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Perioperative Safety: Engage, Integrate, Empower, Sustain to Eliminate Patient Safety Events
The perioperative environment is one of the most complex areas within a hospital with significant safety risks. Despite a long history of safety-focused work, a recent cluster of patient safety events prompted a renewed comprehensive approach to improve safety processes and transform culture. METHOD...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8677994/ https://www.ncbi.nlm.nih.gov/pubmed/34934878 http://dx.doi.org/10.1097/pq9.0000000000000495 |
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author | Falcone, Richard A. Simmons, Jeffrey Carver, Amanda M. Mullett, Brooke Kotagal, Meera Lin, Erica Muething, Stephen von Allmen, Daniel |
author_facet | Falcone, Richard A. Simmons, Jeffrey Carver, Amanda M. Mullett, Brooke Kotagal, Meera Lin, Erica Muething, Stephen von Allmen, Daniel |
author_sort | Falcone, Richard A. |
collection | PubMed |
description | The perioperative environment is one of the most complex areas within a hospital with significant safety risks. Despite a long history of safety-focused work, a recent cluster of patient safety events prompted a renewed comprehensive approach to improve safety processes and transform culture. METHODS: Our team comprehensively approached perioperative safety through integration across traditional silos and a focus on institutional safety culture. This approach consisted of a careful review of all events, developing Perioperative Safety Coordinating and Education teams, testing and implementing new/revised safety processes, and an ongoing evaluation plan. RESULTS: Updates to our Perioperative Safety Mission and Tenets and the development of an empowered Safety Culture Champion team composed of a diverse group of frontline team members addressed our safety culture. In addition, key safety processes (time-outs, intraoperative huddles, and prevention of retained foreign bodies) were revised and implemented. Observation of key safety processes demonstrates a 90% compliance, which includes all steps and team engagement. After implementation, a span of 377 days between events was accomplished, which is significantly higher than the 33 days between events during our cluster. CONCLUSIONS: This work builds upon prior incremental improvements through a comprehensive investment in not only improving key processes but transforming the safety culture. Acceptable deviance from the standard process is no longer the norm. Instead, an approach that emphasizes understanding, integration, engagement, and accountability for safety by each team member for every patient, every time, every day, has been implemented. |
format | Online Article Text |
id | pubmed-8677994 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Lippincott Williams & Wilkins |
record_format | MEDLINE/PubMed |
spelling | pubmed-86779942021-12-20 Perioperative Safety: Engage, Integrate, Empower, Sustain to Eliminate Patient Safety Events Falcone, Richard A. Simmons, Jeffrey Carver, Amanda M. Mullett, Brooke Kotagal, Meera Lin, Erica Muething, Stephen von Allmen, Daniel Pediatr Qual Saf Patient/Employee Safety The perioperative environment is one of the most complex areas within a hospital with significant safety risks. Despite a long history of safety-focused work, a recent cluster of patient safety events prompted a renewed comprehensive approach to improve safety processes and transform culture. METHODS: Our team comprehensively approached perioperative safety through integration across traditional silos and a focus on institutional safety culture. This approach consisted of a careful review of all events, developing Perioperative Safety Coordinating and Education teams, testing and implementing new/revised safety processes, and an ongoing evaluation plan. RESULTS: Updates to our Perioperative Safety Mission and Tenets and the development of an empowered Safety Culture Champion team composed of a diverse group of frontline team members addressed our safety culture. In addition, key safety processes (time-outs, intraoperative huddles, and prevention of retained foreign bodies) were revised and implemented. Observation of key safety processes demonstrates a 90% compliance, which includes all steps and team engagement. After implementation, a span of 377 days between events was accomplished, which is significantly higher than the 33 days between events during our cluster. CONCLUSIONS: This work builds upon prior incremental improvements through a comprehensive investment in not only improving key processes but transforming the safety culture. Acceptable deviance from the standard process is no longer the norm. Instead, an approach that emphasizes understanding, integration, engagement, and accountability for safety by each team member for every patient, every time, every day, has been implemented. Lippincott Williams & Wilkins 2021-12-15 /pmc/articles/PMC8677994/ /pubmed/34934878 http://dx.doi.org/10.1097/pq9.0000000000000495 Text en Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. |
spellingShingle | Patient/Employee Safety Falcone, Richard A. Simmons, Jeffrey Carver, Amanda M. Mullett, Brooke Kotagal, Meera Lin, Erica Muething, Stephen von Allmen, Daniel Perioperative Safety: Engage, Integrate, Empower, Sustain to Eliminate Patient Safety Events |
title | Perioperative Safety: Engage, Integrate, Empower, Sustain to Eliminate Patient Safety Events |
title_full | Perioperative Safety: Engage, Integrate, Empower, Sustain to Eliminate Patient Safety Events |
title_fullStr | Perioperative Safety: Engage, Integrate, Empower, Sustain to Eliminate Patient Safety Events |
title_full_unstemmed | Perioperative Safety: Engage, Integrate, Empower, Sustain to Eliminate Patient Safety Events |
title_short | Perioperative Safety: Engage, Integrate, Empower, Sustain to Eliminate Patient Safety Events |
title_sort | perioperative safety: engage, integrate, empower, sustain to eliminate patient safety events |
topic | Patient/Employee Safety |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8677994/ https://www.ncbi.nlm.nih.gov/pubmed/34934878 http://dx.doi.org/10.1097/pq9.0000000000000495 |
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