Empowering Staff to Lead Quality Improvement and Safety: Safety Briefing Checklist
CCCF ePoster library. Waugh L. Oct 31, 2016; 150903; 25
Lily Waugh
Lily Waugh
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Topic: Quality Assurance & Improvement

Empowering Staff to Lead Quality Improvement and Safety: Implementation of Safety Briefings and Development of a Safety Briefing Checklist


Waugh, Lily¹ ¹Intensive Care Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada
Cercone, Ivana¹ ¹Intensive Care Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada
Chiarelli, Elaine¹ ¹Intensive Care Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada
Dunnill, Yana¹ ¹Intensive Care Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada
Marini-Cserni¹ ¹Intensive Care Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada
McCowell, Raffy¹ ¹Intensive Care Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada
Pettit, Jayne¹ ¹Intensive Care Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada
Brooks, Leslie¹ ¹St. Joseph's Healthcare Hamilton, Hamilton, Canada
Barrett, Jackie¹ ¹St. Joseph's Healthcare Hamilton, Hamilton,  Canada
Duan, Erick¹ ² ¹Intensive Care Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada, ²Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada
Soth, Mark¹ ² ¹Intensive Care Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada ²Division of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada
Cook, Deborah¹ ² ¹Intensive Care Unit, St. Joseph's Healthcare Hamilton, Hamilton, Canada, ²Divison of Critical Care, Department of Medicine, McMaster University, Hamilton, Canada

Abstract:


Introduction: Real-time, face-to-face communication is integral to high quality, safe critical care. In 2015, our intensive care unit (ICU) successfully implemented a quality and safety improvement initiative through facilitating twice daily Safety Briefings with bedside nurses using a standardized checklist.
Objectives: To a) enhance team communication and engagement, b) promote safety consciousness in every shift, and c) align improvement initiatives with organizational patient safety and quality priorities.
Methods: As an organizational directive, our ICU was required to implement daily Safety Briefings. Using a draft institutional template, we created a customized ICU Safety Briefing Checklist. We sent the multidisciplinary team a detailed communication to implement twice daily Safety Briefings wherein the charge nurse leads a discussion with bedside nurses to discuss the specific needs to be attended to that shift, to ensure that our patients and staff are safe. The initial Safety Briefings were led by the unit manager, with participation by charge nurses and front-line nurses. We obtained feedback on the Safety Briefing process and checklist content from participants, and iterative revision of the checklist followed. We utilized a plan-do-study-act (PDSA) approach, competing rapid PDSA cycles, and incorporated knowledge translation initiatives into the Safety Briefing and Checklist. 
Results: We embedded organizational quality and safety priorities including reducing ICU acquired infections, improving medication safety, and improving transitions of care. With feedback from front-line nursing staff, we also included key patient and family centered program-specific priorities such as Hand Hygiene metrics, Footprints initiative, 3 Wishes Program, Trillium Gift of Life Network notification, and Withdrawal of Life Support. After initial training, the charge nurses lead the twice daily safety briefing, at the beginning of each shift, and the unit manager continues to lead the briefings once or twice per week. Front-line staff were empowered to lead this quality improvement initiative, and participation by other members of the multidisciplinary team was strongly encouraged. The Safety Briefing provided a forum for real-time communication led by front-line staff at the beginning of each shift, and multiple opportunities for improved safety consciousness. The discussion included situational awareness including risk awareness as a fundamental part of day-to-day work. Often we found that recognition of key quality and safety issues generated substantial positivity at briefings. The checklist provided structured prompts for the twice daily communication forum where information was shared, issues raised, and new ideas discussed between team members. Feedback and suggestions on how to improve the Safety Briefing and checklist are ongoing, however, preserving the primary goal of our initiative.
Conclusion: The twice daily Safety Briefings and the use of a structured checklist were embedded as part of the routine work during each shift in our ICU. Face-face communication was integral to team attention to safety issues on each shift, and team energy and team building were generated through this quality improvement initiative. Empowerment by the front-line staff, who lead the briefings, has resulted in the success and sustainability of this quality improvement initiative.
 


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