Quality and safety initiatives: What physicians need to know

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Quality and safety initiatives: What physicians need to know

21-Jun-2016

Antimicrobial stewardship program launch

 

Antibiotic resistance is a problem. We need to use antibiotics wisely to stop bacteria from becoming resistant to antibiotics. The Regina Qu’Appelle Health Region’s Antimicrobial Stewardship Program supports the Region’s overall strategy, including our commitment to quality and safety, access/patient flow and system sustainability.

As of June 15, 2016, the program’s researcher and pharmacist have already begun their focus on networking and the basic education around what an antimicrobial stewardship program is and how it affects you;

There are three other important dates for the program this year:

September 15: Accreditation Canada will return to the RQHR and we will have to demonstrate that we now meet accreditation standards for the program; and

November 14-18: Antimicrobial Stewardship Awareness week- stay tuned for more details!

January 2017: We will be onboarding our physician to the program.

Many areas are already stewards of antibiotics without even knowing it. We’re recognizing all the great things people have done to date on this initiative. As we go forward, we intend to consolidate those efforts and ensure all stakeholders see, know and understand what we are collectively trying to achieve.

Monthly five-minute messages are circulated to provide an update on the program’s progress. Please print this information for your teams, post on your visibility wall and have regular discussions about this important initiative for our Region.

Not all bugs need drugs. Patients play an important role in determining what kind of medication is right for them. Please contact us to learn more about the antimicrobial stewardship program and how you can play a role in empowering our patients and ourselves to save antibiotics.

Contact Information:

Website: 

http://www.rqhealth.ca/news-items/antimicrobial-stewardship-program

Email address: antimicrobial.stewardship@rqhealth.ca

 

Physician call schedule

Over time, the specialist physician monthly on-call schedule evolved to serve several purposes.

  • To provide physicians with their on-call schedule and ensure proper compensation, and
  • To provide frontline staff with the name of the physician they should call 24-7 for patient care

While the task of RPIW #100 was to focus on the second purpose, we feel the recommended streamlined process impacts both positively. The goal was to identify a standard, streamlined and reliable process to ensure the right physician could be reached by frontline in order to get care to the patient.

Prior to the improvement event, 33 templates were being used by various specialties to depict their on-call schedules – in some cases, staff needed instruction sheets to understand how to read a schedule. These schedules were posted to the intranet, faxed and e-mailed throughout facilities within the Region. The RPIW #100 team has recommended one template for the monthly calendar – one that reflects the look and feel of a monthly calendar, is easy to read, includes names and current phone numbers and is updated on the intranet regularly to reflect changes.

In addition to a single monthly calendar template, the RPIW team recommended a single template for a daily on-call list and one owner for that list. Evidence showed the majority of staff using the daily on-call list turned to Switchboard for the information they didn’t have – so, we’ve recommended Switchboard as the owner of this process.

In the future state, we will be asking physicians to contact Switchboard directly with any changes to their call schedule. These changes will be reflected in the monthly schedules that ultimately make their way to finance for physician compensation.

The team was able to test some of its newly recommended processes and found great enthusiasm among frontline staff. They are confident the new daily list they’ll have access to will be more accurate and will reduce the number of times they reach the wrong physician.

Key to the success of this process, however, is ensuring physicians communicate any changes they make to their schedules so they can be reflected in the call lists – monthly and daily. If changes aren’t communicated, the risk of incorrect calls remains.

Next steps will be to build the capacity within Switchboard to manage this process and replicate beyond the Emergency Department, Switchboard and Unit 3E at RGH where it was tested. At a follow-up implementation planning meeting on June 9th a decision was made to secure full implementation on September 1, 2016.

Transfusion safety update

Since the launch of the Integrated Consent to Diagnostic and Treatment Procedures forms in September of 2014, there has been significant progress in the documentation of informed consent for blood and blood products. In less than two years, our health system has come so far and this could only have been done with the commitment of you, our clinical partners. We are fulfilling Justice Krever’s directive to ensure that Canadian patients have the opportunity to explicitly consent to or refuse treatment with blood and blood products. As you are aware, we conduct ongoing evaluation and are happy to share the recent audit result. Thank you for your commitment and partnership!

Stop the Line

The breakthrough project Stop the Line - Patient and staff safety will enable the region to fulfill the goals of the provincial priority area/ hoshin Safety culture: Focus on patient and staff safety.

The aim of this project is to create a culture of safety where no patients or staff members are harmed in our facilities. In Regina Qu'Appelle Health Region, an average of four staff members a day are injured on the job - two of whom will be significantly hurt, preventing them from returning to work immediately, if ever. At the same time, patients are harmed in our facilities by preventable errors.

Through this project, the region will implement standard work, concrete performance measures and targets, and an accountability structure involving all levels of the organization which allows staff, managers and patients to truly stop the line when they perceive danger.

A Stop the Line system includes:

  • A protocol to ensure that any serious event is reported up to a senior manager who will resolve the problem within a set timeframe.
  • A system to literally “stops the line” for the most serious patient safety concerns until staff and leaders convene to address the problem and find a solution.
  • Ceasing the unsafe activity and launching a process to understand the root causes and to correct the problem.
  • Empowering individuals to “stop the line” as soon as a problem is identified, with the goal of preventing the problem from causing harm “down the line.”

The rationale behind this system is simple — mistakes are inevitable, but they are also reversible. Defects, however, are mistakes that are not fixed soon enough, and as a result they become relatively permanent. If mistakes are corrected quickly, there will be zero defects, which is what the customer wants.

A provincial steering committee made up of provincial and regional representatives is developing a Stop the Line model, based on the successful Virginia Mason model, for implementation across the province. The RQHR has created its own steering committee for implementation of Stop the Line within the Region. Staff, physicians, patients and their families are represented on the RQHR steering committee. Implementation, which will begin over the next year, will be rolled out gradually across the province.