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A column by Maureen Flynn
Our fourth Quality and Safety column introduces the ‘safety cross system’ – an effective, engaging patient safety method.
Productive ward
The safety cross is one of the methodologies
from the ‘Productive ward:
Releasing time to care initiative’ – a wardbased
quality improvement programme
to empower nurses, midwives and multidisciplinary
teams to streamline how
they manage work. This achieves lasting
improvements, predominantly in the extra
time available to give to patients, which
positively impacts the care delivered.
There are three foundation and eight process modules. Key to the project is the ability of frontline staff to affect changes that are required to improve patient experiences. It is currently being introduced nationally across Ireland in multiple pilot sites (in 27 hospitals).
Knowing how we are doing
Know-How-We-are-Doing (KHWD) is
one of the foundation modules that introduces
measurement systems that are
timely, accurate and useful to ward staff.
The measures help to understand and
benchmark the ward’s performance and
subsequently, how to make decisions on
what to do to improve patient safety and
performance.
One such system is the safety cross, which involves the entire ward team working together to choose the safety measures relevant to the ward, such as monitoring falls, infection rates and medication incidents.
The safety cross
The safety cross is a simple data collection
tool. It is basically a one-month
colour-coded calendar that notes daily
safety measure incidents (see image above).
Each number on the cross represents the
day and date for that month to enable
staff to differentiate safety incidents –
coloured in red, from incident-free days
– coloured in green. This means the team
can focus on timely solutions that are
within their sphere of influence.
Monthly data is plotted and displayed for patients, staff and visitors to view. Regular multidisciplinary team meetings review the data trends and discuss and agree on solutions for improvement.
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Supports for the productive ward
The initiative commenced in January
2011 and it is envisaged that the culture
of patient safety and improvement will
be sustained long after each ward completes
the 11 productive ward modules
(around two years). Each site is supported
with implementation in their organisation
through a local steering group and a
regional ‘area co-ordinator’, who supports
the project.
Experience of using the safety cross
Monthly safety cross data reports have
been collected from each productive
ward and collated and trended nationally.
Improvements have occurred in almost
all of the key patient safety areas in most
pilot sites using the safety cross method.
Many of the patient safety improvements have been reported nationally through the national clinical programmes forum and have highlighted:
Challenges to safety cross introduction
Opportunity to get involved
The productive ward provides a means
to put the spotlight on safety and provide
more time for you to focus on direct
patient care. You can reflect on your area
of practice and identify possible uses of a
safety cross. At your next team, ward, unit
or department meeting, why not suggest
using a safety cross to collect data
and monitor if any clustering or common
trends can be identified in patient falls,
pressure ulcers or medication incidents?
Maureen Flynn is the director of nursing (national lead for quality and safety governance development) at the Office of the Nursing and Midwifery Services Director, Quality and Patient Safety Directorate, HSE
Acknowledgements
With thanks to Mark White, area coordinations and the project teams in each hospital for providing information and sharing their experiences of using this safety tool.
For further information, contact:
National lead productive ward: Releasing Time to Care: Mark White, Interim Director NMPD HSE-SE, mark.white@ hse.ie
Area co-ordinator HSE-NE: Dolores Donegan, NMPD, Kells, dolores.donegan@hse.ie
Area co-ordinator HSE-DNE: Michelle Waldorn, NMPD Swords, michelle.donegan@hse.ie
Area co-ordinator HSE-DML: Raphael McMullin, NMPD Palmerstown, raphael.mcmullin@hse.ie
Area co-ordinator HSE-Midlands: Mary Manning, NMPD Tullamore, mary.manning@hse.ie
Area co-ordinator HSE- South: Miriam Bell, NMPD Kilkenny, miriam.bell@hse.ie
Area co-ordinator HSE-West: Gillian Conway, NMPD Limerick, gillian.conway@hse.ie
Area co-ordinator HSE-NW: Liz Breslin, NMPD Ballyshannon, liz.breslin@hse.ie
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Quality & Safety - The Safety cross system: Simple and effective |