After attending the Advancing Safety for Patients in Residency Education (ASPIRE) program at the Royal College two years ago, Dr. Sarah Stevens, a paediatric anaesthesiologist at the IWK Health Centre in Halifax, Nova Scotia got to thinking that although her perioperative group were functioning well as a team, the review of morbidity and mortality might be improved if the approach to case review was more educational.
"What we did was look at a couple of topics that had raised a lot of discussion," says Dr. Stevens. "One of the early topics was a review on the effect of an upper respiratory tract infection on children and why anaesthetists don't like to put babies who have an acute respiratory infection to sleep. Patient Safety Rounds provided a setting for a joint case presentation between surgery and anesthesia, discussion of outcomes and review of the literature. Rounds included the entire perioperative team (pediatric anesthesiologists, pediatric surgical specialists, OR/ PACU nurses and anesthesia assistants). Input and questions from the audience were encouraged and the format was well received. The audience was provided with evidence-based literature about the decision making process and proceeding with a pediatric elective case, or not, when faced with an acute respiratory infection. It was very instructive for the post-anaesthesia care unit nurses and nurses in the operating room, who also felt much more educated about the topic."
An interdisciplinary team has been formed to plan Patient Safety Rounds quarterly. The team includes a nurse educator, Kathy MacDonald a registered nurse from the Children's Operating Room who also oversees perioperative morbidity reviews; an anesthesiologist (Dr. Stevens); and a surgeon, Dr. R. Romao, Pediatric Surgeon and Urologist. So far, six rounds have taken place with 45 minutes allocated for presentation followed by 15 minutes of active discussion. Attendance at each of the rounds has drawn between 25 to 55 healthcare professionals.
Patient Safety Rounds are also being utilized as a way of providing formal education on quality improvement and patient safety to clinical fellows and residents, who are encouraged to present cases they have experienced, in a safe learning environment.
When a young patient had a pulmonary embolism after surgery, the team used that case and invited the nurses from the floor to attend the Perioperative Patient Safety Rounds and learn about the patient's risks. As a result of a case a screening protocol a decision tree has been developed by a multi- disciplinary team to decide what children should receive venous thromboembolism prophylaxis and determine the type of thromboprophylaxis that should be administered.
"There has been a trickle-down effect in the sense that there is education, collaboration, the ability to ask questions about the management and care of children in a forum where everyone has the opportunity to provide input," says Dr. Stevens. "We are focusing less on the morbidity and mortality, and more on the event and what we can learn from it to improve our care. The formal morbidity and mortality process still occurs at another time."
During another round, data from the surgical safety checklist, central line infections, wound infections, and septic infections was presented so that the staff could see the impact of how changes in the operating room over the last five years are having a positive effect.
"Our goal this year is to get our colleagues in emergency medicine and paediatrics involved," says Dr. Stevens. "Getting information back to the primary care team is really valuable. Medicine has evolved in such a way that we tend to work in silos, and getting education from other team members will give you a much more complete picture."