One Standard Tools

One Standard Resources and Tools

Checklists to support achieving and maintaining preparedness at points of care in accordance with established standards and consistent adherence to protocols

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.

Checklists in digital form can be modified to suit local needs

Checklists

Examples of checklists:

Checklists: Emergency Boxes

Checklist: At Points of Care

Patient Hand off Reports

In this adult airway box, there is a space for every essential item and on the clear lid - above each space - the item that should be in that space is written. There is a graphic showing all of this in the the visual checklist. It is easy to see when an item is missing and to know exactly the name and size of the missing item. This allows for a "cross check" of readiness that can be done quickly and by an an assistant who is not familiar with the items.

There are protocols with the visual checklists that include: Securing the box 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. Keeping everything in the box clean and labeling everything that leaves the box as "dirty". This makes sure items ain the box are always clean and ready.

Assessments to evaluate compliance to standards

Preparedness Assessments 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 and II) The Predicted Usability of the Equipment in the Future. Asking questions and sparking discussions can lead to improvements.

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.

The Pulse Oximeter Video

Foundations Of Patient Ventilation: