One Standard Resources and Tools
To achieve and maintain preparedness and actions at points of care in line with standards:
Tools: Checklists
Checklists are tools that organize and list (show for visual checklists) the items required by standards, to be at points of care. They are simply words on paper that represent an end point of many processes and actions like communication, ordering, retrieving, checking, and more. It is important to recognize that adopting checklist at points of care is not a paper requirement but a host of action requirements that must be taught and learned. While achieving full compliance to checklists produces some standardization that improve patient care and decreases workers' tension, the changeover can be stressful, require dedication, take time, and spark strongholds to old ways that were good. Benefits are lessened and even lost when nonconformity in as few as one person persists. The driving force here is safety. Safety requires preparedness to standards, and checklists are tools that makes this easier. If there is a better tool available, use it. Achieving preparedness of items and actions at points of care must be solid and complete because further standardization of sites that identify where an item should be, and more will be needed to further improve patient care and ease workers' tension.
While the organization of these checklists makes sense to me, this may not be the case across different language, cultural, and institutional landscapes. The checklists were always intended to be available in a digital form so they could be modified to suit needs and updated periodically. The digital version of these tools could not be placed on this website. If you would like these please email me and I will send them to you.
Emergency Boxes
At Points of Care
Patient Hand off Reports
Visual checklists: In this adult airway box of readiness, there is a space for every essential item. It has a clear lid that lets you see the item below. The lid has the name of the item that belongs in the space below written on it, and there is a paper checklist that shows an intact airway box. It is easy to see when an item is missing and to know what that item is. This allows a "cross check" of readiness by an assistant who is not familiar with the items.
The box is secured with a tamper evident plastic lock in the evenings. This makes the box accessible for emergencies yet secures it for the next day's cases making morning set-ups more efficient.
Everything that leaves the box is "dirty" and needs cleaned before it is returned to the box. Thus, the items in the box are always clean and ready.
There are airway boxes for pediatric patients and more.
Airway boxes of readiness
Preparedness Assessments, to evaluate the facilities compliance to preparedness standards: 1) At the time of the assessment, and the capacity for the facility to be in compliance with preparedness standards 2) in the near future and 3) Sustainably
Preparedness Assessments at Points of Care: This assessment is completed on paper forms then entered into a computer program. The computer program calculates what is needed at each site to get it to standards of care. Three reports come from the program and shows each sites:
I) Compliance with standards of preparedness at a point in time. Each site gets both a preparedness score which is a % score that shows what is at a site and against standards of care, and a list of what is needed to get to standards:)
II) The capacity of the hospital to maintain preparedness in the near, 30-day future. This is key to evaluating sustainability. This assesses inventories quantities of medications, supplies, and equipment. The assessment shows why a site will not be in compliance with standards in the near future. Other tools in One Standard show how to fix this.
III) The capacity of the hospital to maintain preparedness sustainably. This is an assessment of ordering processes and inventory management. This is not as developed as the rest of the assessments as this assessment should be done after a site reaches standards of preparedness. By including this assessment with the others exposes the hospital to a final goal in sustainability. While they may not be ready for this step, by simply knowing it they will make decisions in this direction.
Department and Provider Assessment, these general assessments will reveal the characteristics of the department (ie turnover), the backgrounds of staff (ie education), and their duties and compensations compared to outside staff.
The assessment is in a workable draft form. It asks hard questions about sensitive subjects such as compensation, not specific amounts but the compensation and benefits of employees at the site compared to that of the community. Questions are asked about employee expectations regarding time to report for work and leave, call, time off, and more. For safe patient care that is also efficient, this must be known. One may find, as I did at several places, that providers have never had these defined. Some anesthesia providers were expected to be available for work 24 x 7 x 365 days per year, with perhaps a week off. While this may be how health care is covered in some markets, it is not ideal for staff or patients. Some of these providers found the work overwhelming and left anesthesia, an already massively underpowered field, and returned to nursing. The assessment also asks questions about succession planning and how patient care and staff would be affected if there was a sudden decrease in staff. Answers to sensitive questions will allow a transparent picture of the present situation to develop. Simply asking the questions in the assessment spark discussions that can lead to healthier workplaces. Efficiencies contribute to healthier workplaces.
Mission hospitals reflects Christ's love in the care they give patients. Christ's love must also be reflected in the way the hospital interacts with the community, the way administration treats staff, the way staff treats administration, and in all of the interactions in between.
Perioperative Equipment Assessment: Often good equipment that works well when it is in climate-controlled environments and supported by a team of biomedical engineers, seamless maintenance, and user expertise finds its way to mission hospitals where these conditions are not met. Moreover, the items are often incomplete from the start, not coupled with use or care training, and there are no provisions for maintenance and the replacement of fragile parts.
The assessment is in a workable draft form. It assesses equipment and generates reports showing:
I) The Usability of the Equipment at the Time of the Assessment
II) The Predicted Usability of the Equipment in the Future
Simply asking the questions in the assessment spark discussions that can lead to healthier workplaces. E.
Perioperative Equipment Assessment, 1) To evaluate and grade the "suitability" and "function" of the equipment at the facility at the time of the assessment and 2) To guide future equipment procurements. This will improve patient safety, decrease mismatched procurements, add efficiencies and empower local staff with selection input.
Foundational Infrastructure Videos
Introduction-Infrastructure Requirements for Safe Patient Care:
This video introduces the importance of communication and how communication should and should not be done. It introduces the importance of teamwork, accountability and more. This video and other tools support step 4 b of the roadmap: Remediate to Standardize
Educational Videos
The Pulse Oximeter Monitor: Using it correctly and to its full capacity (1.09GB, 120 min)
Misuse of the pulse oximeter monitor causes many deaths worldwide each year. In first tier countries there is redundancy in patient monitoring at many points of care, thus the impact here somewhat small.
This video with a preceptor can help reduce these avoidable deaths.
Foundations Of Patient Ventilation:
Airway Management Video
