Establishing a pediatric family-initiated

safety reporting programQuality Forum 2013

How do we translate research into action?

Formed task force

Denise Hudson, BC PSLSSuzanne Steenburgh, Program Manager Tex Kissoon, VP Medical AffairsPat Gillis, Director Volunteer ResourcesLaurie Johnson, Quality and Safety leaderTricia McBain, Director, Quality, Safety BCCH & SHTracie Northway, Strategic ImplementationSusan Greig, Partners in care family liaison

The problem…

• More than 9% of children in hospitals in Canada experience an adverse event

• The risk of having an adverse event was nearly 3-fold higher in academic pediatric centers than in community hospitals

Adverse Events Among Children in Canadian Hospitals:The Canadian Paediatric Adverse Events Study

Matlow AG, Baker R, et al (2012)

How can patients and families help?

“When patients and families tell their own stories to members of a clinical care system, the organizational culture begins to reflect patient-centeredness. These stories slowly shape the way clinicians speak, think, and behave toward patients…..”

Order from Chaos: Accelerating Care Integration The Lucian Leape Institute (October, 2012)

Face-to-face patient and family engagement model, deploying volunteers with a laptop computer to seek

the patient and family’s view on safety

Patient Reporting for a Safe Environment(PRASE)

• 5-year project in UK (National Institute of Health Research)

• Tested telephone line, paper and pencil, face-to-face• Patient volunteers collecting data from patients;

tools hosted on a tablet personal computer (July 2012)

BMC Health Services ResearchWard, et al (2011)

Great Ormond Street HospitalLondon, UK

• Awarded a national grant for SHINE project• Recruited 2 dedicated full-time staff• Pilot on one ward over the next 15 months• Trialing version of “Patient’s View” application

Stollery Children’s HospitalEdmonton, AB

• Interest in implementing similar program• Shared tools developed for Patient’s View with

clinical quality team at Stollery

Go Live! August 15, 2012

Method

• Selected Surgical Unit as pilot site• Engaged clinical staff on ward • Branded the project

• Recruited eight volunteers and provided education

Process

• Volunteers engage families• Families report safety concerns at the bedside using

a laptop and a tested, validated web-based tool• Quality Leader reviews reports• Staff and leaders use feedback for action planning

and quality improvement

Was the pilot a success?

• Volunteer success• Organization success– Process measures• Family participation rate• Validity of reports as safety concerns• Usefulness of reports to inform QI efforts

• Family success– Satisfaction with process

• Balancing measures

Volunteer SuccessVolunteers report a positive experience where they feel supported

and valued and feel they have contributed to safe care at BCCH

Volunteers rate their experience:

Suggestions for improvement?

“…more communication with the charge nurse to let her know the days volunteers are coming…”

“A faster and easier to carry tablet (i.e. an iPad).”

“…having a list of patients being discharged on hand when you are on the shift…”

Evaluation of orientation process:

Making a difference for patient safety?

Would you recommend this experience?

Comments:

“I think it is a great way to interact with the families/patients that is different from other volunteer roles because you have a purpose and topic of conversation. It gives great insight into their experience and has made me more empathetic to the patients and families situations at BC Children's Hospital. For those volunteers looking to pursue a career in any sort of health care I feel this is a valuable experience.”

Process measure:Family participation rate

65% of shifts available had a volunteer assignedSept. 10th – Nov. 19th, 2012:

420 discharges (total)109 on weekends (no coverage) 311 on weekdays (covered by volunteers)

100/311 families identified by CN as appropriate3 declined participation46 sleeping, out of room, bad timing, etc.51 participated

51% of eligible families participated = 12% of total discharges

Process measure: Validity of reports

Patient’s View = 76 safety concerns reported92% (70/76) assessed as valid safety concerns

What did patients and families tell us?

Medication problems:

Do you think a problem with medication or IV fluid occurred?

•Dose missed?•Too much given?•Too little given?• Incorrect time, rate, route, medicine? • Incorrect patient?• Insufficient pain medicine?•Medication history incorrect?

Complications of care:

Do you think a complication of care occurred or was stopped before occurring?

•Procedure or treatment was not followed correctly•Test was done incorrectly•Poor sterile procedure or care•Changes in care made too rapidly

Equipment problems:

When equipment fails or is not used correctly

•Equipment failure caused a risk• Intravenous or arterial line did not

work correctly•Equipment was incorrectly used•Device was not available when

needed•Room ill-equipped

Miscommunication between staff:

When members of the staff give information or receive information from other staff about diagnosis, treatment or care that is inadequate, conflicting or incorrect

• Information not shared among healthcare providers•Test repeated because original was

lost or destroyed•Documentation was incorrect or

incomplete

Miscommunication between family and staff:

“I think there has been a huge disjoint between myself the parent and the ‘team’. I don’t think I have been kept informed on a number of instances, from a medication being discontinued, to another medication from home being thrown out, to results of tests not being disclosed. I don’t think the different services work well together, and different information gets given by different people. It is all very frustrating and hard to feel confident that things are correct and not being missed.”

Other problems reported:

When any action, not previously described, fails or is the incorrect action.

• Confidentiality not respected• Not given due respect• Verbally assaulted• Physically assaulted

Please describe anything you noticed staff or the hospital doing to help promote safe care

Family satisfaction with process of being asked about safety concerns:

“This conversation is one example of the unbelievable level of engagement with families within BC Children’s Hospital.”

“One mother actually thanked me after doing the survey because she found it very therapeutic. I have never had a parent turn me down or not be appreciative for what we do.” (Patient’s View volunteer)

“I am a business man and have been doing surveys with customers for years. It is excellent you are initiating this at Children's; I believe it will make care safer. Thank you!”

QI work informed by Patient’s View

• In progress: Medication Reconciliation and family involvement in transfer of care

• Update MRSA screening policy• Standardize process for obtaining urine for R&M• Standardize post-op pain control for tonsillectomy/

adenoidectomy• Revisit process for calling families back to bedside for

procedures/rounds• Communication opportunities for staff

Balancing measures:

• Number of spurious reports = 0• Number of reports not related to safety = 6– 6 reports were complaints related to “hotel” aspects (e.g.

food quality, room cleanliness)

• Ward or risk management resources needed for individual follow-up on family reports = Minimal– 51 reports x 5 minutes review = 4.25 hours

• Number of volunteers reporting they cannot meet the expectations of the role = 0

Lessons learned:

Families are highly motivated to report and happy to be invited to give feedback on patient safety

Soliciting reports within 48 hours of dischargeWeb-based reporter form and laptop Trained volunteersFeedback informs/validates quality improvement

workPatient engagement is essential Volunteers benefit from a buddy shift

Next steps?

• Spread to other units• Utilize tablets/iPads/apps• Engage families from all ethnicities and

cultures

• Make “Patient’s View” application available on the Internet

• Close the loop with families; results on a web site• Engage families in improvement projects

Please Contact:Denise Hudson

Quality Leader, BC PSLS604-877-6427

dhudson@cw.bc.ca