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Patient Safety

Implementing Dana-Farber Cancer Institute Patient Safety Rounds in Your Organization - A Toolkit

Toolkit Overview and Rationale

Over the past decade, Dana-Farber Cancer Institute (DFCI) has worked to create an organizational culture that places a high priority on patient safety and on patient- and family-centered care. Today, an assessment of how an action or process will impact the safety of patients and families is a routine part of DFCI's decision-making process, and patients and families participate in decision-making at every level of the Institute. Read More

Organizational Assessment

A Patient Safety Rounds program is most easily implemented in organizations that demonstrate a commitment to patient safety and patient- and family-centered care. In this section, we provide assessment instruments that can be used by leaders to evaluate their organization's culture and determine whether it promotes patient safety and patient- and family- centered care. Based on their findings, leaders will be able to decide whether their institution is ready to introduce a Patient Safety Rounds program.

Additionally, an institution may consider implementing principles of a fair and just culture. A fair and just culture allows for open communication about errors that occur within the workplace. The Principles of a Fair and Just Culture adopted at Dana-Farber Cancer Institute (DFCI) emphasize learning rather than blame and encourage open discussion and examination of mistakes. By including DFCI's principles in this Toolkit, we hope to encourage other organizations to consider adopting and implementing similar principles at their institutions.

• Patient Safety Organizational Assessment
• Patient- and Family-Centered Care Organizational Assessment
• Dana-Farber Cancer Institute's Principles of a Fair and Just Culture

Roles

As you read through this Toolkit, you will find that many different positions and roles are mentioned. In this section, we list each role and briefly explain its function within the Patient Safety Rounds program. Please use this list as a guide as you read through the remaining Toolkit sections.

• Roles of Staff and Patients in Patient Safety Rounds

Implementing Patient Safety Rounds with Staff at Your Organization

Patient Safety Rounds with staff to obtain their input on errors and near misses is a core component of the Patient Safety Rounds program at Dana-Farber Cancer Institute (DFCI). Patient Safety Rounds with staff began in 2001 as a way of addressing the limitations associated with traditional incident reporting systems. The rounds are based on an infection control model of proactive surveillance, and over time they have proven to be an effective way to proactively identify errors and near misses.

At DFCI, Patient Safety Rounds with staff are typically conducted on each unit by a Patient Safety Team. The team is led by DFCI's Risk Manager and includes the unit's nurse manager or charge nurse, a pharmacist, and a "Clinician Champion" or member of the staff who serves as a liaison between the team and the staff on the unit. Every member of the staff on the unit is encouraged to participate in rounds and to share insights and observations about safety issues and concerns. By design, the rounds are informal and do not place additional work on staff.

Over the years, and with the support of executive management, Patient Safety Rounds have become an integral part of DFCI's safety program. In this section of the Toolkit, we provide a slide presentation that outlines how to develop a Patient Safety Rounds program for staff. The presentation also identifies questions that can be used to elicit staff input, discusses the development of a database to store information obtained from staff, and lists factors that are essential to the success of the program. This section also includes a document outlining qualifications for clinicians who serve in the Clinician Champion role - a role that has proven integral to obtaining the buy-in and active participation of staff on the unit.

• Conducting Patient Safety Rounds with Staff
• Conducting Patient Safety Rounds with Staff (PowerPoint presentation)
• Qualifications for Clinician Champions

Involving Patients in Patient Safety Rounds

A patient component was added to Patient Safety Rounds at Dana Farber Cancer Institute (DFCI) in 2004. Through this component, patients who are actively receiving care are interviewed about their safety concerns. The interviews were conducted by trained patients or family members who volunteer for this activity. Read more

• Dana-Farber Cancer Institute Confidentiality Agreement
• Qualifications for Patient/Family Safety Liaisons
• Conducting Patient Interviews
• The Patient Safety Rounds Program - Information for Patients and Families
• Introducing Patient Involvement in Patient Safety Rounds to Clinical Staff
• Patient/Family Safety Liaison Encounter Form

Training Staff and Patients for Patient Safety Rounds

Once Patient/Family Safety Liaisons (Liaisons) were recruited, Dana-Farber Cancer Institute (DFCI) held a Patient Safety Education Day in which we reviewed fundamental concepts of patient safety and discussed the components of the Patient Safety Rounds program. Read more

• Patient Safety Education Day Outline
• Making Health Care Safe: Easier Said Than Done (slide presentation by Lucian Leape, MD)
• Patient Safety and Human Factors Concepts (slide presentation by Deborah Duncombe, MHP)
• Description of First, Do No Harm (video co-produced by p4ps.Ltd and the Risk Management Foundation)
• Conducting a Role Play Session

Taxonomy for Classifying Incidents Reported During Patient Safety Rounds

Many of the issues identified through Patient Safety Rounds cannot be easily classified using standard incident report classification schemas. In this section, we describe a taxonomy that was developed by staff at Dana-Farber Cancer Institute (DFCI) to classify incidents reported through Patient Safety Rounds and to track their occurrence over time.

• Sample Taxonomy

Evaluation Tools

Patient/Family Safety Liaisons (Liaisons) and staff who participate in Patient Safety Rounds can offer useful perspectives on a Patient Safety Rounds program and help identify areas for improvement. In this section, we include surveys we used to obtain participants' feedback on each component of the Patient Safety Education Day that was held at Dana-Farber Cancer Institute (DFCI). Read more

• Patient Safety Education Day Evaluation Tool for Speakers and Presenters
• Patient Safety Rounds Team Survey - Interview Form
• Staff Surveys
• Patient Safety Rounds Survey for Physicians and Nurse Practitioners - Interview Guidelines and Survey Form

References

• Read more

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