Webinar 17: Teamwork in The Operating Room

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Webinar 17Teamwork in The Operating Room
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Summary of Last Weeks Call

• Case Study Results from Last Week
• Measuring the Checklist 101
• Checklist Use
• Positive Impacts on patient care
• Outcomes
• Mortality
• Complications
• We asked for your Feedback about the Webinar
  Series

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How Did the Homework Go?
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Homework to Date Slide 1 of 4

• Build an implementation team.
• Schedule a time and venue for a meeting to take
  place after January.
• Download the OR Personnel Spreadsheet from our
  website and begin completing the information with
  the names, roles, and email addresses if
  relevant.
• Review the checklist modification guide and South
  Carolina Checklist Template.
• Modify the checklist with your implementation
  team and use it in a table-top simulation.
• Test the checklist with one team and modify if
  necessary.

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Homework to DateSlide 2 of 4

• Email us a picture of your checklist
  implementation team.
• Identify departmental meetings to have the
  implementation team speak after call 10.
• Expand the testing of the checklist to one team
  using the checklist for every case for one day.
  Modify the checklist as necessary.
• Email us your hospitals checklist.
• If you havent already done so, please call or
  email our team about whether you would like to
  administer the culture survey.
• Email everything to safesurgery2015_at_hsph.harvard.e
  du.
• Identify people that you think will be skeptical
  of using the checklist and try to talk to them
  before you hold a large meeting.

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Homework to DateSlide 3 of 4

• Organize and conduct one-on-one conversations.
• Create a checklist demonstration video for your
  hospital.
• Decide if the checklist will be used in paper or
  poster form.
• Finalize your hospitals checklist, please send
  it to us so we can see how you made the checklist
  work for you.
• Start your checklist advertizing campaign.
• Prioritize surgical specialties for the roll-out
  using your knowledge of which surgeons will be
  most receptive to the checklist.
• Create a timeline for your hospitals expansion
  and send it to the Safe Surgery 2015 team.

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Homework to DateSlide 4 of 4

• Continue to
• Administer the culture survey
• Have one-on-one conversations with as many people
  as you can
• Hold departmental meetings
• Implement the checklist
• Create a checklist demonstration video and
  consider submitting it to the video competition.
• Mark your calendars and register to attend the
  2012 April Patient Safety Symposium.
• If you have not already done so, hold the large
  inter-disciplinary meeting that you scheduled at
  the beginning of the call series.

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Todays Topics

• Teamwork in the Operating Room
• Overview
• The Checklist as a Teamwork Tool
• Closed Loop Communication
• Speaking Up

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Teamwork in the Operating Room
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Poll 1 Are you or one of your colleagues
planning on attending the April Patient Safety
Symposium?

• Yes
• No
• I am not sure yet

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Poll 2 Reflect on the cases that you have been a
part of or observed over the last month and rate
your perceptions of teamwork(1 Never, 5
Always)

1. Physicians maintained a positive tone throughout
   the operation.
2. Speakers made a visual or spoken effort to
   confirm that important information was received.
3. Team members referred to each other by role
   instead of name (e.g., Nurse instead of Dana)
4. Team members made certain that their concerns
   were understood by other team members.

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Lingard, L et al. Evaluation of Preoperative
Checklist and Team Briefing Among Surgeons,
Nurses, and Anesthesiologists to Reduce Failures
in Communication. ARCH SURG. VOL.143 January
2008.
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Nundy, S, et al. Impact on Preoperative Briefings
on Operating Room Delays A Preliminary Report.
Arch Surg. 2008 Ovember 143(11) 1068-1072.
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Mazzocco, K, et al. Surgical Team Behaviors and
Patient Outcomes. The American Journal of
Surgery 678-685, 2009.
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OR Team Training Program
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What We Created
20 Minute Presentation
Exercise
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Team Training Topics

• The Checklist as a Means to Enhance Teamwork in
  the OR
• Closed Loop Communication
• Speaking Up
• Coaching in the OR

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3 Spots Left For April 24th Team Training

• Contact Mary Stargel to register
• mstargel_at_scha.org

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The Checklist Can Be Poor Mans Team Training
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Closed Loop Communication

1. The sender initiates a message.
2. The receiver accepts the message, interprets it,
   and confirms what was communicated.
3. The sender verifies that the message was
   received.

Derived from the Agency for Healthcare Research
and Quality, TeamSTEPPS
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Speaking Up The Solution

• Use special words that indicate that there is a
  problem.
• Both the sender and the receiver need to
  understand these words.

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Coaching Teamwork in the OR
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Teamwork Coaching Tool
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Closed Loop Communication
5. Verbal communication among team members was
easy to understand (e.g., clearly articulated and
spoken at an adequate volume.)
7. Speakers made a visual or spoken effort to
confirm that important information was received.

• Nurse review with Team
• Instrument, sponge and needle counts are correct
• Name of the procedure performed
• Specimen labeling
• Read back specimen labeling including patient name

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Speaking Up
17. Team members made certain that their concerns
were understood by other team members.

• Everyone please state your name and role.
• Surgeon discusses
• Operative plan and possible difficulties
• Expected duration of procedure
• Anticipated blood loss
• Implants or special equipment needed
• Anesthesia Provider discusses
• Anesthetic Plan
• Airway or other Concerns
• Nursing Team Discusses
• Sterility, including indicator results
• Any Equipment Issues or other concerns
• Surgeon States
• Does anybody have any concerns? If you see
  something that concerns you during this case,
  please speak up.

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Checklist Teamwork
3. Physicians were present and actively
participating in patient care prior to skin
incision.
4. Physicians maintained a positive tone
throughout the operation.
13.Team members referred to each other by role
instead of name (e.g. Nurse instead of Dana).

• Everyone please state your name and role.
• Surgeon discusses
• Operative plan and possible difficulties
• Expected duration of procedure
• Anticipated blood loss
• Implants or special equipment needed
• Anesthesia Provider discusses
• Anesthetic Plan
• Airway or other Concerns
• Nursing Team Discusses
• Sterility, including indicator results
• Any Equipment Issues or other concerns
• Surgeon States
• Does anybody have any concerns? If you see
  something that concerns you during this case,
  please speak up.

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Who Should Complete This Tool?

• Observers, i.e. members of the checklist
  implementation team, nurse educators, nurse
  managers, quality improvement officers.
• Observers should stay for at least 30 minutes of
  a given case.
• We recommend that you limit the number of people
  that are performing the observations so you will
  get consistent feedback.

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Pairing This Tool With the Checklist Observation
Tool

• To better understand how the checklist affects
  teamwork, we recommend that both of the coaching
  tools be used in the same case.
• The circulating nurse should complete the
  Checklist Coaching Tool and an outside observer
  should complete the Teamwork Coaching Tool.
• Another option is to have two outside observers
  complete the tools.

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How Many To Collect

• In order to give you the best feedback we suggest
  collecting a minimum of 10 observations per
  quarter.
• If you perform more than 10 per quarter you will
  have a better understanding of checklist use and
  teamwork.
• If you perform fewer observations we will still
  give you feedback.

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We Will Give You Feedback Based on the
Observations

• If you send our team your completed tools we will
  give you a report on how your hospital is doing.
• These reports are extremely helpful and are
  offered to you at no cost.
• We recommend that every hospital use this tool to
  better understand how the checklist is used.

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This Weeks Homework

• Continue to
• Administer the culture survey.
• Have one-on-one conversations with as many people
  as you can.
• Hold departmental meetings.
• Implement the checklist
• Create a checklist demonstration video and
  consider submitting it to the video competition.
  Deadline for the competition is April 6th.
• Mark your calendars and register to attend the
  2012 April Patient Safety Symposium.
• If you have not already done so, hold the large
  inter-disciplinary meeting that you scheduled at
  the beginning of the call series.

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Next Call Keeping the Checklist Going . . . It
will be our last call for a few monthsApril 5th,
2012200-300
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Questions
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Ask Us a Question By Using the Raise Hand Button
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Office HoursNext Tuesday from 200-300
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Resources
Website www.safesurgery2015.org Email
safesurgery2015_at_hsph.harvard.edu