trained observers for donning doffing ppe cbrne collaborative[1]

Trained Observers forDonning/Doffing PPE

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Reducing Serious Communicable Disease Threats

Join the Move to Sustainable Safety: www.cbrnecc.ca

At the end of this session you will understand:

• The Culture of Safety

• What Trained Observers watch for in Donning/Doffing

• Why Organizational Safety Leaders need your input

• Failure Mode and Effect Analysis (FMEA)

• How you can use your Observer (FMEA) Skills Daily

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THE CULTURE OF SAFETY

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The Culture of Safety

• Safety is everyone’s responsibility

• Openly sharing information without reprisal is essential

• LISTENING is the first step in mitigating risks

CHECK OUT: http://www.ihi.org/resources/Pages/Changes/DevelopaCultureofSafety.aspxhttp://aubreydaniels.com/blog/2013/01/23/7-keys-for-creating-a-safety-culture/ 4

Language is Important

• United Airlines discovered that crew “hierarchy” can lead to important information being missed, with sometimes fatal results

CHECK OUT: http://en.wikipedia.org/wiki/Crew_resource_management 5

Language is Important

• When black box tapes of the air crash were reviewed, it was noted there were times the Co-pilot expressed concerns to the Pilot, which could have prevented the crash

6CHECK OUT: http://gtresearchnews.gatech.edu/newsrelease/CREW.html

CUUS

United Airlines created CUUS - 4 critical words – which - if used - translate to

“STOP AND LISTEN. We have a potential problem.”

• I am Concerned

• I am Uncomfortable

• This is Unsafe

• I am Scared

If anyone uses this language, it is important to immediately STOP AND LISTEN.

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You will know you have a Culture of Safety when you:

• Openly share ideas

• Listen to each other

• Think innovatively about safety

• Develop ways together to reduce risk and prevent failure

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TRAINED OBSERVERS FOR DONNING/DOFFING PPE

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What is a Trained Observer?

That’s a great question!

In general terms, Trained Observers are people trained to “observe a situation” and “rate it” using:

• written description

• photographs, or

• other visual scales such as drawings or videos

10http://www.urban.org/toolkit/data-methods/ratings.cfm

Trained Observers for Donning/Donning of PPE

This Trained Observer will watch others:

1. Prepare to Don PPE

2. Don their PPE

3. Doff Their PPE

AND correct any risks or failures they observe in the process

To do this Trained Observers will use:

• Written aids such as check lists

• Photo or visual aids

• Rating scales

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Trained Observers forDonning and Doffing of PPE

• Observe others using a checklist to ensure the donning-doffing process is done correctly

• Do not perform hands-on tasks to assist (unless an emergency)

• Is there a Trained Observer in this picture?

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Trained Observers forDonning and Doffing of PPE

• The Trained Observer must verbally confirm each step with the person being observed

• Is there a Trained Observer in this picture?

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Trained Observers forDonning and Doffing of PPE

• If staff need hands-on assistance, a “buddy” should help and the Trained Observer remains a 3rd

person

• Is there a Trained Observer in this picture?

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Trained Observers forDonning and Doffing of PPE

• Over time, as staff gain experience, they will be able to don and doff by themselves.

• To reach this level requires almost daily practice ( rare).

• The buddy could potentially become a Trained Observer under those conditions

• Is there a potential Trained Observer in this picture?

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Trained Observers forDonning and Doffing of PPE

• The Safest Model for a Trained Observer in the Donning and Doffing of PPE is using 3 people– Two Buddies in PPE to assist

each other as needed.

– One Trained Observer

• Is there a Trained Observer in this picture?

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To Support the Trained Observer

Institutions/Agencies must have:

• Checklists for donning and doffing their specific PPE

• Simple protocols for documentation

• Training sessions to develop/maintain the Trained Observer Skills

• A Safety Leader if assistance is needed

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ORGANIZATIONAL SAFETY LEADERS

Working with

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Organizational Safety Leaders

• The Role of a Safety Leader is to monitor workplace activities to ensure workers comply with company policies and government safety regulations

• This includes organizational policy development, safety inspections and training.

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In the Setting of A Serious Communicable Disease

Organizational Safety Leaders oversee:

• Risk based Selection of PPE

• Screening Staff for suitability to use PPE

• Development of Donning and Doffing Protocols

• Setting up Serious Communicable Disease Units and Teams

• Training Teams including Trained Observers for PPE

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In the Setting of A Serious Communicable Disease

Organizational Safety Leaders

Must work with others to establish protocols for the safe management of:

• Lab specimens

• Waste

• Patient movement within the hospital

• Diagnostic Imaging

• Visitors

• Etc.

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In the Setting of A Serious Communicable Disease

Organizational Safety Leaders

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• Must be strong promoters of the Culture of Safety

• Remain current and continually monitor health and safety guidance as it evolves

• Work with staff to find even better ways to improve safety

FAILURE MODE AND EFFECTS ANALYSIS

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Failure Mode and Effects Analysis(FMEA)

FMEA is a systematic, proactive method for evaluating a process to:

• Identify where and how it might fail

• Assess the relative impact of different failures

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Failure Mode and Effects Analysis(FMEA)

• The Ultimate Goal of FMEA is identifying risk/failures and PROACTIVELY correcting them

• This is the main role of a Trained Observer

25CHECK OUT:

http://www.ihi.org/resources/Pages/Tools/FailureModesandEffectsAnalysisTool.aspx

EXERCISING YOUR OBSERVER (FMEA) SKILLS DAILY

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Exercising your Observer (FMEA) Skills Daily

• Hand-washing

• Seal checks of your N95

• Proper Glove removal

• Waste disposal

• All of the above are Donning-Doffing Steps you do daily

• Practice them as if you were dealing with a patient with a Serious Communicable Disease

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Exercising your Trained Observer (FMEA) Skills Daily

Review online protocols or the training materials of others to:

• Identify the risk

• Consider the impact of the failure

• Think proactively of correction

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EXERCISE YOUR OBSERVER SKILLS

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Failure RISK?

Anticipate Correction

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Failure Risk?

Pre: PPE Vitals: Anticipate Correction

• P120

• BP 160/100

• R 24

• O2Sat 95%

• T 37.6

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Failure Risk?: Pre-PPE

Caution: If Drink 700 cc Correction

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Failure Risk?

Anticipate Correction

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Failure Risk?

Anticipate Correction

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Failure Risk?

Anticipate Correction

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Failure Risk?

Anticipate Correction

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Failure Risk?

Anticipate Correction

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Failure Risk?

Anticipate Correction

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Failure Risk?

Anticipate Correction

39http://www.ecdc.europa.eu/

Failure RISK?

Anticipate Correction

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Failure Risk?

Anticipate Correction

41http://www.ecdc.europa.eu/

Failure Risk?

Anticipate Correction

42http://www.ecdc.europa.eu/

Failure Risk?

Anticipate Correction

43http://www.ecdc.europa.eu/

Failure Risk?

Anticipate Correction

44http://www.ecdc.europa.eu/

Failure Risk?

Anticipate Correction

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Failure Risk?

Anticipate Correction

46http://www.ecdc.europa.eu/

Failure Risk?

Anticipate Correction

47http://www.ecdc.europa.eu/

Failure Risk?

Anticipate Correction

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Failure Risk?

Anticipate Correction

49http://www.ecdc.europa.eu/

Failure Risk?

Anticipate Correction

50http://www.ecdc.europa.eu/

Failure Risk?

Anticipate Correction

51http://www.ecdc.europa.eu/

Failure Risk?

Anticipate Correction

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General Failure Risks

• Contamination

• Equipment: Improper use or Failure

• Physiologic: Fatigue, Heat

• Psychological: Claustrophobia

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Safety belongs to all of US

• The CBRNE Collaborative is a Public Health Agency of Canada Project, sponsored by the Canadian Safety and Security Program.

• It is managed by Sunnybrook Research Academy (Toronto).

• Check us out at:

www.cbrnecc.ca

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The Trained Observer Slide Presentation

• Was Created by Dr. Laurie Mazurik, Staff Emergency Physician at Sunnybrook Health Science Centre Toronto, CANADA

• Her experience with SARS in 2003, ignited a passion to support better training for HCW in personal protection and emergency preparedness.

• Laurie.mazurik@cbrnecc.ca

55www.cbrnecc.ca