Future steps for the Perioperative Harm programme

16 Feb 2015 | Safe Surgery NZ

The Health Quality & Safety Commission’s perioperative harm programme aims to reduce the significant harm caused by adverse events and other preventable errors that take place during the perioperative period.

To-date, the programme’s focus has largely been on supporting implementation and measuring uptake of the World Health Organization (WHO) surgical safety checklist via the programme’s quality QSM and completing a pilot project with Lakes and Waikato DHBs and Southern Cross, Auckland. The pilot aimed to test methods for moving the checklist away from being an audit tool and towards it being used as intended, as a teamwork and communication tool.

More recently, the Commission has recognised the checklist, while now routinely used during surgery in every DHB, has not reached its full potential as a tool to improve teamwork and communication within the surgical team. Research suggests that communication and teamwork failure is at the core of nearly every medical error and adverse event[1]. The next phase of the Perioperative Harm programme will build on the pilot project and emphasise improving surgical teamwork and communication as its key focus.

In support of this aim, during 2015–16 the Commission will be:

  • working with DHBs to roll out a teamwork and communication quality improvement bundle
  • retiring the existing QSM which focused on compliance with the checklist in favour of a measuring the use of the checklist as a teamwork and communication tool.

Teamwork and communication bundle
The bundle is made up of the following evidence-based components:

  • the surgical checklist, modified to be used in paperless form, as a poster on the operating theatre wall
  • briefing
  • debriefing.

Each element of the bundle will be supported by comprehensive written and online education materials (including a resource pack of optional tools to enhance communication), videos and training sessions. Tools will also be provided for monitoring the bundle’s implementation.

All elements of the bundle have been trialled with Lakes and Waikato DHBs and Southern Cross Auckland. Results from the trial were positive, with participants reporting increased buy-in to, and more appropriate use of, the surgical checklist and improved teamwork and communication within surgical teams[1]. Some quotes from the participating teams are below.

“Information is not relayed by telepathy. The trial interventions help clarify in my mind whether I have considered all aspects of patients’ anaesthesia and interventions required.. the briefing completes the team.” Anaesthetist

“When the trial came through, we as theatre nurses had very negative thoughts about it – one more time consuming bureaucratic procedure/burden on our shoulders. Now I have to admit that we were so wrong about it.” Theatre Nurse

The final report from the pilot project will be released on the Commission’s website shortly.

Bundle rollout
The Commission intends to undertake a three-phase roll-out of the teamwork and communication bundle to all 20 DHBs through a regional network approach over 18 months. All DHBs are expected start implementation of the bundle before the start of the 2016–17 financial year.

We aim to recruit approximately seven DHBs for cohort one, up to seven for cohort two and the remainder for cohort three. The first cohort is anticipated to include those keen to be early adopters as well as the initial trial sites (to encourage the spread to other surgical teams within the sites). They will be asked to support subsequent DHBs with implementing the bundle, with support from the regional quality and safety steering groups.

Each DHB will be supported to agree a local implementation team and clinical lead who is responsible for the roll-out of the bundle. Consumer representatives should be involved on these local teams and part of the implementation will focus on consumer engagement.

Local implementation teams may choose how to implement the bundle within certain parameters eg, trial within one or two operating theatres at first before expanding across the hospital. Lessons learned during each improvement cycle would be shared via multiple communication channels – regional workshops/learning sessions, newsletters, webinars/teleconferences. The Commission will provide quality improvement advice through on-site implementation support, phone calls and email.

Change to the QSM
As per the advice on QSMs provided in the Ministry of Health’s annual plan guidance to DHBs in February 2014, the current perioperative harm process QSM (all three parts of the WHO surgical safety checklist used in 90 percent of operations) will be retired at the end of 2014–15. A new measure aimed at ensuring that the checklist is used in at least 90 percent of operations, but measuring the use of the checklist as a teamwork and communication tool, will be developed during 2015–16, with public reporting from 1 July 2016. A web-based tool to assist with collecting the new QSM data has been trialled and will be released for DHBs to use alongside the bundle as a data collection method if they wish.

For more information contact emma.forbes@hqsc.govt.nz.

  1. PriceWaterhouseCooper, Improving Teamwork and Communication in Surgical Teams Proof of Concept Project Review and Recommendation Report, December 2014

Last updated 16/02/2015