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

doi:10.1016/j.cpem.2006.08.012

Clinical Pediatric Emergency Medicine

Volume 7, Issue 4, December 2006, Pages 231-237

https://doi.org/10.1016/j.cpem.2006.08.012 Get rights and content

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.

Section snippets

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.

References (14)

J.M. Chamberlain et al.
Reducing errors and promoting safety in pediatric emergency care
Ambul Pediatr
(2004)
A. Frankel et al.
Patient safety leadership WalkRounds
Jt Comm J Qual Saf
(2003)
Institute of Medicine
To err is human: building a safer health system
(1999)
American College of Emergency Physicians
Patient safety in the emergency department environment
S.M. Selbst et al.
Preventing medical errors in pediatric emergency medicine
Pediatr Emerg Care
(2004)
A. Frankel
Patient safety leadership WalkRounds. Institute for Healthcare Improvement

There are more references available in the full text version of this article.

Cited by (12)

Group discussions on how to implement a participatory process in climate adaptation planning: a case study in Malaysia
2020, Ecological Economics
Citation Excerpt :
Safety Walks are a risk management technique designed to deal with public hazards, by means of a standard checklist to enhance the safety of pedestrian areas and businesses (Gnoni et al., 2013; Powell et al., 2000; Webb, 2009). Safety Walks are a well-known method to guarantee safety in many social and economic sectors, for example: in air transport, to check aircrafts before take-off (High et al., 2005); in the health sector, to monitor patient wellbeing (Ayuso-Murillo et al., 2017; Behm et al., 2014; Shaw et al., 2006); on construction sites, to minimize on-site risks (Chan et al., 2010; Choi et al., 2011; Choi et al., 2012; Dennerlein et al., 2009; Langfield-Smith, 2008; McDonald et al., 2009; Oswald et al., 2018; Oswald and Lingard, 2019; Rowlinson and Jia, 2015; Winge et al., 2019; Zou et al., 2017); in port operations, as preventive maintenance activities (Gerbec and Kontic, 2017); in industrial activities (Tappura et al., 2017); in the farming sector, to control possible risks on the farm (Holte and Follo, 2018); at schools, to enhance proactive safety behaviour (Kurki et al., 2019); as well as other business activities (Zwetsloot et al., 2017). Walks have also been used to build seismic vulnerability maps, referring to this tool as “transect walk”.
The frequency and intensity of extreme climate events are increasing all around the world, due to climate change. Climate adaptation strategies are therefore needed, since mitigation strategies alone are not sufficient to avoid serious impacts of climate change. However, adaptation to climate change is not straightforward, as it is highly influenced by diverse and conflicting interests as well as epistemological (or scientific) uncertainties. Therefore, a minimum requirement for its success is the active participation of stakeholders and citizens in the adaptation policy cycle. This paper presents a case study on a participatory process involving civil servants from different municipalities in Malaysia, in Southeast Asia, with a view to considering the optimal level of engagement that is required for climate adaptation planning. The exercise consisted of a Focus Group session, where participants were asked to discuss the level of stakeholder and citizen participation that should be adopted within the Global Covenant of Mayors for Climate and Energy initiative. Contrary to authors' expectations, the participants tended to suggest medium to high levels of participation in the planning process. During the dialogues, a walking activity through the city, aimed at identifying hotspots of climate risks and defined as “safety walks”, was one of the ideas proposed as a high-potential participatory method, spreading in the adaptation framework. Safety walks could complement climate modelling and enhance the robustness of climate risk assessments.
Best Practices in Patient Safety and Communication
2020, Emergency Medicine Clinics of North America
Citation Excerpt :
In 1 study, PSWs implemented in the ED, performed by a physicians and 2 staff nurses, were found to be effective in increase in medication near-miss incident reports (44% increase) and in hand hygiene compliance within the ED (23% increase).55 The experience of regular PSWs is thought to help bridge the gap between ED leadership and front-line staff perspectives on patient safety.23,55 The last domain of the patient safety framework involves creating structural mechanisms to support a systems-based approaches to patient safety.
Using four-phased unit-based patient safety walkrounds to uncover correctable system flaws
2013, Joint Commission Journal on Quality and Patient Safety
Citation Excerpt :
We required a nurse manager and medical director from each unit to participate as leaders in the planning and implementation of PSWR on their unit. We describe four phases of the PSWR framework6 (Figure 1, page 398). The first two phases involved interactions with staff on the unit floors, while the last two phases describe how knowledge gained from staff was discussed with and among unit leadership.
A unit-based Patient Safety Leadership Walkrounds™ (PSWR) model was deployed in six medical/surgical units at The Children’s Hospital of Philadelphia to identify patient safety issues in the clinical microsystem. Specific objectives of PSWR were to (1) provide a forum for frontline staff to freely report and discuss patient safety problems with unit local leaders, (2) improve teamwork and communication within and across units, and (3) develop a supportive environment in which staff and leaders brainstorm on potential solutions.
Baseline data collection and discussion with leaders and staff from the pilot units were used to create a standard set of safety tools and questions. Through multiple Plan-Do-Study-Act cycles, safety tools and questions were refined, while the process of walkrounds in each of the six pilot units was customized.
Leaders in all six pilot units indicated that PSWR helped them to uncover previously unidentified safety concerns. Top-impact areas included nurse-medical team relationship, work-flow flaws, equipment defects, staff education, and medication safety. The project engaged 149 individuals across all disciplines, including 33 physicians, and entailed 34 PSWR in its first year. Information from these pilot units initiated safety changes that spread across multiple units, with identification of hospital-wide quality and patient safety issues.
For participating units, the PSWR process is a situational awareness tool that helps management periodically assess new or unresolved vulnerabilities that may affect safety and care quality on the unit. Unit-based PSWR help identify safety concerns at the microsystem level while improving communication about safety events across units and to hospital leaders in the macrosystem.
Impact of leadership walkarounds on operational, cultural and clinical outcomes: A systematic review
2023, BMJ Open Quality
The effect of executive managers' walk round on patient safety culture in emergency nurses
2023, Research Square
Non-clinical rounds in hospital settings: a scoping review
2019, Journal of Health Organization and Management

View all citing articles on Scopus

View full text

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

Section snippets

Materials and Methods

Results

Discussion

Conclusion

Ambul Pediatr

Jt Comm J Qual Saf

To err is human: building a safer health system

Patient safety in the emergency department environment

Preventing medical errors in pediatric emergency medicine

Pediatr Emerg Care

Patient safety leadership WalkRounds. Institute for Healthcare Improvement