Monje Curiel Sonsoles Paniagua Tejo Eduardo Tamayo Gómez Marta Tejada Garcia Alberto Vegas Miguel Isabel García Palomar Mª José Pérez Boillos

THANK YOU