quality and patient safety toolkit
TRANSCRIPT
Quality and Patient Safety Team
“Getting Started Toolkit”
Performance Excellence Program
Capital District Health Authority
Summer 2014
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Quality & Patient Safety Team
Getting Started Toolkit
Table of Contents
Content Page Introduction to the Quality & Patient Safety Toolkit 3 Quality & Patient Safety Leader Role 5 Frequently Asked Questions 6 Accreditation 2013 Information 7 Citizen Engagement and the Q&PS Team 9 Patient Experience Survey Information 11 Overview PSRS 12 List of relevant CDHA policies 14 *Terms of Reference for Quality & Patient Safety Teams 16 *Quality Review Meeting Agenda template 23 *Quality Review Recommendations and Action Plan 24 Q&PS Team Meeting Agenda Template 25 Quality and Patient Safety scorecard template, guidelines and instructions 26 Quality and Patient Safety Action Plan template 32 Indicator Data Navigation Guide 33 Patient Safety Report System (PSRS) Report Formats 37 Audits Templates 39 *10 chart/Kardex Audit tool
• Inpatient 40 • Ambulatory 41
*Single chart/Kardex Audit tool • Inpatient 42 • Ambulatory 43
*Medication Reconciliation Monthly Chart Audit (Safer Healthcare Now) 44 Falls Audit Tool (Safer Healthcare Now) 45 *Pressure Ulcer Prevalence Audit and instructions 46 *Transfer of Accountability Audits 47 Quality and Patient Safety Team Success story 49 Template of the Q&PS Whiteboard 50 Patient Safety Flashcards 51 DO NOT Use Abbreviations 52
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Introduction Purpose of the Quality & Patient Safety Toolkit The purpose of this toolkit is to provide teams with the initial resources and tools necessary to establish a Quality & Patient Safety Team in their area of care or service department. The tools provided in the kit are meant to be flexible and can be modified to suit the needs of the team, unless otherwise stated. Quality & Patient Safety Team Terms of Reference must include the information in the template, with team specific information added. The toolkit is intended as a living document that will be updated and revised as new information becomes available. The most current version will be available electronically. What is a Quality & Patient Safety Team (Q&PS Team)? The Q&PS team is part of Capital Health quality and patient safety improvement program and is established to contribute to education and improvement in medical and hospital care or practice within the area for which the team is responsible for providing care or services. This requires the team to collect and review information and identify successes and opportunities for improvement related to quality and efficiency of care, patient safety, utilization, accreditation, patient experience, unexpected deaths or trends, or other reviewable matters. The information and documents generated by the team are for the purposes of education and or improvement of interdisciplinary care or practice. The Q&PS Team is made up of interdisciplinary members (e.g. healthcare professionals, staff, and physicians) and healthcare experience advisors (e.g. patients, family members, clients). The team must meet a minimum of four times a year and may on the call of the chair meet more frequently and as the need arises. General minutes of these meetings and recommendations arising from the review of specific clinical/patient case reviews (but not the specific details of any clinical/patient cases discussed) are recorded and shared with team members. Please see the Quality & Patient Safety Team Terms of Reference template for a detailed list of responsibilities. Quality reviews must fall under the Terms of Reference of the Q&PS Team or Council. The Q&PS team will participate in and communicate findings of completed Morbidity and Mortality
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(M&M) Rounds and reviews of other Reviewable Matters to the Department/Service/Facility Q&PS Council. It is essential that recommendations resulting from these quality review processes are disseminated to the service/ quality team, (or council) and mechanisms are in place to ensure implementation of recommendations. The team will review and may be asked to review events/ processes under the Management of Serious Clinical Occurrences Policy and Procedure (CH 70-005, which is in the process of being updated) and make recommendations within the department to address issues identified and oversee the implementation of those recommendations. Please contact the Performance Excellence Program for further details. If the information generated by the Q&PS Team indicates the need for a more in-depth or extensive review or further review by another body, the Q&PS Team makes this recommendation to the Q&PS Council to whom it reports and to the Performance Excellence portfolio. Q&PS Team Structure and Accountability Q&PS Teams and Councils fall under the quality structure and accountabilities as described in Capital Health’s Integrated Quality and Patient Safety Framework. Capital Health Patient Safety Plan
Capital Health’s Patient Safety Plan, "Patients First – Learn-Act-Communicate-Improve", promotes a patient safety and quality improvement culture within the health authority.
The CDHA Patient Safety Plan supports patient safety and reduces risk to patients by creating and sustaining a safe environment that ensures the recognition and acknowledgement of risks to patient safety; initiation of actions to reduce these patient safety issues and risk; internal reporting of patient safety issues and corrective actions taken; a focus on processes and systems; organizational learning about patient safety; and supporting and sharing knowledge about patient safety within CDHA and other healthcare organizations.
The guiding principles and philosophy of patient safety at CDHA are first organized following the six domains of the Canadian Patient Safety Institute Safety Competencies framework. The competencies are then overlaid on each of the Accreditation Canada Required Organizational Practices (ROPs) and both are further mapped to the Canadian Medical Protective Association “Good Practices Guide” to create a Practices Map.
You may provide feedback to Performance Excellence on the toolkit: Jane Palmer at [email protected] or Gredi Patrick at [email protected]
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Quality and Patient Safety Leader Role
Below is a list of some of the responsibilities and specific services of the Performance Excellence based Q&PS Team Leader as related to Q&PS Teams and Councils:
• Support and facilitate initiatives in quality improvement, patient safety, accreditation, utilization and knowledge exchange.
• Work with Quality & Patient Safety Teams and Councils to facilitate and accelerate quality improvement and patient safety, utilizing quality improvement and other relevant tools (i.e. indicator development, scorecards, quality review).
• Provide templates to assist Quality & Patient Safety teams and councils in their development of terms of reference, scorecard and toolkits for quality reviews.
• Participate in relevant Quality & Patient Safety Teams and Councils as required.
• Interact with health care and service provision staff and clinical and program managers as required to facilitate quality and safe patient care.
• Build, maintain and monitor networks of relationships with various components and stakeholders of the health system.
• Build capacity for quality improvement and patient safety through education and mentorship.
• Plan and deliver programs and events for learning and knowledge exchange.
• Act as a liaison between the Quality & Patient Safety Teams and Councils and the Performance Excellence team members for quality, patient safety, utilization and accreditation.
Our goal will be to attend a meeting(s) with the Q&PS team to get a sense of the work that your team is doing. There will be some initiatives or work that will be unique to your specific population and some that will be applicable and relevant for all teams. We will be the "connect" for your teams within the organization to ensure that information is flowing both ways.
Quality & Patient Safety Leaders, Performance Excellence:
Gredi Patrick Phone: 473-8279 Email: [email protected]
Jane Palmer Phone: 473-7075 Email: [email protected]
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FAQs – Quality & Patient Safety (Q&PS) Teams
Q: What is the significance of a Q&PS team? A: The Q&PS team is part of Capital Health quality and patient safety improvement program and is established for the purpose of improving education and improvement in medical and hospital care or practice within the area for which the team is responsible for providing care or services. This requires the team to collect and review information and identify successes and opportunities for improvement related to quality and efficiency of care, patient safety, utilization, accreditation, patient experience, unexpected deaths or trends, or other reviewable matters. The information and documents generated by the team are for the purposes of education and or improvement of interdisciplinary care or practice. Q: What topics do we discuss at the meetings? A: A typical Q&PS Team meeting agenda includes: review of previous meeting, review of the team based scorecard (new data, trends, etc.), quality improvement initiatives, accreditation action items, reviewable matters, etc. Q: Are the meetings confidential? A: Please see Quality and Patient Safety Terms of Reference for details. Q: Even if I am not a member, can I bring a question or concern forward to this team for review? A: Yes, all regular meetings are open to staff members and physicians to attend. You may attend a meeting or report any successes or opportunities for improvement to any member of the team to discuss at the meeting. Q: What happens after a plan of action is developed? A: After a plan of action is developed to address an issue or opportunity for improvement, a person or people should be assigned accountability for the plan and a timeline should be developed, the item should become a standing item on the agenda so regular reports can be provided to the Q&PS Team. Q: Who is accountable for doing the work? A: The Q&PS team co-leads and members are ultimately accountable for the actions of the team however individual members are responsible and accountable for their own actions. When accountability for a project or task is assigned to a member or members of the team, it is expected the member or members complete the task. Please refer to the Q&PS Team Terms of Reference for more details.
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Accreditation
Purpose: The purpose of Accreditation is to evaluate health care organizations using standards of excellence for patient safety and quality of care. In Nova Scotia, health districts must be accredited in order to receive provincial health care funding. Accreditation Canada standards are developed using national and international research and expertise. The accreditation process is intended as a tool to identify areas of strength and areas improvement and to guide actions to improve quality and safety for health care recipients and providers.
Process: Accreditation is now a four-year cycle involving self assessment, continuous evaluation and improvement, an on-site evaluation by a group of surveyors from Accreditation Canada (which results in the organization receiving an accreditation status), and follow up based on the report issued for the on-site visit.
Accreditation at Capital Health: In June 2012, staff and physicians were asked to complete three electronic self assessment tools: a self assessment questionnaire and two survey instruments. The last accreditation survey visit was October 2013. Capital Health has received the higher rating from Accreditation Canada – accredited with exemplary standing.
The three surveys:
1. Self Assessment Questionnaire – This survey asked questions related to sets of Standards associated with specific services or care areas (e.g. medicine services, laboratory services, home care). The questions focused on Required Organizational Practices (ROPs) and processes that are considered to be of significant importance in providing safe, high quality patient care.
2. Survey Instruments – Measure critical aspects of health services across the organization as a whole.
• Patient Safety Culture Instrument • Worklife Pulse Instrument
Results from the surveys are now available and can be accessed through the Accreditation Canada website. Q&PS Teams have access to the Accreditation portal associated with their area of care. The portal also contains many resources for the purpose
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of Accreditation. The “RoadMap” portion of the portal can also be used to input evidence of action related to the Standards.
What is a Standard?
• A Standard is a best practice criterion that Accreditation Canada uses to measure how well and how safely care is provided in health care organizations. There are 32 individual sets of standards that address the various services offered at Capital Health. Standards are designed to be easily integrated into daily activities. They are used as an ongoing tool for quality improvement and to continuously monitor and refine practice.
What is an ROP? • Required Organizational Practices (ROPs) are essential practices that enhance
client safety and minimize risk. ROPs are found within most sets of standards used at Capital Health.
Please contact Sheri Roach ([email protected]), Amanda Creelman ([email protected] or Kim Ryan ([email protected]) for questions related to Accreditation. You can also refer to the Accreditation website which is listed under “Service A-Z” or available as a link from the Performance Indicators and Reports tab under the “quick links” on the Capital Health intranet homepage.
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Citizen Engagement and the Q&PS Team
Patient engagement is an organizational priority and is one of our Strategic Milestones (100% involvement in Patient Care Committees). Historically, patients were first involved in our organization as volunteers, and more recently in our Q&PS teams as the last accreditation process rolled out. Patient, family or client representation on all committees has however remained an important milestone in our strategic plan, and now continues through the citizens, who bring their health care experience and insights to the Q&PS Teams. Citizens may include patients, family members or clients. The Performance Excellence Program provides orientation, educational support and opportunity for networking within this group of volunteers. Performance Excellence hosts 2 – 3 meetings a year with citizens, offering education on confidentiality, their role in the Q & PS Teams, and accreditation, in addition to any education requests by this group. Benefits for Citizens
• It can lead to services improvements for existing/future patients and families. • It provides an opportunity to bring about meaningful change in health care. • It increases opportunities for patients/families/clients to share information and gather
broader feedback from other patients and families. • It feels good to make a contribution and is satisfying to give back to the health system. • It provides opportunities’ to network with other consumers and health care providers. • It expands one’s knowledge and skills.
Qualities to look for in a Citizen: Look for individuals who:
• Have direct (patient, client or family/support person) experience with the clinical areas within the scope of the user group
• Able to share their experiences constructively • Are comfortable expressing views and opinions in a group • Able to see beyond their own experience • Able to network • Collaborates; attitude of partnership • Listens well and respects others’ opinions and diversity • Reflect the diversity of those served by the clinical or program area • Are able to dedicate their time to the meetings anticipated • Commits to the confidentiality of all matters discussed at Q&PS team meetings
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Responsibility of Q&PS Team: • Teams are responsible for reimbursing parking/transportation costs incurred by the
patient/consumer through their own cost centres.
• Contact the citizen and ensure they are on the team’s mailing list. The team is responsible for making the engagement meaningful for the citizen and the team. This may require a phone conversation to provide important background information, progress to date, etc.
• Provide Q&PS team or council specific education to help the patient, family or client (citizen) feel as comfortable as possible in their role and to be able to contribute meaningfully.
Please refer to the Engagement Policy (CH 70-080) for more details or contact Gredi Patrick ([email protected]), or Susan Dunn ([email protected]).
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Patient Experience Survey
Every day we strive to improve our service and provide the best care possible to our patients. One way we learn how we can improve is to ask the opinions of those who have been patients. The Patient Experience Survey is one example of our commitment to quality improvement. The annual survey measures patient perceptions and opinions about the care they received. Results from the survey are used to identify strengths and opportunities for quality improvement initiatives. Measuring the patient experience is an Accreditation Canada Required Organizational Practice (ROP). Specifically, the survey is comprised of 41 questions and is grouped into nine dimensions:
1. Overall assessment of care received 2. Accessibility of services 3. Emergency Department (if applicable) 4. Continuity and Coordination of Care 5. Care Received from Health Care Professionals 6. Respect for rights 7. Hospital Support Services 8. Concern for Safety 9. Hospital Environment
Patients are also able to write additional comments at the end of the survey. Reporting of survey results takes place annually, through the leadership of the Performance Excellence Program. Organizational-level results are presented to the Capital Health Board of Directors, Leadership Enabling Team, and Director and Physician leadership groups. Reports are prepared as well by site and service, allowing for focused quality improvement efforts in local levels of the organization through quality teams. This year’s survey results can be found on our intranet site, at: Patient Experience Survey Results . If you have any questions regarding Capital Health’s Patient Experience Survey, please contact Ruth Harding ([email protected]).
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Patient safety is about managing and reducing the chances of patient safety incidents/ events and harm happening to patients and making sure that the care patients receive is as safe as possible. In 2007, Capital Health established the Patient Safety Reporting System (PSRS) for the reporting of actual and near miss patient safety incidents/events. Health-care providers are required to report all incidents/events where patients have experienced real or perceived harm, all hazards and patient safety issues including near miss events. Leadership within Capital Health is committed to reviewing and following up on all reported patient safety incidents/events in the PSRS including near miss events. Reporters of events can check for follow-up on individual reports they have submitted with their manager. The PSRS does not provide for individual responses to reporters as it is an anonymous system. All patient safety incidents/events are reported anonymously through PSRS to support and foster a safe learning environment and a just culture. Did you know…in FY 20011/12 there were near 20,000 events reported in the PSRS. Data from the PSRS is reported quarterly to the District Quality and Patient Safety Committee. To see the annual reports on the PSRS for the last 4 years go to: http://chdintra.nshealth.ca/departmentservices/riskmanagement/safetyEventsSummary.html Information on Risk Management/Patient Safety, the PSRS and contacts are on our intranet webpage at: http://chdintra.nshealth.ca/departmentservices/riskmanagement/aboutUs.html Tips & Tools http://chdintra.nshealth.ca/departmentservices/riskmanagement/PatientSafetyDefinitions.pdf
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Entering an Event to PSRS Anonymously: http://chdintra.nshealth.ca/departmentservices/riskmanagement/documents/cheatSheetPSRS.pdf Access the interactive learning module through LMS: http://lms.cdha.nshealth.ca/cdha-shared/learningstudio/index.cfm?fuseAction=MyLearningCenter.MyLearningPage&tab=Home Risk Management Tools : Investigating an Adverse Event Patient Safety Event Checklist: http://chdintra.nshealth.ca/forms/CD2428-10-11.pdf Pocket Guide to Disclosure: http://chdintra.nshealth.ca/departmentservices/riskmanagement/disclosurePocketGuide.pdf
Disclosure: Patient Guide: http://www.cdha.nshealth.ca/patientinformation/nshealthnet/1448.pdf
Medical Device Issue Tag: http://chdintra.nshealth.ca/forms/PrinA1171- MedicalDeviceIssueTag.pdf
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Quality & Patient Safety (Q&PS) Toolkit
Relevant Policies & Procedures
(Please note the list is not all inclusive and that Policies and Procedures are revised regularly. The more current Policies and Procedure are available on the CDHA intranet, under “Policies & Procedures”.)
• A-003 Allergy alert
• CC 04-040 Clinical Documentation in Health Record
• CC 05-030 Least Restraint
• CC 05-045 Falls Prevention Inpatients
• CC 05-046 Falls Prevention Ambulatory
• CC 55-045 Skin and Wound Assessment Documentation
• CC 75-005 Blood Transfusion: Administration of Blood, Blood Components and Blood Products
• CH 30-035 Patient Admission, Discharge and Transfer Data Entry-STAR
• CH 30-060 Transfer of Health Information between Facilities/ Transfer of Accountability (Unit to Unit, Shift to Shift)
• CH 70-005 Management of Serious Clinical Occurrences (update in progress to include Quality
and Patient Safety Review)
• CH 70-006 Disclosure of Adverse Patient Safety Events and Harm
• CH 70-040 Patient Identification and Same Name Alert
• CH 70-080 Engagement
• CH 100-035 Patient Safety Reporting System
• IC 05-002 Patient Education, Infection & Prevention Control, Antibiotic Resistant Organisms.
• IC 04-008 Contact Precautions
• IC 06-016 Hand Hygiene for Health Care Providers
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• MM 20-004 Insulin Dose Adjustment
• MM 50-003 Medication Reconciliation Admission and Discharge
• VTE Prophylaxis (in draft)
• High risk activity policies (e.g. Restraint Use, Blood Product transfusion, Insulin, Heparin, high concentration electrolytes, etc.
Click here for the full listing of Capital Health’s Policies and Procedures.
Quality & Patient Safety Committee Pursuant to section 60 of the Nova Scotia Evidence Act (2) and Section 19 D of the Freedom of Information and Protection of Privacy Act (1) as amended
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Terms of Reference Quality & Patient Safety Team (or Council)
*** (Unit/Service Area Name) Quality & Patient Safety Team (or Council)
(Referred to herein as the Q&PS Team or Council) REPORTS TO: The District Quality & Patient Safety Council and District Medical Advisory Committee (DMAC) Quality Sub-Committee through the Department/Service/Facility Q&PS Council in which the Q&PS team resides. (Appendix A)
CO-CHAIR(S): A medical co-chair as designated by the Chief of the Department/Service and an administrative/other health professional co-chair as designated by the Director of Health Services. Co-chair appointments are for a term of 2 years and co-chairs may be re-appointed for a maximum of 2 additional terms of 2 years each.
MEMBERSHIP: Participation in Q&PS team’s (or council’s) work should reflect an interdisciplinary approach to care. All staff and learners are encouraged to take part in Quality and Patient Safety initiatives. The *** Q&PS team or council will consist of
• Healthcare Professionals including but not limited to Nurses, Physicians(in addition to the medical co-chair), Pharmacists, Social work, Occupational therapists, Physiotherapists, Infection Control Practitioners and Administrative staff
• Medical co-chair • Administrative/other health professional co-chair
Additional health care professionals will attend the Q&PS team (or council) as required and will commit to the confidentiality of the meeting at the beginning of each meeting of the team.
I. PURPOSE
The *** Q&PS Team (or Council) is part of the Capital District Health Authority’s (Capital Health) quality and patient safety improvement program and is formed for the purpose of improving education and improvement in medical and hospital care or practice.
Quality & Patient Safety Committee Pursuant to section 60 of the Nova Scotia Evidence Act (2) and Section 19 D of the Freedom of Information and Protection of Privacy Act (1) as amended
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The information and documents generated by the *** Q&PS team (or council) are used for the purposes outlined above and accordingly the purpose of education or improvement in medical or hospital care or practice. The information used during the meetings and the reports that follow are protected pursuant to the Evidence Act of Nova Scotia S.60 (2) and Freedom of Information and Protection of Privacy Act of Nova Scotia S. 19D (1) as amended.
The information used during the meetings and the reports that follow are protected pursuant to the Evidence Act of Nova Scotia S.60 (2) http://www.canlii.org/en/ns/laws/stat/rsns-1989-c-154/latest/rsns-1989-c-154.html and Freedom of Information and Protection of Privacy Act of Nova Scotia S. 19D (1) http://www.canlii.org/en/ns/laws/stat/sns-1993-c-5/latest/sns-1993-c-5.html
II. RESPONSIBILITIES
1. Collect and review information, at least on a quarterly basis to identify successes and issues related to quality and efficiency of care, patient safety, utilization (scorecards), accreditation, patient complaints, unexpected deaths and any other services and issues as may be identified by the organization, or by the team, as integral to the Q&PS team (or council).
2. Upon identification of reviewable events/processes, as outlined above, pursuant to the requirements/processes outlined in the Quality & Patient Safety Review policy, make recommendations within the department/site to address issues identified and oversee the implementation of the recommendations.
3. If an issue cannot be fully addressed at the department/site level, or if the issue has implications/recommendations beyond the department/site, then the committee will refer it to the District Quality & Patient Safety Council and/or the District Medical Advisory Committee – Quality Sub-Committee (DMAC-QC) as appropriate. The referral should include a timeframe for consideration and reporting back to the *** Q&PS team (or council).
4. The Q&PS team (or council) will participate in and communicate findings of completed Morbidity and Mortality (M&M) Rounds and reviews of other Reviewable Matters to the Department/Service/Facility Q&PS Council. It is essential that recommendations resulting from these quality review processes are disseminated to the service/ quality team, (or council) and mechanisms are in place to ensure implementation of recommendations.
5. The Q&PS team (or council) will: a) oversee the implementation of recommendations; b)
evaluate the effectiveness of recommendations; c) report semi-annually or otherwise as required under section 4 above to the Departmental/Service Q&PS Council and through
Quality & Patient Safety Committee Pursuant to section 60 of the Nova Scotia Evidence Act (2) and Section 19 D of the Freedom of Information and Protection of Privacy Act (1) as amended
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them to the DMAC-QC and the District Q&PS Council and d) conduct annual review of recommendations to identify themes, successes and trends leading to quality improvement of patient care and services.
6. Maintain a record of all Q&PS team (or council) activities, both through regular meeting minutes(restrictions as indicated before hand), as well as indicator cards with reporting through established reporting structures (see Appendix A)only one recorder per meeting;
7. The Q&PS team (or council) shall meet at least quarterly and as required to address specific events/issues.
8. Maintain site/department-wide accessibility and awareness of the Q&PS team (or
council). Review the Q&PS team (or council) mandate annually.
9. Maintain a liaison with the following committees;
• Unit/Practice Councils; • District Q&PS Council • DMAC Quality Sub-Committee • M&M committees
10. Internal Reviews and external reviews requested by the District Quality & Patient Safety Council or by DMAC-QC, reports are and are to be kept confidential pursuant to the Evidence Act of Nova Scotia S. 60(2) and Freedom of Information and Protection of Privacy Act of Nova Scotia S.19D(1) as amended.
V. PROCESS FOR REVIEW 1. In a just culture, any staff, physician, student, patient or volunteer may identify
appropriate reviewable matters for the *** Q&PS team (or council) to review. Quality review is NOT limited to unique occurrences/incidents but is also inclusive of continuous self-monitoring of appropriate and applicable indicators, as they relate to the quality patient care that the *** provides.
2. Please refer to Capital Health Policy & Procedure: Quality Review Process CH-70-005, Procedure Section for information on Reporting and Quality Review Process.
3. If a case reviewed by the *** Q&PS team (or council):
a. Reveals only a single division or department level issue, with no broader Capital Health issues (e.g. issues touching on any other division or department), that
Quality & Patient Safety Committee Pursuant to section 60 of the Nova Scotia Evidence Act (2) and Section 19 D of the Freedom of Information and Protection of Privacy Act (1) as amended
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committee shall enact their solution locally, and report the case to the Department’s Leadership Team for documentation only; or,
b. Reveals a broader Capital Health issues (e.g. touching on any other sites, or with the potential to impact any other services in Capital Health), that case shall be referred to the Department’s Leadership Team with a report of the review, and recommendations for follow up to DMAC – Quality Committee and District Quality & Patient Safety Council.
Quality & Patient Safety Committee Pursuant to section 60 of the Nova Scotia Evidence Act (2) and Section 19 D of the Freedom of Information and Protection of Privacy Act (1) as amended
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Appendix A
Quality Structure and Accountabilities
Board of Directors
• Ultimately responsible for the quality of service provided for our patients, families, learners and staff.
Quality and Patient Safety Committee of the Board
• Review, report and recommend to the Board on all matters related to the quality and safety of patient care provided by Capital Health. The committee will, together with other relevant Board subcommittees, seek to improve health outcomes of the population served by Capital Health (see Appendix 2 for Terms of Reference).
Quality & Patient Safety Committee Pursuant to section 60 of the Nova Scotia Evidence Act (2) and Section 19 D of the Freedom of Information and Protection of Privacy Act (1) as amended
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District Medical Advisory Committee (DMAC) Quality Sub-Committee
• Provide leadership and direction for reviewing, evaluating and making recommendations in relation to specific health care, learning and research initiatives related to the medical staff at Capital Health.
• Identify and support quality management programs to enhance quality health care. • Educate, communicate and liaise with Medical Staff, Family Practitioners, community
based specialists and other clinical care providers on quality improvement / management programs and activities (see Appendix 3 for Terms of Reference).
Leadership Enabling Team (LET)
• Provide administrative oversight of services provided for our patients, families, learners and staff.
District Quality and Patient Safety Council
• Recommend to LET and the Quality Committee of the Board annual improvement initiatives in the areas of patient safety, quality, utilization, accreditation and any related educational requirements.
• Establish and monitor quality benchmarks and initiatives through key performance indicators, measuring quality, patient safety, patient and staff satisfaction and related education to meet quality objectives.
• Monitor and promote compliance with Accreditation Canada standards and ROPs, provide leadership and support to meet and exceed these requirements. (see Appendix 4 for Terms of Reference).
Quality and Patient Safety teams / councils
Teams at the service / department / unit level; implement changes, measure, study and report compliance and outcome results. The teams will use the plan-do-study-act (PDSA) continuous improvement model to guide their initiatives.
Performance Excellence Program
The Performance Excellence Program works with individuals, units, departments and portfolios across the organization to foster an understanding and culture of quality. Performance Excellence provides support and facilitation for quality improvement throughout the district.
Appendix B
Quality & Patient Safety Committee Pursuant to section 60 of the Nova Scotia Evidence Act (2) and Section 19 D of the Freedom of Information and Protection of Privacy Act (1) as amended
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Unit/Site/Service Quality & Patient Safety Structure
Please illustrate your team reporting structure below.
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Privileged and Confidential – for Quality Improvement Purposes
Quality Review Agenda Template for Reviewable Matters
(Insert name of team) Quality & Patient Safety Team (Q&PS) or Council Date
AGENDA 1. Introductions
2. Review of Quality Review Meeting Requirements
• This Quality Review is under the Terms of Reference of (insert name of Q&PS team or
council): Evidence Act of Nova Scotia S.60 (2) and Freedom of Information and Protection of Privacy Act of Nova Scotia S. 19D (1) as amended
• No names of patients or staff involved should be used • No electronic notes. No paper will leave the room. Please ensure that you hand in any
paper notes to the Chair at the end of the meeting • There is a legal requirement to ensure confidentiality related to the Quality Review. • The finalized recommendations will be made available through the Quality Review co-leads • All opinions are valid • The purpose is not to find blame
This review must be restricted to an assessment of the course of treatment for this patient and recommendations, if any, in relation to how care could be enhanced or procedures improved to increase quality in the future
3. Review case timelines/facts of the case
4. Discussion of the de-identified facts of the case 5. Discussion of recommendations for the future
Recommendations are written in the SMART format: specific, measurable, attainable, realistic and timely.
6. Adjournment
Quality Review Recommendations & Action Plan for Reviewable Matters Team/Department _________________ Meeting Date: ____________________ Recommendations are written in the SMART format: specific, measurable, attainable, realistic and timely Recommendation Action Plan Accountability Bring Forward
Date Completion Date
#1
#2
#3
#4
Copy to: _______________________________ Privileged and Confidential – for Quality Improvement purposes only
Evidence Act of Nova Scotia S.60 (2) and Freedom of Information and Protection of Privacy Act of Nova Scotia S. 190 (1) as amended.
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(Insert team name) Quality & Patient Safety Team Agenda Template
(Date of meeting)
(Location of meeting)
Regrets:
1. Approval of agenda
2. Approval of previous minutes
3. Business Arising/Updates • Accreditation Preparation
4. New Business
• Scorecard review • Action plan review •
5. Round Table
6. Next Meeting
Example of an In-patient Quality & Patient Safety Team Scorecard
Measures
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Infection Control Rates IPC
MRSA # carriers on unit IPC M MRSA # of transmissions per month IPC 0 M New cases of c. diff on unit per month IPC 0 M - VRE # carriers on unit IPC M -VRE # of transmissions per month IPC 0 M - Surgical infection rates (if applicable) IPC M Hand Hygiene (HH)– overall compliance IPC Q - HH compliance before pt contact IPC Q - HH compliance after pt contact IPC Q Documented TOA or TOI (compliance)
- TOA shift to Shift CA 100% M - TOA Unit to Unit (includes episodic care) CA 100% M Pressure Ulcer Prevention (ROP)
- Admission Braden Scale Compliance Rates
CA 100% M
- Pressure Ulcer Prevalence Rates CA M Medication Reconciliation
- Med Rec Compliance Rates CA 100% M - Unintentional Discrepancies (if applicable) CA 0 M - Undocumented Intentional (if applicable) CA 0 M - Success Index (if applicable) CA M Falls Prevention (ROP)
- % of Falls Assessment Completed CA 100% M - Patient Fall Rate per month CA M - % of falls causing injury CA M VTE Prophylaxis Ordered ( PPO ) CA Q
Wait time (if applicable) CA Q
Legend – Frequency of Data Collection: A-Annually B–Biannually Q–Quarterly M-Monthly
Measures
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20
14
Citiz
en E
ngag
emen
t &
Acco
unta
bilit
y
Patient Experience Survey PI - Inpatient Survey HSM 90% A -% of patients responding positively to decision making survey questions
PI ↑10% A
Patient/Family/Client Complaints/Compliments
HSM/PSRS
Q
Patient, Family or Client Engagement HSM Y/N
Tran
sfor
mat
iona
l Le
ader
ship
Absenteeism (illness) FTEs HSM Q
% of employees and physicians responding positively to leadership survey questions
PI ↑20% A
% of staff, management and physicians responding positively to accountability survey questions
PI ↑20% A
# (%) staff completing front line leadership program
LMS A
Inno
vatin
g He
alth
&
Lear
ning
# Inter-professional learning opportunities
HSM Q
# (%) staff completed required annual patient safety education
HSM A
# (%) staff completed required annual hand hygiene education
LMS A
# (%) staff completed required annual O&HS education
LMS A
Sust
aina
bilit
y
Readmission Rate PI Q % of patients discharge by 1100 AM PI Q ALC days PI Q Case Mix Group – Typical (# days) ALOS/ELOS/TARGET
CMG # PI Q
CMG # PI Q
CMG # PI Q
Guidelines for Scorecard The scorecard is to be used in conjunction with action template.
• The purpose of the scorecard is to: o align operational related team goals with Capital Health’s 2013 milestones and 2016 strategic goals o track trends for improvement in your care/service area o track and trend compliance to best practice, patient safety and accreditation Required Organizational Practices (ROPs) o track and trend adverse events prevalence and or incidence of ie falls, pressure ulcers, medication reconciliations;
infection control measures; etc. • The scorecard is to be populated monthly, quarterly or annually depending on the indicator and availability of data. • The co-leads or those delegated by the co-lead are accountable for populating the scorecard. • The scorecard should be regularly discussed at the Q& PS team members. • Actions need to be taken to investigate and address concerning trends in indicators. • To be used as evidence for development of a quality improvement action plan and quality initiatives.
Instructions for Scorecard
1. Prior to use, please review Capital Health’s 2013 milestones, 2016 Strategic goals, patient safety indicators, Accreditation ROPs , Patient Experience surveys, Employee and Physician Surveys and your program goals
2. Consider areas and opportunities of interest for quality improvement 3. Referring to the Data Navigation Guide for details of where and how to obtain data; ‘data source’ column also provide guidance 4. Populate the Scorecard on a monthly, quarterly or annual basis depending of the frequency of data collection for each indicator 5. Track trends 6. Implement strategies for improvement based on evidence using the Action Template
Data Source Legend:
IPC- Infection & Prevention Control CA- Chart Audit PI- Performance Indicators PSRS- Patient Safety Reporting system
HSM- Health Services Manager LMS- Learning Management System
Example of an Ambulatory Quality & Patient Safety Team Scorecard
Measures
Dat
a So
urce
ELO
S (d
ays)
Targ
et
13/1
4
Freq
uenc
y
Apr
2013
May
20
13
Jun
2013
Jul
2013
Aug
2013
Sep
2013
Oct
20
13
Nov
20
13
Dec
20
13
Jan
2014
Feb
2014
Mar
20
14
Tran
sfor
min
g Pe
rson
Cen
tere
d He
alth
Car
e
Infection Control Rates (if applicable) ICP
Hand Hygiene overall compliance IPC/ HH Audit
80% Q HH compliance before patient contact 75% Q HH compliance after patient contact 80% Q Documented Transfer of Information (compliance to standard process for area))
- Episodic Care CA 100% M - To community based care 100% - End of Service 100% M Medication Reconciliation
- Med Rec Compliance Rates (if applicable)
CA 100% M
Falls Prevention (ROP)
- % of Falls Observation Completed CA 100% M - Patient Fall Rate per month PSRS M Two client identifier
% of two client identifiers checked before intervention or service provided
CA 100% M
Citiz
en E
ngag
emen
t &
Acco
unta
bilit
y
Patient Experience Survey PI >90% A
% of patients responding positively to decision making survey questions
PI 10% A
Patient/Family/Client Complaints/Compliments (date reviewed by team)
PSRS M
Patient, Family or Client Engagement Y/N M
Legend – Frequency of Data Collection: A-Annually B–Biannually Q–Quarterly M-Monthly
Measures
Dat
a So
urce
ELO
S (d
ays)
Targ
et
13/1
4
Freq
uenc
y
Apr
2013
May
20
13
Jun
2013
Jul
2013
Aug
2013
Sep
2013
Oct
20
13
Nov
20
13
Dec
20
13
Jan
2014
Feb
2014
Mar
20
14
Tran
sfor
mat
iona
l Lea
ders
hip Absenteeism (illness) FTEs HSM Q
% of employees and physicians responding positively to leadership survey questions
PI 20% q 2 years
% of staff, management and physician responding positively to accountability survey questions
PI 10% q 2 years
% of staff completing front line leadership program
LMS A
Inno
vatin
g He
alth
& L
earn
ing # Inter-professional learning
opportunities HSM Q
% staff completed required annual competencies
LMS 100% A
% staff completed required annual patient safety education
LMS 100% A
% staff completed required hand hygiene education
LMS 100% A
% staff completed required hand O&HS education
LMS 100% A
Sust
aina
bilit
y No show rates CA 10% Q Cancellations CA 10% Q Wait list times CA 10% Q
Guidelines for Scorecard • The scorecard is to be used in conjunction with action template. • The purpose of the scorecard is to:
o align operational related team goals with Capital Health’s 2013 milestones and 2016 strategic goals o track trends for improvement in your care/service area o track and trend compliance to best practice, patient safety and accreditation Required Organizational Practices (ROPs) o track and trend adverse events prevalence and or incidence of ie falls, pressure ulcers, medication reconciliations;
infection control measures; etc. • The scorecard is to be populated monthly, quarterly or annually depending on the indicator and availability of data. • The co-leads or those delegated by the co-lead are accountable for populating the scorecard. • The scorecard should be regularly discussed at the Q& PS team members. • Actions need to be taken to investigated and address concerning trends in indicators. • To be used as evidence for development of a quality improvement action plan and quality initiatives.
Instructions for Scorecard
7. Prior to use, please review Capital Health’s 2013 milestones, 2016 Strategic goals, patient safety indicators, Accreditation ROPs and your program goals
8. Consider areas and opportunities of interest for quality improvement 9. Referring to the Data Navigation Guide or ‘data source’ for details of where and how to obtain data 10. Populate the Scorecard on a monthly, quarterly or annual basis depending of the frequency of data collection for each indicator 11. Track trends 12. Implement strategies for improvement based on evidence using the Action Template
Data Source Legend IPC- Infection & Prevention Control CA- Chart Audit PI- Performance Indicators PSRS- Patient Safety Reporting system
HSM- Health Services Manager LMS- Learning Management System
(Name of) Quality & Patient Safety Team Action Plan Recommendations are written in the SMART format: specific, measurable, attainable, realistic and timely Goal or Indicator Action Plan Accountability Target Date Completion
Date #1
#2
#3
#4
Date: _______________________
Data Navigation Guide-CDHA Data To assist in populating Q&PS Team Scorecards Strategic Pillars Indicator Source of Data Directions to Data Comments/ Contacts Transforming Person Centered Health Care or Sustainability or Innovating Health and Learning
Accreditation Data Audit Tools (Falls Risk, Pressure Ulcer, Medication Reconciliation, VTE, TOA, Patient and Family role in safety, High Risk Activities)
This information can be collected and tabulated in relation to compliance to ROPs (i.e. Pressure Ulcer Prevention, Falls Risk Prevention, VTE Prophylaxis, Medication Reconciliation, High Risk Activities, etc.)
The data collected from chart audits or visual audits is specific to the ROPs related to the Accreditation Standards applicable to your area or information audited of interest to you care area
Transforming Person Centered Health Care
Case Mix Groups (CMG’s) Please note: This data can be analyzed as typical cases or all cases (includes typical and atypical).
DAD (Discharge Abstract Database)
CDHA Intranet→ Right Side of page→ Quick Links→ Performance Indicators & Reports→ Under TYPES OF REPORT→ select Length of Stay Reports→ select Fiscal Year desired→ select Institution: desired→ select Unit desired→ select Service desired
Monthly report See Definitions and CMG Names tabs for further information and understanding
Sustainability Discharges by 11 a.m. or Transfer by 11 a.m.
Decision Support Services CDHA Intranet→ Right Side of page→ Quick Links→ Performance Indicators & Reports→ under TYPES OF REPORTS section → select Percentage of Patients Discharged by 11:00am or Percentage of Patients Transferred by 11:00am Report → Scroll through to find desired unit
Transforming Person Centered Health Care
Infection Control (MRSA, VRE, Clostridium Difficile, Hand Hygiene Compliance, Surgical Site Infections)
Infection Control Staff-CDHA
MRSA transmission rate per 1000 patient days c. difficile incidence per 1000 patient days VRE incidence per 1000 patient days Hand hygiene compliance – before patient contact, after
Please contact the Infection Control practitioner who works with you unit/service for unit/service specific information. Or contact Tammy MacDonald, Manager of Infection Control [email protected]
Strategic Pillars Indicator Source of Data Directions to Data Comments/ Contacts patient contact and overall compliance
Transformational Leadership
Learning Management System (LMS) reports
LMS online CDHA Intranet→ Right Side of page→ Services→ Click L→ Click LMS→ Right hand side next page click LMS button→ Sign-in (username and password) → Click Report tab→ Click “Item compliance detailed report”→ New screern drop down box, under “select item” → catergories→ your when uploaded→ choose specific department→ Click “…” box to select cost centre→ Click add→ Click Submit→ select a date range (1 year period)→ Click continue→ Print report
Transforming Person Centered Health Care
Bed Availability Bed Management Dashboard
CDHA Intranet→ Right Side of page→ Quick Links→ Bed Management Dashboard→ select desired Site → select Building desired → select Unit desired
Able to view all units in building, bed allotted to each service and update date bed availability and occupancy rates in real time
Transformational Leadership
Overtime Rate (%) People Services-CDHA
CDHA Intranet→ Right Side of page→ Quick Links→ Performance Indicators & Reports→ Right Side of page→ select People Services→ select Scorecard-Overtime Percentage by cost Centre
Strategic Pillars Indicator Source of Data Directions to Data Comments/ Contacts Citizen Engagement & Accountability
Patient Experience (previously Patient Satisfaction)
Performance Excellence CDHA Intranet→ Right Side of page→ Quick Links→ Performance Indicators & Reports→ under Departmental Specialized Reports→ select Patient Experience Survey→ Scroll through to and select Service desired
Choose desired area to review latest survey results. Be aware services are broken into ambulatory and inpatient.
Innovating Health and Learning
Patient Safety Reporting System Patient Safety Reporting System (PSRS)
CDHA Intranet→ Right Side of page→ Quick Links→ Patient Safety Reporting→ Login (use username and password)→ Click Run Report
Data not to be used for indicator reporting but rather as trending data for education and quality improvement.
Transformational Leadership
Performance Appraisal Rate (%) People Services-CDHA CDHA Intranet→ Right Side of page→ Quick Links→ Performance Indicators & Reports→ Right Side of page→ People Services→ select Scorecard-Performance Dates
Sort by individual name
Innovating Health and Learning
Pressure Ulcer Prevention Pressure Ulcer Prevention Program Coordinator
Sheila Moffat (Project Coordinator) can provide Unit specific data on the prevalence and incidence of pressure ulcers, measure are done on a 2 year rotation. [email protected]
Sustainability Readmission Rates DAD (Discharge Abstract Database)
CDHA Intranet→ Right Side of page→ Quick Links→ Performance Indicators & Reports→ under TYPES OF REPORT section → Length of Stay Reports→ select Fiscal Year desired→ select Institution: desired → select Unit desired→ select Service desired
Readmission Rates are contained in the column labeled “Unplanned Readmissions”
Strategic Pillars Indicator Source of Data Directions to Data Comments/ Contacts Policies and Procedures CDHA Intranet CDHA Intranet → Right side
of page → Policies and Procedures → Policy Search → enter key word or policy number or policy title in “search box” → select applicable policy
39
Audits Templates
Audit Tool Name Notes Monthly 10 Chart/Kardex Audit
Audit to be completed monthly • The tool measures compliance to ROPs
and other unit specific items.
• After the 10 chart audit tool has been completed for the month, it should be compiled in the excel format provided in the tool kit and emailed to your Manager or delegate.
• The information provided will allow the quality teams to discuss staff compliance with Accreditation ROP’s at the team meetings and plan for improvements.
Monthly Single Chart/Kardex Audit
Can complete the 10 chart audit tool or 10 of the single chart tools.
Medication Reconciliation Audit
This is a more detailed Medication Reconciliation Audit developed by Safer Health Care Now.
Falls Risk Audit This is a more detailed Falls Risk Audit developed by Safer Health Care Now.
Pressure Ulcer Prevalence audit
Tool to be used to measure the prevalence of pressure ulcers on unit. Information to be sent to Sheila Moffatt (see toll for instructions)
Transfer of Accountability Audit
More detailed Transfer of Accountability Audit, relevant information captured in the monthly audit tool.
42
43
44
Capital Health Medication Reconciliation Monthly Chart Audit Medication Reconciliation Performance Indicator Data (ROP) (This information is captured on the 10 chart/kardex monthly audit tool) Percentage of patients on your unit with a completed Medication Reconciliation and Admissions Order Form Record the following information: Total # of patients from the charts audited with all sections of the medication reconciliation and admission order form completed for this audit. # ________________ Total # of charts audited for this measurement period: #_______________________ Then Calculate: #1 = ___________ x 100 = __________________% #2 Signature: _________________________________ Print Name: ________________________________ Date :( yyyy/mm/dd) ________________ Site: _____________________________Unit: ___________________________ 2. Safer Healthcare Now
Randomly select 10 reconciled patient charts for this month’s unit audit. Include patients who have been admitted to the nursing unit for greater than 24 hours and have had the reconciliation section of their form completed. • Data to be collected and given to unit manager. • Manager reviews results and forwards to quality lead by the 7th working day of following month. • Patient names and copies of the Medication Reconciliation and Admission Orders do not need to accompany this audit form.
Tally numbers alone provide sufficient data for auditing purposes. How to identify the discrepancy type from the medication reconciliation admission form:
1. Undocumented Intentional – A discrepancy whereby a medication has been added, changed or discontinued, but lacks documentation to support the rationale for this section.
2. Unintentional Discrepancy – A discrepancy whereby a medication has been • Recorded with inaccurate information for dose, route or frequency • Listed on the BPMH, but the patient was not taking it prior to admission, • Listed as a late additions to the BPMH
Send to Room 906 Bethune Building, Performance Excellence Program, VG Site, or fax to 473-3295.
Data from Medication Reconciliation and Admission Order Forms # Undocumented
Intentional # Unintentional Discrepancies
Total # Medications On BPMH
1. 2. 3. 4. 5. 6. 7. 8. 9.
10. Total
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46
Pressure Ulcer Prevalence - Monthly Audit sheet This report is required to be sent to Sheila Moffatt’s office by the
15th of each month via intra-office mail or through a means agreed upon with Sheila Moffat. You may send it to Room 4023, 4th Floor, HI.
Unit: ________________ Date: ______________
Pressure Ulcer Prevalence Audit Instructions
Audits are to be completed on a monthly basis all at one time.
Should be completed by one person or a group of people by assignment; day, evening or night shift
The tool is designed to be used to identify prevalence based on the number of active pressure ulcers on your unit and the specific stage of each occurring ulcer.
The audit tool is based on your total # of inpatients (B) in your unit/service area at the time of the audit.
A) # Total
Pressure Ulcers/
Unit
# Deep Tissue Injury
# Stage
1
# Stage
2
# Stage
3
# Stage
4
# Unstageable
# Care Plans
Documented for Braden score < 18 (Black Ink)
B) # Total
Inpatients on Unit
A divided by B =
prevalence %
47
Transfer of Accountability Quarterly Audit Worksheet (shift/shift)
Unit: ____ Year: _____
Fiscal Quarter: Apr. – June � July – Sept. � Oct. – Dec. � Jan. – Mar. �
Shift to Shift 1. Transferring care provider prepares report information (i.e. data written report is reflective of pertinent min data set, Kardex up to date and comprehensive etc.) MONTH QUARTERLY
TOTAL # of Audits Complete Incomplete Not done 2. Safety Round completed and documented at beginning of shift # of Audits Complete Incomplete Not done 3. ToA documented in Progress Notes or Flow Sheet # of Audits Complete Incomplete Not done
• Random sample size for auditing - minimum of 20 shift to shift audits per month
• Complete initial audits for three consecutive months then “quarterly” • Evaluate data and address issues • Report results to your Quality/Accreditation Team quarterly • Retain data results for Accreditation purposes
48
Transfer of Accountability Quarterly Audit Worksheet (unit to unit)
Unit: ____ Year: _____
Fiscal Quarter: Apr. – June � July – Sept. � Oct. – Dec. � Jan. – Mar. �
Unit to Unit 1. Transferring care provider documents in progress notes that ToA information has been provided to accepting care provider/EHS MONTH QUARTERLY
TOTAL # of Audits Complete Incomplete Not done 2. Accepting care provider documents Bedside Patient Safety Check # of Audits Complete Incomplete Not done 3. Accepting care provider documents ToA received/accepted in patient chart # of Audits Complete Incomplete Not done 4. Chart transferred with the patient # of Audits Complete Incomplete Not done
• Random sample size for auditing minimum of 20 transfers per month, if less than 20 transfers per month, audit all transfers
• Complete initial audits for three consecutive months then “quarterly” • Evaluate data and address issues • Report results to your Quality/Accreditation Team quarterly • Retain data results for Accreditation purposes
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Success Stories…
Medical Training Unit decides to “Live quality every day” Wednesday, May 30, 2012 - 2:12pm
Today’s Puzzle
[(38 patients + (16 new physician learners each month)] + [(internal medicine specialists + sub-specialists) X 2 weeks] + [(12 nurses + OT PT SW Pharmacy teams) + (nursing students) X rotating shifts] + 2 housekeepers + 2 ward aids + 2 ward clerks + (difficult and wide-ranging set of health challenges such as lung disease, kidney failure, frail elderly, chronic disease) =???
Answer:
The Medical Teaching Unit (MTU) at the QEII Health Sciences Centre - a crowded general medicine unit that provides care to over 1,500 patients per year while supporting the development of multiple learners in many disciplines.
“MTU can be hectic and busy,” says Linda Hutchins, Health Services Manager, Medicine, and Geriatrics & Emergency. “Critical thinking is required because nearly all our patients come from emergency, ICU and IMCU. With this level of staff and the complicated health issues with our patients, coordination is everything.” Some days are better than others.
“We needed a common point of information for front line care givers and the changing physician teams,” says Linda. “We needed help, so we started an operational team and put quality on the agenda.”
Previously, the team would “pull things together just for accreditation” and then one day, Linda had had enough. “We needed to live it every day. It was too much work living like this. No other way made sense.” The team decided to invest time to work quality into everything they did.
The Quality and Patient Safety team worked with MTU to create a specific scorecard and a dashboard, and these tools have made all the difference. Auditing is a regular occurrence.
“They brought a lot of data to our group and a routine and reliable way of measuring the same key performance items,” says Linda. “The scorecard gives us indicators, our aims and action plans and the dashboard shows us how we are doing with our measurements”.
Today, information within MTU is easily and accurately shared among all team members and the real benefit is being able to provide feedback and direction. Before, “you couldn’t give feedback because there was no standard to compare to. Now we see clearly what we are doing well and where we can improve. We have a vision.
“Trust me,” says Linda, “If you can do quality here you can do quality anywhere!”
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Patient Safety Flashcards:
The flashcards, discussion guide, power point PRS from last week and evaluation form are posted on our Risk Management/Patient Safety Webpage at:
http://chdintra.nshealth.ca/departmentservices/riskmanagement/riskManagementTools.html
