Behaviour Based Safety Observation (BBSO): Proactive Approach for Promoting Safe Sharp Handling Culture in Operating Theatre LAW NGAI WAN APN ANAESTHESIOLOGY AND OPERATING THEATRE SERVICES QUEEN ELIZABETH HOSPITAL 1
Sharp injury Increasing trend in sharp injury Contact sharp objects directly with bare hand Lack of communication during transfer of sharp instrument Inappropriate use of sharp safety devices All these causes of injury are preventable Green staff Suture handling Standard practice was not followed 2
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Team approach! Work together! Meeting with Hospital OSH team and ICT team in May 2016 Standard practice Staff engagement Continuous monitoring by BBSO 1. Reduce sharp injury rate 2. Enhance staff awareness in safe sharp handling 3. Promote and sustain safety culture 4
Promote staff awareness and engagement Launch slogan design competition in June2016 Kick off ceremony 15 July 2016 Management commitment signing & support 5
Standardized Practices Photos of standardized practice delivered to all staff, COS for promulgation to surgeons and anaesthetists Video uploaded to department website for training & easy access 6
Training workshop Demonstration and return demonstration on practical skill of sharps handling Target for staff under 3 years OT experience 7
Behaviour Based Safety Observation (BBSO) Process focuses on safe acts/behaviours and unsafe acts/at risk behaviours, Proactively address all unsafe acts, not just those which result in incidents/injuries, Process provides positive feedback and reinforcement on safe acts, Promote staff awareness on safety culture, Sustain culture change by continuous safety observation. 8
BBSO checklist Adobe Acrobat Document 9
Steps in Observation 1) Introduce yourself and explain purpose of observation 2) Use Observation Checklist as a guide 3) Observe the surgical team activity (safe behaviour and at risk behaviour) 4) Feedback to observees: positive reinforcement on safe behavior, reflection on unsafe acts/at risk behaviour 5) Perform data analysis, find out causes of unsafe acts 6) Communication observation results (safe & unsafe acts) 7) NO BLAME, NO NAME 10
BBSO results 100.0% 98.0% 96.0% 96.2% 94.7% 96.2% 97.8% 97.6% 98.1% 94.0% 92.0% 90.0% 89.8% 88.0% 86.0% 84.0% Mar 17 Apr 17 May 17 Jun 17 Jul 17 Aug 17 Sep 17 SBI Safe Behaviour Index 11
Scalpel Blade Syringe needle Suture needle Overall 0 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Number of at risk behaviors 12
1 2 3 At risk behaviour Item 9: Give verbal announcements when passing sharps Item 8: Avoid putting fingers inside or immediate above transferring dish when passing sharps to surgeon Item 11: Use appropriate instrument for pointing the sharps s during counting procedures 13
Continue improvement 14
Sharp injury incident rate 18 16 14 12 10 8 6 4 2 Pre BBSO implementation 17 Post BBSO implementation 8 52% 0 Mar Sept 2016 No.of injury Mar Sept 2017 15
Challenges 3T Time constrain (manpower) Timely feedback Time for cultural change 16
Keys to Success Communication Teamwork Compliance 17
Acknowledgement COS: Dr. S Wong DOM: Ms SH Chan NC: Ms C Yip WMs: Ms A Che, Ms P Lee, Ms MS Ma BBSO Observers Team Mr Fung Hing Man Ms Chu Wai Ling Ms Choi Shuk Mei Ms Ho Kit Ying Ms Hui Mo Yin Ms Lai Hoi Yan Ms Leung Chow Ming Ms Lui So Han Sharp Injury Prevention Workgroup Members Law Ngai Wan: blnwz02@ha.org.hk 18
Reference L. Spruce. Back to Basics: Sharp Safety. AORN Journal, vol.104, pp. 30 45, July 2016. R. Berguer & P.J. Heller. (Sept 2004) Preventing Sharps Injuries in the Operating Room. American College of Surgeons. Internet: 199(3), pp.462 467. Retrieved from: https://pdfs.semanticscholar.org/6fee/a3e27ed045883b71e0c34546d328bd45b1f 4.pdf (3 March 2018). WSH Guide To Behavioural Observation and Intervention. Workplace Safety and Health Council in collaboration with the Ministry of Manpower, April 2014. Retrieved from: https://www.wshc.sg/files/wshc/upload/cms/file/2014/wsh_guide_to_behaviou ral_observation_intervention.pdf (25 April 2018). 19