Developing HUDDLES in Healthcare

Developing HUDDLES in Healthcare Dr Kate Pryde Consultant Paediatrician, Southampton Children s Hospital October 2017 @katepryde

Huddles

Healthcare HUDDLES Preparatory briefing among healthcare professionals for the purpose of collaborating, exchanging information and bringing awareness to patient safety concerns

Situational Awareness

Healthcare HUDDLES Healthcare Utilising Deliberate Discussion Linking Events Glymph et al 2015

Look back Look forward Interrogate The Huddle Suite Escalate Leaders safety brief (Macro) Overview of risk and harm Mitigate Ward Safety Huddle (Meso) Nurses, Doctors, AHP, play & admin Identify Bedside huddles (Micro) Patient, family, nurse, doctor

Southampton Children s Hospital 150 Beds, inc 14 bedded PICU, 11 wards 40 000 admissions/year Tertiary specialist children s hospital inc cardiac, neurology, oncology, nephrology, respiratory, gastroenterology, ENT and more DGH for local population

Overarching aim....to constantly strive for the highest quality care we can achieve and to reduce avoidable error and harm to children in our children s hospital through the development of a proactive safety culture

Outcomes Primary Drivers Secondary Drivers Overall aim: To reduce avoidable error and harm to children on the paediatric medical unit through the development of a proactive safety culture Outcomes: This will be demonstrated by: 1.Increased understanding in clinical teams of the concepts of: 1. situational awareness, 2. proactive actions to reduce harm, 3. sharing of learning 4. the pivotal role of patients, parents & carers in providing harm free care 2.Improved awareness of safety from patients, parents and carers through: 1. Improved Manchester Safety awareness survey scores 2. Reduction in complaints 3. Completion of safer care checklist 3.A 25% reduction in unplanned PICU admissions 4.Of unplanned PICU admissions: 1. 25% reduction in LoS 2. 25% improvement in PiMM 2 score 5.50% reduction in number of medication errors that reach patient 6.50% decrease in extravasation injuries Improved situational awareness Developing a culture based on safety Improved Engagement with patients and their parents/carers in delivering care recognised as being safe Recognition and escalation of deteriorating child in timely manner Learning from excellence Introduction of MDT huddle intervention Reinforcement of use of structured communication Introduction and development of other appropriate tools and interventions Education of teams in concepts of situation awareness, anticipation, containment and reliability Utilisation of Manchester Patient Safety Questionnaire Fostering an open approach to working as clinical teams incorporating whole of MDT Introducing patients, parent and cares as key components of team Utilisation of the Safer care checklist Introduction of patient/parents safety awareness survey Engaging patients, parents and carers in development of local projects Accurate recording of physiological observations Correct use of PEWS escalation protocol Use of structured approach (SBAR) for communication Embedding and utilisation of FERF RCA of excellent practice events

Start small.... and grow

But where to start? Satellite theatre lists LP & BMT Anaesthetists & WHO surgical safety checklist Retirement of staff

Engaging colleagues

Communicating the programme

Design and test change Start small Rapid, frequent PDSA Share results Promote positivity

PMU SAFE Huddle checklist (v.4) Date: Time: Pre Huddle Questions: What have we done well? Were we SAFE on the last shift? Are our systems and processes reliable? Are we SAFE today? Will we be SAFE in the next shift? Are we responding and improving? Bed No Acuity score HDU/ PICU step down Pews Nursing concern Watcher Parental Concern Active IP Issues Safeguarding concerns Similar Names ACP EDD AER/ Near Miss Action Other Information 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Power of recognition & value

Huddle Spread PB PICU PMU JADW PHDU Hub Huddle 13.00 & Midnight PAU G2N G4N G3 G4S

Summary of Outcomes to Date Improved information sharing Clinical (sick and deteriorating patient) 21 patient reviews Safety 90 rapid adverse event reviews morphine, razors, NGT checks Operational 21 wating on PAU to 3 beds in 4 hours Empowerment Culture of collaboration and community

Our Learning Staff appreciating iterative process when, how many, format Huddle leadership -TIMING Seeing value evidencing outcomes People wanting to sit and chat! It s NOT a handover or a meeting.... Not just about staffing Reactive to proactive still work in progress! Ensuring we walk before try to run

Implementing your own Huddle What matters to patients? What matters to staff? What does your data tell you? Adverse event reports Complaints

Planning for your Huddle Communication- Individuals aware of situation in areas of responsibility Location - Suitable place for the huddle People - Representation from whole MDT Timing Culture Open approach to communication Valuing everyone s input

Huddle Trigger Tool and Script To support the huddle, some sites use different tools: Trigger tools Used to identify, in advance of a huddle, which patients need to be discussed Checklist/Scripts Acts as an aide memoire to ensure huddles follow a consistent format, helping reliable use

What might your checklist/script include?

Take the HUDDLE concept & develop to suit YOUR workplace: Watford Drug-gle is medications safety huddle

Huddles Core Principles Increased situational awareness Reactive to proactive Improved team communication Flat hierarchy all contributions valued Structured Continuous learning

Acknowledgements RCPCH SAFE Project, Peter Lachman Staff of Southampton Children s Hospital In particular: Leigh Shaw, Amy Mitchell, Grace Reynolds, Jenny Bull, Amy Withers, Bev Watson, Outreach, Bleep, PB and PMU teams

More information..... www.rcpch.ac.uk/safe Kate.pryde@uhs.nhs.uk @katepryde