SCCM Resource Library-What We Permit, We Promote: Developing and Maintaining a Culture of Patient Safety in Diverse ICUs

Video Transcription

Hi, my name is Pat Posa and I'm going to talk to you today about what we permit, we promote, developing and maintaining a culture of patient safety in diverse  ICUs. The objectives for this presentation include defining patient safety and the incidence of patient harm, discussing strategies to create a  culture of safety, and reviewing the impact of safety culture on hospital acquired infections. What is patient safety? Institute of Medicine defines  patient safety as the prevention of harm to patients. The emphasis is placed on systems of care delivery that prevent errors, learn from errors that do occur,  and is built on a culture of safety that involves health care professionals, organizations, and patients. The World Health Organization recognizes patient  safety as a global concern. In high-income countries, one out of ten patients are harmed in hospitals and nearly 50% of this is preventable.  Adverse events due to unsafe care is likely one of the ten leading causes of death and disability in the world. The majority of two-thirds of the adverse  events resulted from unsafe care and years lost to disability incur in low and middle-income countries. So how do we prevent patient harm? Well, first of  all, assuming that individual perfection is possible will not improve safety. We know humans are fallible. Humans are guarded from making mistakes when placed  in an error-proof environment where system tasks and processes work well and are well designed. Also, focusing on systems that allow harm to occur is the  beginning. Preventing harm can only occur in setting those systems up in an environment that is open and transparent where a safety culture prevails. So a  culture where a high level of importance is placed on safety beliefs, values, and attitudes and shared by most people in the workplace is how we will prevent  harm. So what are safe organizations? These are organizations that can consistently perform at high levels of safety over long periods of time and they  have key characteristics. One, they possess a collective mindfulness which means that everyone that works in that organization both individually and  together are aware that even small failures and safety protocols or processes can lead to catastrophic adverse events. If some action is not  taken to solve the problem, they have two other key features. They eliminate deficiencies and safety processes through the use of powerful tools to  improve their processes and they create an organizational culture that focuses on safety that remains constantly aware of the possibility of failure. So you've  heard culture is key. So what is culture? Culture represents a set of shared attitudes, values, goals, practices, and  behavior that makes one unit distinct from the other. We know safety culture evolves from unmindful. We show up, don't we? Chronically complacent. Moving through  being reactive. Safety is important. We we do a lot every time there's an accident to systemic where systems are being put in place to manage most hazards. Moving  to proactive where we methodically anticipate so we prevent problems before they occur. We look for those near misses, right? And then generative where  organizational culture is wired to produce safety. So how do we create a  culture of safety in your unit? There are five safety culture components. Trust. Workers exhibit trust in their peers and management and they routinely recognize  and report errors and unsafe conditions and intimidating behavior is eliminated. Accountability. Establishing a code of behaviors and establishing equitable  disciplinary procedures and a safety culture that supports personal accountability. So a just culture. Third, identifying unsafe conditions. So  retrospective analysis of reported events. Moving forward to analysis of close calls of unsafe conditions to proactive approach and correcting  situations before harm occurs. Another key component is strengthening systems. So they evaluate different systems, safety systems, proactively so weaknesses can  be identified and resolved. And then assessment. So they measure the culture of safety and then based on what they find, they define focused interventions  to remedy where there are shortfalls. You can set up a unit-based culture program by following a number of steps. Get a committee together, minimum of two  like-minded people. Assess your current safety culture. Select process improvement methodology. Ensure all staff is educated on the science of  safety. Implement teamwork and communication tools. Identify your defects and learn from those defects and then ensure that you embed this  education and culture into new staff when onboarded. So let's delve into each one of these. Set up a committee. Again, two like-minded people. Call it the Do No  Harm Committee. Establish the team and its goals and they should align with the organizational goals of preventing harm. Define a vision with some clearly  defined goals and associated action plan. Create some data, a unit dashboard. The team should meet once a month, review data, create action plans, and report up  the quality structure if it's present. The next step in getting to positive safety culture on your unit is to measure. You need to understand where  your current state is and so you need to measure safety culture. There are a number of tools out. Here are just an example of two. Assessment of  safety and workplace culture, organizational and unit-based, and that's free. And then AACN, the American Association of Critical Care Nurses, also  has a healthy work environment assessment tool at the unit level. In those two culture assessment tools, you can see on the left the safety attitude  questionnaire has key areas. It's looking at teamwork, safety, work conditions, job satisfaction, stress recognition, perception of upper management, and  perception of unit management. And in the AACN healthy work environment, they're assessing skilled communication, collaboration, effective decision-making,  appropriate staffing, meaningful recognition, and authentic leadership. When you measure your safety culture using one of those tools, you need to  identify areas of opportunities or themes and then put in some actions to help improve in those areas. A number of studies from around the world, so in the  United States, Belgium, and Arab countries, as they have looked at patient safety culture, where they have identified areas of opportunity are non-putative response  to errors and teamwork across units. So, it's common both in the around the world, we're finding some common areas of opportunity related to our safety  culture. As you're building that unit-based safety programs, it's important to pick a model or a framework that will be used to guide change, and  here are just two examples. The Johns Hopkins translating evidence and practice model, and then the IHI's Plan-Do-Check-Act model. The next step in  building a unit-based safety program is to ensure all staff are educated on the science of safety, understanding that safety is a property of a system. Every  system is perfectly designed to achieve its end results, and that there are key principles for safe design, standardization, independent checks, and  learning from your defects. Those principles of safe design apply both to the technical work that we do, those evidence-based interventions, as well as  the teamwork, and understanding that teams with diverse and independent input make better decisions. Creating effective teamwork and communication is the next  step, and we know by having those qualities, effective teamwork and communication, we have a positive impact on health care. Lower length of stays,  lower nurse turnover, higher quality of care, better patient outcomes, and better patient experience scores. There are many communication and teamwork tools. I'm  going to just review a few. The first one being SBAR. So SBAR is a framework for team members to effectively communicate information to one another. The acronym  SBAR stands for, S stands for situation. So what is the situation as I'm communicating? Maybe a clinical concern to a provider. Share then the background.  What is the clinical background? What have I assessed? My assessment, what is the problem? And then what is the recommendation? What do I recommend or  request to be done? Encouraging staff to speak up for safety is very important to creating that culture of safety and improving patient outcomes. One strategy  is to create a phrase or word to say when someone is concerned, to help them speak up. And so one of those such phrases are is cuz. I am concerned. I am  uncomfortable. This is not safe. So having team members use phrases like that will help bring attention to that we need to stop, think about what we're doing, and  improve patient safety. Also the effective use of chain of command where if a clinical concern is not being dealt with or addressed appropriately that we  move up the chain of command based on the discipline to different levels to be able to get that concern resolved. Other strategies that have been used  across the country and the world are huddles. And this enables teams to have frequent but short briefings so that they can stay informed, review work, make  plans, and move ahead. It allows fuller participation for the frontline staff and it keeps the momentum going. Use of a huddle board or a document to guide the  conversation during those daily meets is important. So this is just one example where different metrics are displayed on the board and discussed an area time to  talk about daily critical communications and then problem-solving.  Multidisciplinary rounds with daily goals is an effective teamwork and communication tool. It should be done in the ICUs as well as in other units in  the hospital. It can be difficult to implement especially if you have an open unit or don't have intensivists or you're in a non-ICU area. But you need  to create a standardized structure and process. You see benefits even if a physician cannot attend consistently or at all. And oftentimes there's a second  round that's done in the afternoon and there you can evaluate if the goals of the day have been met, readjust if necessary. It's important to have  standard work related to interdisciplinary rounds and here's just an example of what the script is during the multidisciplinary rounds in an ICU.  One of the key components in a unit-based safety program is to be able to identify defects and learn from them. And here's an example of a learn from a  defect tool looking at a CLABSI. And so there's key information that we want to learn about how the care was, what type of line, and did we do all of the  necessary prevention strategies. And what coming to the conclusion of what was that root cause for the defect and then developing an action plan to reduce the  risk of it happening again. The final piece of a unit-based safety program is to ensure that all new staff are trained in evidence-based prevention practices  and safety culture. So incorporating these new practices and safety culture strategies into orientation for all disciplines and then getting a  strategy together to embed this training and accountability for new staff, traveling nurses, hospitalists, residents, etc. We know there's a  significant impact of culture on safety and hospital-acquired infections. Work done in Michigan ICUs, you can see here that the strongest predictor of the  lowest number of bloodstream infections came when the caregiver felt comfortable speaking up if they perceived a problem. So a culture where  speaking up was made possible and encouraged. In that work in Michigan, they were able to sustain those gains and you can see here at a 10-year analysis that  they had a continued decrease in central line associated bloodstream infections. And culture was a part of that work in Michigan, improving culture. Here is an  example of a study where by working on safety culture and teamwork, they saw a statistically significant reduction in all hospital harm, serious safety events  and severity adjusted hospital mortality. 25 pediatric hospitals in the United States, as part of a collaborative, applied high reliability principle tools.  So those safety culture components, trust, accountability, identification of unsafe conditions, strengthening systems, and assessment of safety culture. And found  that the higher the safety culture component score, the lower the quartile  of serious harm. By establishing a unit-based safety program as described here today, you will be able to positively impact your culture that will  result in a decrease in hospital acquired infections. Thank you for your time and attention.

Video Summary

In this video, Pat Posa discusses the importance of developing and maintaining a culture of patient safety in diverse ICUs. Patient safety is defined as the prevention of harm to patients, and it is a global concern. In high-income countries, one in ten patients experience harm in hospitals, and almost 50% of this harm is preventable. Posa emphasizes that preventing harm requires creating a culture that values safety and focuses on system tasks and processes. Safe organizations consistently perform at high levels of safety over time and possess a collective mindfulness. To create a culture of safety in a unit, Posa recommends focusing on five components: trust, accountability, identifying unsafe conditions, strengthening systems, and assessment. Specific strategies include establishing a committee, measuring safety culture, educating staff on the science of safety, promoting effective teamwork and communication, and implementing unit-based safety programs. Posa also highlights the significant impact of culture on safety and hospital-acquired infections.

Asset Subtitle

Infection, Quality and Patient Safety, 2022

Asset Caption

Hospital-acquired infections (HAIs) cause serious harm in ICUs across the world. Many successful strategies initiated in resource-limited areas have been proven to mitigate infections and are cost-effective. This session will highlight how healthcare systems with disparate levels of resources can apply successful strategies to prevent harm from catheter-based HAIs.

Meta Tag

Content Type Presentation

Knowledge Area Infection

Knowledge Area Quality and Patient Safety

Knowledge Level Foundational

Knowledge Level Intermediate

Knowledge Level Advanced

Membership Level Select

Tag Nosocomial Infection

Tag Quality and Patient Safety

Year 2022

Keywords

patient safety

culture of safety

diverse ICUs

harm prevention

safety culture

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