This is the second article in a three-part series on how Bridgepoint Health tailored the Patient Safety Education Program – Canada (PSEP – Canada) to create an internal education program that would result in long-term advancements in patient safety. This article focuses on the perspectives of the Bridgepoint participants and provides a short profile of their work projects to advance patient safety.
Improving the efficiency and effectiveness on the frontline
To participate in the Bridgepoint Patient Safety Education Program teams identified work-based projects to improve patient safety. The teams then had the opportunity to apply the learning and tools from the patient safety program to these projects. The processes the teams followed to develop improvement strategies were all similar in style. They conducted staff surveys and interviewed staff for input and feedback; completed a variety of audits, both pre- and post implementation; and compiled literature reviews to learn from what others were doing and to seek out best practices.
The teams quickly learned to start small and focus on one aspect of the change they would like to implement. Many of the unit-based projects have since been expanded into larger projects, but more importantly, the teams now have the knowledge and the tools and feel empowered to effect change that will improve the efficiency and effectiveness on the frontline. Here are profiles of three of the work-based projects:
Using a systems thinking approach
The medication room in the palliative care unit was a catch-all. It was used to store medications and equipment and it was also used for charting; it was cluttered and unorganized. “We did not have what the patient needed, when they needed it,” says Danielle Lapointe, Registered Practical Nurse.
As part of a larger project a separate room was established providing more space for charting, and the toasters, coffeemakers, microwaves, refrigerators and snacks for patients were moved to a newly created nutrition centre – thus freeing up space to reorganize the medication room. The team then simplified, standardized and organized the medication room. “Everything was cleaned and everything was given a spot on a medication cart,” says Lapointe. “We have assigned people to replenish the medication carts on a daily basis to ensure everything is in the right spot and we have everything we need, when and where we need it.”
Lapointe says that the Bridgepoint PSEP – Canada training gave her the ability to identify potential patient safety hazards and how to act on them. “It provided a systems thinking approach so that there is no blame if something goes wrong,” says Lapointe. “If we have a medication error, we don’t blame the person, we look at what are the factors that led to the error.”
Sharing the knowledge
Lapointe received a Bridgepoint Good Catch Award for identifying a potential safety hazard where mouthwash, chlorhexidine swabs and mouth swabs were all housed in the same container, separated by a small plexi-glass partition, which could lead to using chlorhexidine as a mouth swab by accident.
“This program taught us to identify issues, what to look for, how to address them, and how to educate your colleagues to share in the education,” adds Lapointe. “Bridgepoint did not teach us about patient safety so that the information would stay only with us; it is shared throughout the facility so that all health disciplines can share our knowledge.” As soon as Lapointe reported the issue of the chlorhexidine swab placement, every unit on the hospital was checked and every medication cart was changed.
Lapointe says that once you have been trained in systems thinking you learn how to make changes and that the PSEP – Canada has a ripple effect that is changing the culture at Bridgepoint. “Bridgepoint is so supportive and takes patient safety seriously,” says Lapointe. “Programs like this go a long way in supporting frontline workers who can quickly identify issues and provides the opportunity to make a difference.”
Gaining the confidence to make a change
Another project focused on eliminating missing medication orders in an inpatient Neuromuscular Program. Information was gathered to determine: Was it because the staff is too busy? Was it due to a heavy caseload? Was the writing on the medication orders illegible? An education program was instituted and signage posted in various locations, including the medication room, nursing stations and areas where charts are checked. Follow-up emails are sent to staff on the unit to remind and encourage them to ensure all medication orders are complete.
Prior to the pilot study, there were about two or three missing orders every month; since the interventions were implemented last year, there has only been one missing order. The team concentrated on ongoing staff education and the provision of signage in appropriate locations to help eliminate missing medication orders. “This is not rocket science, it just takes some extra energy and attention,” says Ken So, Occupational Therapist. “The training I received through the program has given me the confidence to enhance my working environment and to make changes. I realized that I don’t need a huge research grant; I can simply conduct a survey, do some preliminary audits and provide education for the team – it is small, useful, specific and effective.”
Applying the learning in everyday practice
Staff on one unit did not find the cardex system useful as the information was often out-of-date and messy, or the card lacked enough space to write. The team found it would be unrealistic to revamp the cardex system within the timeline of the program, so they focused on the allergy section of the card; another team of allied health professionals is now looking at revising the entire cardex system for the unit.
Once allergies were identified as a focus, an audit of the cardex cards was completed and compared with the online documentation system to see if there were inconsistencies. They found a huge gap where allergies documented on the cardex were not necessarily the same ones that were documented on the computerized document system, and that was a major patient safety concern. An allergy sticker was developed that can be affixed on each cardex card and they made it everyone’s responsibility to update the allergy section for their patients.
“The Bridgepoint PSEP – Canada program provided us a framework to work with, gave us tools to use that were easy to follow, and brought an increased awareness of patient safety,” says Maya Nikoloski, Registered Nurse and Nurse Educator. “It provides you with a safety lens that you can apply to micro or macro level initiatives from unit-based projects to hospital-wide programs. It has changed my perspective on how I approach a project and it has really allowed me to apply the learning in my everyday practice.”
Click here to link to the first article in the three-part series on how Bridgepoint Health has customized the Patient Safety Education Program – Canada to advance patient safety in their organization.
For more information on the PSEP – Canada program offered by the Canadian Patient Safety Institute, click here.