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Developing HUDDLES in Healthcare Dr Kate Pryde Consultant Paediatrician, Southampton Children’s Hospital October 2017 @katepryde
Developing HUDDLES in Healthcare
Dr Kate Pryde Consultant Paediatrician, Southampton Children’s
Hospital
October 2017 @katepryde
Huddles
Healthcare HUDDLES
Preparatory briefing among healthcare professionals for the purpose of collaborating,
exchanging information and bringing awareness to patient safety concerns
Situational Awareness
Healthcare HUDDLES
Healthcare
Utilising
Deliberate
Discussion
Linking
Events
Glymph et al 2015
The ‘Huddle’ Suite
Identify Bedside huddles (Micro)
Patient, family, nurse, doctor
Mitigate Ward Safety Huddle (Meso)
Nurses, Doctors, AHP, play & admin
Escalate Leaders safety brief (Macro)
Overview of risk and harm
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Southampton Children’s Hospital
• 150 Beds, inc 14 bedded PICU, 11 wards
• 40 000 admissions/year
• Tertiary specialist children’s hospital inc cardiac, neurology, oncology, nephrology, respiratory, gastroenterology, ENT and more
• DGH for local population
. . . .to constantly strive for the
highest quality care we can achieve
and to reduce avoidable error and
harm to children in our children’s
hospital through the development of a
proactive safety culture
Overarching aim
Overall aim: To reduce avoidable error and harm to children on the paediatric medical unit through the development of a proactive safety culture
Outcomes: This will be demonstrated by: 1.Increased understanding in clinical teams of the concepts of:
1. situational awareness, 2. proactive actions to reduce
harm, 3. sharing of learning 4. the pivotal role of patients,
parents & carers in providing harm free care
2.Improved awareness of safety from patients, parents and carers through:
1. Improved Manchester Safety awareness survey scores
2. Reduction in complaints 3. Completion of safer care
checklist 3.A 25% reduction in unplanned PICU admissions 4.Of unplanned PICU admissions:
1. 25% reduction in LoS 2. 25% improvement in PiMM 2
score 5.50% reduction in number of medication errors that reach patient 6.50% decrease in extravasation injuries
Improved situational awareness
Developing a culture based on safety
Improved Engagement with patients and their parents/carers in
delivering care recognised as being safe
Recognition and escalation of deteriorating child in
timely manner
Learning from excellence
Introduction of MDT ‘huddle’ intervention Reinforcement of use of structured communication
Introduction and development of other appropriate tools and interventions
Education of teams in concepts of situation awareness, anticipation, containment and reliability Utilisation of Manchester Patient Safety Questionnaire Fostering an open approach to working as clinical teams incorporating whole of MDT
Introducing patients, parent and cares as key components of team Utilisation of the Safer care checklist Introduction of patient/parents safety awareness survey Engaging patients, parents and carers in development of local projects
Accurate recording of physiological observations Correct use of PEWS escalation protocol Use of structured approach (SBAR) for communication
Embedding and utilisation of FERF RCA of excellent practice events
Outcomes Primary Drivers Secondary Drivers
Start small . . . . and grow
But where to start?
• Satellite theatre lists – LP & BMT
• Anaesthetists & WHO surgical safety checklist
• Retirement of staff
Engaging colleagues
Communicating the programme
Design and test change
• Start small
• Rapid, frequent PDSA
• Share results
• Promote positivity
Bed No Acuity score
HDU/ PICU step down
Pews Nursing concern
Watcher Parental Concern
Active Safeguarding concerns
IP Issues Similar Names
ACP EDD AER/ Near Miss
Action Other Information
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2
3
4
5
6
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9
10
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PMU SAFE Huddle checklist (v.4) Date: Time: Pre Huddle Questions: What have we done well?
Were we SAFE on the last shift?
Are our systems and processes reliable?
Are we SAFE today?
Will we be SAFE in the next shift?
Are we responding and improving?
Power of recognition & value
Hub Huddle 13.00 &
Midnight
PB
PMU
PHDU
G2N
G3
G4S
G4N
PAU
JADW
PICU
Huddle Spread
Summary of Outcomes to Date
• Improved information sharing
– Clinical (sick and deteriorating patient) – 21 patient reviews
– Safety – 90 rapid adverse event reviews – morphine, razors, NGT checks
– Operational – 21 wating on PAU to 3 beds in 4 hours
• Empowerment
• Culture of collaboration and community
Our Learning
• Staff appreciating iterative process – when, how many, format
• Huddle leadership -TIMING
• Seeing value – evidencing outcomes
• People wanting to sit and chat! It’s NOT a handover or a meeting . . . .
• Not just about staffing
• Reactive to proactive – still work in progress!
• Ensuring we walk before try to run
Implementing your own Huddle
• What matters to patients?
• What matters to staff?
• What does your data tell you?
– Adverse event reports
– Complaints
Planning for your Huddle
• Communication- Individuals aware of situation in areas
of responsibility
• Location - Suitable place for the huddle
• People - Representation from whole MDT
• Timing
• Culture – Open approach to communication
– Valuing everyone’s input
Huddle Trigger Tool and Script
To support the huddle, some sites use different tools:
• Trigger tools
– Used to identify, in advance of a huddle, which patients need to be discussed
• Checklist/Scripts
– Acts as an aide memoire to ensure huddles follow a consistent format, helping reliable use
What might your checklist/script include?
Bed No Acuity score
HDU/ PICU step down
Pews Nursing concern
Watcher Parental Concern
Active Safeguarding concerns
IP Issues Similar Names
ACP EDD AER/ Near Miss
Action Other Information
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
PMU SAFE Huddle checklist (v.4) Date: Time: Pre Huddle Questions: What have we done well?
Were we SAFE on the last shift?
Are our systems and processes reliable?
Are we SAFE today?
Will we be SAFE in the next shift?
Are we responding and improving?
Take the HUDDLE concept & develop to suit YOUR
workplace: Watford Drug-gle is medications safety
huddle
Huddles Core Principles
• Increased situational awareness
• Reactive to proactive
• Improved team communication
• Flat hierarchy – all contributions valued
• Structured
• Continuous learning
Acknowledgements RCPCH SAFE Project, Peter Lachman
Staff of Southampton Children’s Hospital
In particular: Leigh Shaw, Amy Mitchell, Grace Reynolds, Jenny Bull, Amy Withers, Bev Watson, Outreach, Bleep, PB and PMU teams
More information . . . . .
www.rcpch.ac.uk/safe
@katepryde
