Safety Rounds in Ambulatory and Inpatient Settings Wednesday, October 25, 2006 12:00 1:00 p.m. EDT - PowerPoint PPT Presentation


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Safety Rounds in Ambulatory and Inpatient Settings Wednesday, October 25, 2006 12:00 1:00 p.m. EDT


Kelly Crescenzo, RN, BSN, CEN. Jacqueline Noll, RN, BSN, CEN. Nancy Bonalumi, RN, MS, CEN. Jill Baren, MD. Clin Pediatr Emerg Med, December, 2006, Elsevier, Inc. ... – PowerPoint PPT presentation

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Title: Safety Rounds in Ambulatory and Inpatient Settings Wednesday, October 25, 2006 12:00 1:00 p.m. EDT

Safety Rounds in Ambulatory and Inpatient
SettingsWednesday, October 25, 20061200
100 p.m. EDT
  • Moderator
  • Uma Kotagal, MD, MBBS, MSCE, FAAP
  • Vice President for Quality and Transformation
  • Director, Center for Health Policy Clinical
  • Cincinnati Childrens Hospital Medical Center
  • Cincinnati, Ohio

This activity was funded through an educational
grant from the Physicians Foundation for Health
Systems Excellence.
Disclosure of Financial Relationships and
Resolution of Conflicts of Interest for AAP CME
Activities Grid
  • The AAP CME program aims to develop, maintain,
    and increase the competency, skills, and
    professional performance of pediatric healthcare
    professionals by providing high quality,
    relevant, accessible and cost-effective
    educational experiences. The AAP CME program
    provides activities to meet the participants
    identified education needs and to support their
    lifelong learning towards a goal of improving
    care for children and families (AAP CME Program
    Mission Statement, August 2004).
  • The AAP recognizes that there are a variety of
    financial relationships between individuals and
    commercial interests that require review to
    identify possible conflicts of interest in a CME
    activity. The AAP Policy on Disclosure of
    Financial Relationships and Resolution of
    Conflicts of Interest for AAP CME Activities is
    designed to ensure quality, objective, balanced,
    and scientifically rigorous AAP CME activities by
    identifying and resolving all potential conflicts
    of interest prior to the confirmation of service
    of those in a position to influence and/or
    control CME content. The AAP has taken steps to
    resolve any potential conflicts of interest.
  • All AAP CME activities will strictly adhere to
    the 2004 Updated Accreditation Council for
    Continuing Medical Education (ACCME) Standards
    for Commercial Support Standards to Ensure the
    Independence of CME Activities. In accordance
    with these Standards, the following decisions
    will be made free of the control of a commercial
    interest identification of CME needs,
    determination of educational objectives,
    selection and presentation of content, selection
    of all persons and organizations that will be in
    a position to control the content, selection of
    educational methods, and evaluation of the CME
  • The purpose of this policy is to ensure all
    potential conflicts of interest are identified
    and mechanisms to resolve them prior to the CME
    activity are implemented in ways that are
    consistent with the public good. The AAP is
    committed to providing learners with commercially
    unbiased CME activities.

  • The American Academy of Pediatrics (AAP) is
    accredited by the Accreditation Council for
    Continuing Medical Education to provide
    continuing medical education for physicians.
  • The AAP designates this educational activity for
    a maximum of 1.0 AMA PRA Category 1 Credit.
    Physicians should only claim credit commensurate
    with the extent of their participation in the
  • This activity is acceptable for up to 1.0 AAP
    credit. This credit can be applied toward the
    AAP CME/CPD Award available to Fellows and
    Candidate Fellows of the American Academy of

  • This webinar is approved by the National
    Association of Pediatric Nurse Practitioners
    (NAPNAP) for 1.2 NAPNAP contact hours of which
    0.0 contain pharmacology (Rx) content. The AAP
    is designated as Agency 17. Upon completion of
    the program, each participant desiring NAPNAP
    contact hours should send a completed certificate
    of attendance, along with the required recording
    fee (10 for NAPNAP members, 15 for nonmembers),
    to the NAPNAP National Office at 20 Brace Road,
    Suite 200, Cherry Hill, NJ 08034-2633.
  • The American Academy of Physician Assistants
    accepts AMA PRA Category 1 Credit(s)TM from
    organizations accredited by the ACCME .

  • Featured Speaker
  • Kathy N. Shaw, MD, MSCE, FAAP
  • Chief, Division of Emergency Medicine
  • The Childrens Hospital of Philadelphia
  • Philadelphia, Pennsylvania

  • Upon completion of this activity, participants
  • will be able to
  • Describe the process and explain the rationale
    for senior leader-driven Safety Rounds in
    ambulatory and inpatient settings.
  • List the types of safety issues identified on
    Safety Rounds, and distinguish similarities and
    differences between safety issues in ambulatory
    and inpatient settings.
  • Select and apply at least one strategy to ensure
    issues identified on Safety Rounds are
    efficiently and effectively discussed with all
    appropriate individuals and improvements are

The Childrens Hospital of Philadelphia Emergency
Department Unit-Based Patient Safety WalkRounds
  • Kathy N. Shaw, M.D., M.S.C.E.
  • Chief, Division of Emergency Medicine
  • Professor of Pediatrics at CHOP
  • University of Pennsylvania School of Medicine
  • The Nicholas Crognale Endowed Chair
  • in Pediatric Emergency Medicine

Purpose of WalkRounds
  • Mechanism for communicating with staff
  • about safety issues
  • Signal staff on the front lines that there is
  • commitment to a culture of safety
  • Foster open communication and
  • a blame-free environment
  • Gather ideas to take action to make
  • a safer work place

Unit-based PSWR
  • Stakeholders vs. visitors
  • Ubiquitous vs. sporadic
  • Rapid response and dissemination
  • of information vs. not . . .

When Unit-based PSWR
  • Minimum of 2 times / month
  • All days of the week
  • All times of the day

Participants Unit-based PSWR
  • Team leaders
  • PEM attending / 2 RNs
  • Staff Participants
  • Resident
  • ED nurse
  • Clerical staff
  • Social worker or Child Life therapist
  • Respiratory therapist or Radiology tech
  • Environmental Services or ED tech

Where Unit-based PSWR
  • CQI in patient care area of the ED (15-20 min)
  • Group meeting in the ED conference room (15-20

Tool Kit Unit-based PSWR
  • Step by Step Guide to Conducting PSWR
  • Quality Improvement Indicator Tools
  • General Questions for Group Discussion

ED Based CQI Activities
  • 4 team members complete CQI tools in ED
  • Clinical observations
  • Interviews with staff / parents
  • Review of chart, electronic tracking and
  • ordering system

Quality Improvement Tools
  • 1. Accuracy of weight and allergy documentation
  • RN or tech joins PSWR
  • Appropriateness of patient monitoring
  • and alarm parameters / central monitoring
  • RN joins PSWR
  • 3. Reasons for prolonged ED length of stay 3
  • Resident joins PSWR

Quality Improvement Tools
  • Accuracy of medication orders, administration,
  • and documentation
  • ED RN or MD joins PSWR
  • 5. Compliance with hand washing
  • RN joins PSWR person from Environmental
    Services identified to complete room check part
    of QI
  • 6. Patient / family communication (directed at
  • Clerk or Social Work / Child Life or RN join PSWR


Conference Room Discussion
  • Review purpose of PSWRs
  • Open-ended general questions and discussion
  • with 5 individuals chosen from clinical area
  • Discussion / information is reported without
  • identifiers to an individual

General Questions for PSWR Participants
  • In your last few shifts, have you experienced any
    near misses that almost caused patient harm but
    were avoided? Have you noticed any incidents
    that actually did result in patient harm?
    (please describe)
  • What should be done to encourage reporting of
  • near misses events?

General Questions for PSWR Participants
  • Based on discussion of near misses, please
    provide suggestions on how we could improve the
    safety of patients in our ED.
  • Have you developed any personal practices to help
  • you prevent making errors in the ED?
  • If you could fix one thing in the ED to make it a
  • place for patients, what would it be?

PSWR Follow-up
  • Multidisciplinary team meets twice per month
  • - Reviews latest PSWR data and IRs
  • - Follow-up report generated regarding issues
  • observed, resolution, and who is accountable
  • Dissemination of ideas / results to staff

Our Experience(First 9 Months)
  • 20 Unit-based PSWR
  • 30 on weekends,
  • 65 on evenings / overnights
  • 99 staff members participated

Lessons Learned
  • 20 aborted and rescheduled
  • Orientation and Communication are Essential
  • General each group of constituents
  • Individual leaders prior to PSWR

Discoveries and Actions
  • Numerous issues identified
  • Action items involved
  • - Multiple services
  • - Education of staff
  • - New policies and procedures
  • - Occasional quick fixes

Patient / Family Communication Tool
  • Systems Issue
  • Families could not identify staff roles
  • Solutions (unit-based)
  • Dry erase board in each room
  • with providers names
  • Bedside report and rounding

Hand-Washing Tool
  • Systems Issue
  • Lack of alcohol hand-rub in each room
  • Solutions (multiple services)
  • Environmental Services
  • Environmental Health and Safety
  • Purchasing

Monitoring and Alarms
  • Systems Issue
  • No standard for initiating CR mentoring
  • Lack of age-appropriate alarm parameter
  • Inaudible alarms
  • Solutions (unit-based and hospital-wide)
  • Standards established
  • Mandatory education on age-based parameters
  • Biomedical engineering to increase alarm volumes

Patient Safety Discussion
  • Systems Issue
  • Staff unclear as to when or why to complete
    incident reports tattling vs. identification
  • and prevention
  • Solutions
  • Staff communication (emails, meetings)
  • Emphasis on systems issues and solutions
  • Praising near-miss reporting
  • Feedback on PSWR / IRs monthly

Medication Near-Miss Incident Reports
Rate per 1000 ED Patients
Conclusions Unit-based PSWR
  • Inspire staff to participate in making their unit
  • Identify multiple issues not reported
  • by usual practice
  • Lead to multiple systems improvements
  • to improve patient safety

Further Information
  • Creating Unit-based Patient Safety Walkrounds in
    a Pediatric Emergency Department
  • Kathy N. Shaw, MD, MSCE
  • Jane M. Lavelle, MD
  • Kelly Crescenzo, RN, BSN, CEN
  • Jacqueline Noll, RN, BSN, CEN
  • Nancy Bonalumi, RN, MS, CEN
  • Jill Baren, MD
  • Clin Pediatr Emerg Med, December, 2006, Elsevier,