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Perinatal Patient Safety

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Perinatal Patient Safety An interdisciplinary approach to improve performance J. Chris Carey MD Director, Obstetrics and Gynecology, Denver Health – PowerPoint PPT presentation

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Title: Perinatal Patient Safety


1
Perinatal Patient Safety
  • An interdisciplinary approach to improve
    performance
  • J. Chris Carey MDDirector, Obstetrics and
    Gynecology, Denver HealthProfessor, Obstetrics
    and Gynecology

2
High reliability organizations are those that
operate highly complex and hazardous
technological systems essentially without
mistakes over long periods of time.High
reliability patient care units are built on a
solid foundation of timely communication and
collegial teamwork to maintain patient safety as
a top priority. Managing the Unexpected
Assuring High Performance in an Age of
Complexity K. Sutcliff, MSN, PhDSan Francisco
Jossey-Bass 2001
3
In these units
  • Concise, real-time and constant communication is
    valued
  • Teamwork and collegiality characterize the
    professional relationships
  • Hierarchy is minimized
  • Safety is the hallmark of the organizational
    culture
  • Their operations are viewed as potentially
    dangerous
  • Emergencies are rehearsed and the unexpected
    practiced

4
Partnering Relationships Are..
  • Collaboration and teamwork that is an authentic
    partnership in which power on both sides is
    valued
  • Each recognizes and accepts spheres of activity
    and responsibility
  • Each mutually safeguards the interests of each
    other
  • Each recognizes a commonality of goals
  • Based more on respect and contribution than power
    and dependency

5
Partnership is evidenced by
  • Communicating with patients family and
    healthcare providers regarding patient care and
    all providers role in the provision of that care
  • Collaborating in creating a documented plan,
    focused on outcomes and communication with
    families and others
  • Partners with others to effect change and
    generate positive outcomes through knowledge of
    the patient or situation

6
Strategies to achieve a strong partnership ethic
include
  • Thinking expansively
  • Being flexible
  • Challenging assumptions
  • Abandon the comfort zone
  • Redefine boundaries
  • Realize the vision

7
Think Expansively, become a Totalist
  • Always learning and supporting the changes that
    benefit the patient
  • Thinks beyond the confines of own experiences or
    knowledge
  • Sees the whole picture
  • Sees how people and processes work together

8
Be Flexible
  • Adapt to change
  • When situations are not controllable, your
    reaction to it is
  • Work together to manage the surprises, ambiguity,
    conflict or disorientation that are part of every
    change

9
Challenge Assumptions
  • Never blindly trust assumptions
  • Build on knowledge and understanding
  • Mistakes, errors, wrong turns and confusion are
    often built on assumptions
  • Knowing your partners is essential
  • Believing assumptions to be true encourages a
    lose-lose situation that fosters resentment,
    confusion, delays and waste.
  • Stop Making Stuff Up check it out!

10
Abandon the Niche
  • Step outside of your personal comfort zone
  • Understand your team
  • Cannot continue to do things in the old way
  • Be willing to trust others
  • Be willing to stretch and share our expertise
  • Be willing to work on projects that involve
    others in the organization
  • Be willing to take risks

11
Redefine Boundaries
  • Let go of traditional roles
  • Eliminate turf protection
  • Remove barriers to cross-functional interactions
  • Think big and out of the box
  • Focus on patient needs

12
Key Elements for success
  • Partnership
  • Equity
  • Outcomes
  • Benefits
  • Barriers
  • Accountability
  • Ownership

13
Why Effective Communication and Teamwork ?
  • The overwhelming majority of untoward events
    involve communication failure
  • Somebody knows theres a problem but cant get
    everyone in the same movie
  • The clinical environment has evolved beyond the
    limitations of individual human performance

14
MD RN DifferentCommunication Styles
  • Nurses are trained to be narrative and
    descriptive
  • Physicians are trained to be problem solvers -
    what do you want me to do just give me the
    headlines
  • Complicating factors gender, national culture,
    the pecking order, prior relationship
  • Perceptions of teamwork depend on your point of
    view

15
Effective Communication Requires
  • Structured communication SBAR
  • Assertion/ Critical Language key words, the
    ability to speak up and stop the show
  • Psychological safety an environment of respect

16
Situational Briefing Model
  • S-B-A-R
  • Situation
  • Background
  • Assessment
  • Recommendation

17
(No Transcript)
18
SBAR in OB
  • S Impending uterine rupture
  • B VBAC, dense epidural, persistent breakthrough
    pain, complete
  • A Im concerned, somethings wrong
  • R I think she needs a C-S. I need you now

19
SBAR
  • Situation the punch line 5-10 seconds
  • Background the context, objective data, how did
    we get here
  • Assessment what is the problem ?
  • Recommendation what do we need to do ?

20
Assertion
  • Model to guide andimprove assertion inthe
    interest of patient safety

21
The Difficult Conversation
  • Focus on the common goal high quality, safe
    care
  • 3rd person depersonalize the conversation
    its not about you and me
  • Avoid judgment whos right, whos wrong is a
    loser
  • What needs to happen for us to do the right thing
    here?

Difficult Conversations Stone, Patton, Heen
Viking (1999)
22
Sustaining SBAR Use
  • Give it to me in SBAR
  • Use prompts and ticklers
  • Checklists
  • Phone labels
  • Pocket cards
  • Thanks for using SBAR
  • Reward and recognize
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