Creating Unit-Based Patient Safety Walk-Rounds in a Pediatric Emergency Department

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We describe how a new program of unit-based patient safety walk-rounds (PSW), where staff participate in quality improvement monitoring and discuss patient safety issues, was developed and conducted, share our tools, and report preliminary results. Over the first 9 months, 20 unit-based PSW involving 99 staff members occurred, including 30% on weekends, 40% during the evening, and 25% during the overnight shifts. Several systems issues were identified using 6 quality improvement tools and acted upon including creation of educational programs, collaboration with multiple departments external to the emergency department, changes in computerized physician order sets, and institution of multidisciplinary bedside rounds. The number of medication “near-miss” incident reports during this period increased by 44% compared with the 24 months before beginning this program. Through unit-based PSW, clinical, administrative, and ancillary support staff have successfully worked together to improve safety and quality of care and awareness of patient safety in a children's hospital emergency department.

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Materials and Methods

A multidisciplinary leadership group from the ED convened to create a unit-based PSW program. Members of this group, the ED Patient Safety Committee, included the Director and Associate Director, the Nurse Director, the senior leadership nurses who are members of the ED Nurses' Quality Council, and the manager of the clerical staff. This group liked the concept and content of the Institute for Healthcare Improvement's Patient Safety WalkRounds™ [6]; however, it was recognized that to create

Results

From August 2005 through April 2006, 20 unit-based PSW involving 99 ED staff members occurred. Unit-based PSW were distributed matching patient volume and staffing: 14 (70%) took place on weekdays and 6 (30%) on weekends. Similarly, 7 (35%) took place during days, 8(40%) during the evening, and 5 (25%) during the overnight shifts. Seventeen (68%) of the PEM attending physicians led unit-based PSW and 41 (44%) of the nursing staff participated. In addition, residents, nurse practitioners,

Discussion

Organizations that have conducted PSW in conjunction with other patient safety activities have achieved greater success in changing the culture than with either of these activities alone [6]. The PSW is a mechanism for communicating about safety issues and to signal staff on the “front lines” that there is a commitment to a culture of safety. Creating and maintaining a culture of safety requires many steps—identification of near misses, open and blameless communication, analysis of problems,

Conclusion

Through unit-based PSW, clinical, administrative, and ancillary support staff have successfully worked together to improve safety and quality of care and awareness of patient safety in a children's hospital ED. Unit-based PSW can work in conjunction with other patient safety initiatives and activities to inspire staff to participate in making their unit a safer place for patients.

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