SDS Accreditation Update: Collaboration promotes patient safety as a team effort

Madison, WI, facilities share ideas and work together to improve risk management

With the focus on patient safety in the general media, it would be natural for a provider to promote its own patient safety statistics and efforts to set itself apart from competitors in the marketplace.

That is not the case in Madison, WI, where hospitals and medical groups work together to address patient safety issues.

The four hospitals and three medical groups that make up the Madison (WI) Patient Safety Collaborative work together through brainstorming sessions and meetings to identify key patient safety issues and develop tools that will help all hospitals and health care organizations in the area improve patient safety, says Kendra Jacobsen, administrator of the collaborative.

"The organization started in 2000 with the idea that patient safety is too important for health care organizations to use it as another issue on which to compete," she explains.

Reduction of risk for patient falls is one of the 2005 National Patient Safety Goals identified for hospital-based same-day surgery programs by the Joint Commission on the Accreditation of Healthcare Organizations. Risks to consider include environmental factors such as where the poles for intravenous (IV) lines are placed, Jacobsen says.

"If the patient decides to get up to go to the bathroom or walk to the door, make sure there is no equipment with wheels between the patient and the destination, she suggests.

"A patient may grab onto an IV pole or piece of equipment for support, and if the wheels are not locked, the patient falls when the equipment moves," Jacobsen notes.

The staff members at Meriter Hospital in Madison address the risk of patient falls by making sure patients are never left unattended, says Sherry Cheadle, MSPA, RN, CNOR, manager of the operating room and post-anesthesia recovery unit.

"If a nurse is not with the patient, a family member is sitting with them," she says. "We also make sure the OR table wheels are locked before the patient is moved onto the table, use patient safety straps, and require a wheelchair for discharge."

Another key to falls reduction is educating the patient and the family members about the effects of medication the patient may have received during surgery to make sure everyone understands that the patient may fall more easily until the medication wears off, Jacobsen explains.

Another significant issue for same-day surgery is verifying patient identification and correct procedure and site.

Checklists, forums address safety issues

The same-day surgery staff at St. Mary’s Hospital in Madison soon will be using a checklist to ensure that they don’t overlook any of the items necessary to ensure the correct patient is in the room and the correct site is marked, says Cheryl Blaskowski, RN, ambulatory surgery nurse at the hospital.

"Our checklist takes about 10 seconds to go through and will be completed just prior to the start of surgery," Blaskowski says.

The nurse will check a "yes" or "no" box next to these areas: correct patient, site of procedure, side for procedure, documentation completed, and implants or special equipment for procedure in place, she explains.

"The circulating nurse doesn’t need to rewrite the information, just verify that it has all been verified, and then he or she signs and dates the checklist along with the time," Blaskowski adds.

The surgery staff members at Meriter Hospital discuss safety issues at an annual safety forum, Cheadle explains.

"We invite all of our nurses, operating room technicians, and physicians to a panel discussion of safety issues such as time-out, site identification, and accurate sponge and instrument counts," she adds.

The spring forum is held at the hospital, and about half of the nurses and OR techs attended the most recent one, Cheadle says. "We did pay staff for their attendance, and we did provide dinner that was catered by a local restaurant rather than the hospital kitchen."

The forum was well attended by staff members and physicians because it was the first time everyone had a chance to meet in a setting where the entire focus was patient safety, she explains.

The medical director, an OR nurse, and an OR tech lead the discussion and introduce the issues from their own perspectives, Cheadle notes.

"We’ve learned that safety means something different to each group," she says.

For example, surgeons believe that patient safety requires competent, trained staff, and nurses and OR techs believe a key to improving patient safety is to reduce the noise level in the OR, Cheadle points out.

Because the issue has been discussed by all staff members and reinforced at regular staff meetings, everyone feels more comfortable asking that everyone be quiet or that the music be turned off while a sponge count is done or while the pre-surgical time-out is conducted, she adds.

Provide tools to monitor safety

Also on the safety radar at Meriter Hospital is anesthetics. Although most anesthesia is overseen by anesthesiologists, local anesthetics are administered by the surgeon, so Meriter Hospital has developed a tool to help surgeons and nurses gauge safety parameters for anesthetics. A grid that provides information on patient weight and amount of local anesthetic needed is given to nurses in the OR when a procedure using local anesthetic is performed, says Cheadle.

"Nurses have always kept a running tab as anesthetic is administered, but we didn’t always have the information about dosage parameters available to us," she says.

"This gives the nurse some guidelines, so if she or he notices that the amount of anesthetic administered is close to the maximum, the surgeon can be alerted," Cheadle explains.

This alert gives the surgeon an opportunity to talk with the anesthesiologist and decide whether the procedure should continue with local anesthetic, she adds.

Because medication safety also relies upon the same-day surgery program having accurate information about medications patients already take when they arrive for surgery, the Patient Safety Collaborative has developed a brochure — Guide to Prescription Health — that includes a wallet card patients can complete and carry with them, Jacobsen says.

The brochure is available in English and Spanish on the collaborative web site. (For more information, see resources box, below.)

Even though patient safety is emphasized in accreditation surveys, it is important that same-day surgery programs not think of patient safety as an accreditation issue but rather as an ongoing effort to improve care, Cheadle continues.

"We approach patient safety from a proactive approach with our safety forum and discussions at all staff meetings," she says. "We have all nurses, physicians, and techs working together to support each other as we introduce activities to improve patient safety."

Sources and Resource

For more information about patient safety, contact:

  • Cheryl Blaskowski, RN, Ambulatory Surgery Nurse, St. Mary’s Hospital, 707 S. Mills, Madison, WI 53715. Phone: (608) 258-6856. E-mail: Cheryl_Blaskowski@sshmc.com.
  • Sherry Cheadle, MSPA, RN, CNOR, Manager, OR and PACU, Meriter Hospital, 202 S. Park St., Madison, WI 53715. Phone: (608) 267-6428. E-mail: scheadle@meriter.com.
  • Kendra Jacobsen, Administrator, Madison Patient Safety Collaborative, 202 S. Park St., Madison, WI 53715. Phone: (608) 267-5889. E-mail: kjacobsen@meriter.com.

To obtain a copy of the patient’s Guide to Prescription Health, go to www.madisonpatientsafety.org, Choose "Medication Safety Brochure with Wallet Card" on the right navigational bar, and then click on "Medication Safety Brochure" and "Accompanying Pocket Card to Record Medications."