1. Call 6: Testing the Checklist in the Operating Room

2. Last Week’s Call Modification 101 Continued. Small-Scale Testing: “Table-Top Simulation”. The Checklist as a Documentation Tool.

3. How Did the Homework Go?

4. Homework to Date Build an implementation team. Schedule a time and venue for a meeting to take place after January. Send us an email at: safesurgery2015@hsph.harvard.edu letting us know how you would like to administer the survey at your hospital. Please also include your mailing address in this email. Download the OR Personnel Spreadsheet from our website and begin completing the information with the names, roles, and email addresses if relevant. Review the checklist modification guide and South Carolina Checklist Template. Modify the checklist with your implementation team and use it in a “table-top simulation”.

5. Poll 1: Did You Use Your Checklist in a “Table-top Simulation”? Yes No

6. Meeting the Team Ashley Kay Childers, PhD Systems Engineer SCHA Clemson University

7. Today’s Topics Does our checklist meet the goals of the South Carolina Checklist? Taking the Checklist into the OR. Identifying the right people to use the checklist for the first time. Preparing and teaching surgical teams how to use the checklist during testing.

8. Does Our Checklist Meet the Goals of the South Carolina Checklist?

9. Communication Counts The easy way out with the checklist is to remove the communication items. The communication items make the difference in American hospitals. You will know if you have your checklist right, when you hear everyone’s voice.

11. Before Testing the Checklist in the OR Ask Yourself the Following Questions: 1. Does your surgical checklist have three phases in the OR, before induction of anesthesia, before skin incision, and before the patient leaves the room? 2. Are the items on the checklist meant to be read aloud, without reliance on memory, so all members of the team can hear them? 3. Does every person that is present in the operating room have the opportunity to say something before skin incision, at a minimum they introduce themselves by name and role or state that they are ready to proceed? (This includes perfusionists, surgical assistants, PAs, residents, observers, manufacturer representatives, and other observers)

12. 4. Will the surgeon share an operative plan and discuss: anticipated blood loss, expected duration of the procedure, possible difficulties, and implants or special equipment needed for the case with the entire team before skin incision? 5. Will the nurses and surgical techs discuss with the entire team their concerns about the patient? 6. Will the anesthesia providers discuss with the entire team the anesthetic plan and airway or other concerns? Before Testing the Checklist in the OR Ask Yourself the Following Questions Continued:

13. 7.Will the surgeon ask the entire team to speak up if they have any concerns during the case? 8.Before the patient leaves the OR will ALL members of the surgical team discuss equipment problems that need to be addressed, key concerns for recovery and management, and anything that could have been done better to make the case safer or more efficient? Before Testing the Checklist in the OR Ask Yourself the Following Questions Continued:

14. Taking the Checklist Into the OR

15. Right NowEventually Have circulator hold the checklist up in front of clinicians so they can read their parts aloud. Have multiple copies of the checklist in the OR. Poster Electronic Medical Record Paper

16. Using the Checklist in the OR The team that you test the checklist with might not be the implementation team. Test with a team that has an enthusiastic anesthesia provider, nurse, surgeon, and tech. Have a member of the implementation team in the OR when they are using the checklist.

17. Finding an Enthusiastic Surgeon to Test With Find an “informal leader”. The person that people look up to. Ask the nurses, if you don’t know. Ask the surgeon on your implementation team to ask them to test the checklist, if they can’t test it themselves.

18. Prior to Testing Talk to Everybody on the Surgical Team

19. What Does This Conversation Sound Like?

20. Prior to Testing Talk to Everybody on the Surgical Team “We are bringing a new checklist into our ORs.” “This checklist builds on what we already do.” “Please help us test it.” Show him/her your hospital’s checklist with their parts highlighted If you have time run through the checklist with everybody before they bring it into the OR (or practice it in an empty OR). “I will be in the OR to help you use it for the first time.”

21. What Can Happen if you Don’t Talk to Everybody

22. What’s to Come in the New Year We will hold a special webinar for surgeons on January 12 th from 7:00-7:30. Starting in January we will move office hours from Fridays to Tuesdays at 2:00. The first Tuesday office hours will be on January 10 th. Starting in January we will be focusing on the following topics: –Engaging surgical team members in this work –Expanding the use of the checklist –Coaching the checklist –Monitoring the use of the checklist –OR Team-Training Program

23. This Week’s Homework Test the checklist with one team and modify if necessary. Email our team and let us know if you will be administering the culture survey, if you haven’t already done so. Email us a picture of your checklist implementation team. Email: safesurgery2015@hsph.harvard.edu Identify departmental meetings to have the implementation team speak after call 10. Catch up on any other homework that you haven’t completed.

24. ? ? Questions

25. Ask Us a Question By Using the Raise Hand Button

26. Next call will be on January 5 th at 2:00 Please email us if there is anything that we can do to help in the meantime.

27. Office Hours: Tomorrow 12:00-1:00

28. Resources Website: www.safesurgery2015.org Email: safesurgery2015@hsph.harvard.edu