FEATURE
the staff to buy into solutions to chal- lenges we encounter because they are empowered to develop the solutions.” As an example, Mitros recalls a situ-
ation where a patient was almost given an antibiotic that would have triggered an allergic reaction. Up to that time, the ASC’s process for providing antibi- otics was to have the order written and, then, taken by a nurse who would pre- pare the antibiotic for administration by anesthesia. “Although the anesthesiologist has an electronic medical record in front of him, while he is getting ready to do induction, it is not easy to go back to the page where the medication allergies are listed,” Mitros says. “When we were faced with this challenge, we looked at the process we had in place, and with a relatively simple exchange of ideas, came up with a much better and safer way of administering antibiotics. “The solution was to make a copy of the order page, which has the aller- gies listed, and tape that to the IV bag,” he continues. “Now, when the anesthe- siologist gets the intravenous (IV) bag in the operating room (OR) and pulls the order page off, he sees that this is an order for the patient he has in front of him, the order matches the bag and the page tells him if there are any aller- gies. This solution was devised by the frontline workers—the people who are actually in the trenches and delivering the care. If you are able to get even small ‘wins’ like this, making the tran- sition to a culture of safety becomes a gratifying and reinforcing process.” While situations such as this one opportunities
present for improve-
ment, establishing a culture of safety also involves ongoing efforts to bring about positive change, notes Blasco. “ASCs should consider establish- ing quality councils or task groups that establish safety vision and goals both from a unit as well as overall organiza- tion level,” he says. “These groups are composed of a cross-section of front-
10 Safety Interventions
To help mitigate risk and create a culture of safety in the operating room (OR), Tom Blasco, MD, managing partner, and Robert Dahl, senior vice president and chief operating officer, of Surgical Directions in Chicago, Illinois, suggest 10 interventions.
1. Establish a collaborative governance model. 2. Adopt a single pathway for boarding cases.
3. Establish a strong pre-surgical testing process to optimize patient care prior to the procedure.
4. Adopt an electronic scheduling and pre-anesthesia testing management system.
5. Institute a “daily huddle.” 6 Ensure the sterile processing department is optimized.
7. Implement crew resource management (an integrated training, process im- provement and management system that uses all available resources, in- cluding people, process and technology, to enhance safety and operational efficiency).
8. Implement universal protocols and adopt the World Health Organization safety checklist.
9. Ensure that all errors and near misses are documented.
10. Instill a “just culture” whereby all team members can communicate without fear of retribution.
It is a journey. It is not something you can fix and forget about. It needs to be an ongoing focus.”
—Ann Shimek, RN, CASC, United Surgical Partners International
line representatives that are directly involved in the area of patient care.” For example, he suggests, in addition to an ASC’s medical director, busi- ness manager and nursing director, a task group in charge of improving the quality of scheduling and preop patient preparation would likely include repre- sentatives from scheduling, pre-cer- tification, pre-admissions, preop, the OR and the surgeons’ offices, such as schedulers or office managers. “Defining the current process, dis- cussing the deficits and gaps, and establishing the goals and benchmarks should be part of the ongoing discussion
in these groups,” Dahl adds. “A ‘team- work-based’
organization facilitates
the confidence within all members of the organization to discuss issues and observations related to improving qual- ity without concern for recrimination.” Shimek says a valuable, ongoing
effort that ASCs should institute as part of their efforts to establish a culture of safety is a daily huddle. “This is where one member from each department gets together at the same time every day for 5-10 minutes to discuss what went well during the day and what opportunities exist for improvement, and then, the team looks at the schedule for the next
ASC FOCUS JUNE/JULY 2014 21
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