Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.
Issue link: http://outpatientsurgery.uberflip.com/i/153372
N E V E R E V E N T S POLICY IMPROVEMENT steps to the care of every surgical patient to pre- Make Change Happen vent an event that may or may not happen to them S personally in an entire career. o you know what needs improving in your site-marking policy, but the real 2. Manpower must be adequate to effect implementation — specifically issue is that gives you access to downloadable education. 4. Patience must be practiced. resources and materials for doing quality Implementation takes time to co-opt early and improvement in your facility. Compare late adopters — in our experience, about 6 your current site-marking protocols to the months. Joint Commission's suggestions (see So what we're really talking about isn't motiva- "Reduce Wrong-Site Risks" on page 14). how to imple- surgical, anesthesia and ment those nursing champions who will tion or encouragement, it's implementation sci- Do you notice any room for improvement? improvements have the authority, time and ence — what you need to do to create an envi- If so, you might face some hurdles. and make them resources to work with the ronment that encourages compliance with behav- stick. These 4 frontline clinicians and busi- ior change, across an organization. This science tracking and paperwork required to know components to ness office staff so they can involves the 4 components described above. One if change is actually happening at the front successful imple- meet best practice goals in a more thing: Although a degree of patience is key, line. Before beginning our policy improve- mentation are way that acknowledges the so are follow-up and reinforcement. Because if ments, for example, we collected data for necessary, realistic concerns of the you know there's a policeman patrolling a particu- 30 days just so we could spot errors. After according to 70 hospital and medical staff. lar length of highway, you proceed with caution. making changes, we tracked data for facilities — a mix PUSHBACK Surgeons often resist wrong-site surgery precautions because they're reluctant to add steps to the care of every patient. — John R. Clarke, MD 3. Data on procedures every procedure another 30 days, to validate the implementation of new practices. must be captured, analyzed comprising The biggest barrier might be all the Dr. Clarke (jclarke@ecri.org) is the editor of the Pennsylvania Patient Safety Advisory, clinical director of the Pennsylvania Patient Safety Authority and a professor of surgery at Drexel University. roughly two-thirds hospitals, one-third ASCs — and discussed. Anecdotally, some of the push- that shared with the Pennsylvania Patient Safety back seems to be related to difficulty assembling Authority their barriers to implementing wrong- all the information needed for verification, due to site surgery prevention measures. archaic information systems, including interfaces ON THE WEB between surgeons' offices and hospitals. Pennsylvania Patient Safety Authority • 21 Recommendations and Barriers to Preventing Wrong-Site Surgery bit.ly/UGH9DT • Wrong-Site Surgery Toolkit bit.ly/nTXLxH Although it's a lot of work, trust me: It'll 1. Leadership must establish the priority of implementation by empowering the nurses to Survey the frontline clinicians on the changes all feel worthwhile when you reach full compliance. One of the facilities I now manage recently used the TST to do its own quality improvement project. That facility has never had a wrong-site surgery, but the enforce the facility's best practice policies and by you want to make, and for their suggestions for providing the resources to improve systems and improvements; they might present legitimate educate providers, including the physicians on logistical reasons why change will be difficult. ing process-related risks and redesigning the medical staff. Be aware that much of the Use near-miss events to rationally drive quality those processes to further reduce the pushback comes from physicians reluctant to add improvement, policy and system changes, and chance of a wrong event's occurrence. 2 6 SUPPLEMENT TO O U T PAT I E N T S U R G E R Y M A G A Z I N E | J A N U A R Y 2013 staff recognized the importance of assess- J A N U A R Y 2013 | S U P P L E M E N T TO O U T PAT I E N T S U R G E R Y M A G A Z I N E 2 7