15 Minute Break

1. 15 Minute Break

2. OHSU RESIDENT and FACULTY WELLNESS PROGRAM Sydney Ey, Ph.D. Donald Girard, M.D. Mark Kinzie, M.D., Ph.D. Mary Moffit, Ph.D. .

3. OHSU Faculty and Resident Wellness Programs • Eligibility • All residents and fellows • All primary (0.5 FTE) SOM faculty • Resident/Fellow couples • Personal or Work Issues • Providers • Mary Moffit, Ph.D., R.N. • Sydney Ey, Ph.D. • Mark Kinzie, M.D., Ph.D. • Outside Referral Sources

4. OHSU Faculty and Resident Wellness Programs • Services offered: • Brief evaluation/ consultation • Coaching/ Counseling • Psychiatric medical consultation • Referrals to community resources – counseling, psychiatric, primary care

5. Availability • Over 100 visits a month • Over 400 residents and faculty physicians seen since program started 6 years ago • Appointments throughout the day, lunch times, early evening hours • Same day appointments often possible

6. OHSU Resident Wellness Program • Confidentiality/privacy • No medical record • No insurance billing • Private location “on the hill” • No information shared with program w/o consent • (Unless there is a concern regarding safety—danger to self or others) • No role in disciplinary or “fitness for duty evals”

7. Anonymous Resident Survey (Spring 2006 )n=133; 20% response rate

8. Anonymous Resident Survey (Spring 2006)n=133; 20% response rate

9. “You Can Do It, We Can Help” • 58% of residents either did not know or thought they could not take an hour break for self-care to meet with counselor or PCP • 89% of program directors (who responded to the April 2006 survey) said an hour break was allowed without explanation

10. Quality of RWP Services • 80% rated services as “excellent” • 9% rated as “good” • 2% rated as “fair” • 0 rated as “poor”

11. “Overall satisfaction with services” • very satisfied 69% • mostly satisfied 22% • indifferent 10% • quite dissatisfied 0%

12. Feedback: Anonymous Resident Survey (Spring 2006) “The RWP is a special program. It made a huge difference in my life and I am very thankful it exists. I don’t think I would have been able to be as successful (without it)” “My intern year was especially difficult transition for me for a variety of reasons. I sought help through the residency wellness program and found the program very helpful” (The RWP provider) “was extremely helpful to me. I am very grateful to her. Her flexibility in scheduling was essential to our success.”

13. Scheduling an Appointment • Contact Mary Moffit or any of the other providers • Email: moffitm@ohsu.edu • Pager 1-2047 • Voice-mail: 4-1208 • Urgent/ After Hours: (503) 330-7880 • Other Providers: • Mark Kinzie, M.D., Ph.D. • Email: kinziem@ohsu.edu ; pager 1-4559 • Sydney Ey, Ph.D.: • Email: eys@ohsu.edu ; pager 1-1291

14. TEN STEPS TO RESILIENCE • Make connections • Avoid seeing crises as insurmountable problems • Accept that change is a part of living • Move toward your goals • Take decisive actions • Look for opportunities for self-discovery • Nurture a positive view of yourself • Keep things in perspective • Maintain a hopeful outlook • Take care of yourself (American Psychological Association) A • a

15. Websites http://www.ohsu.edu/faculty-wellness/ http://www.ohsu/edu/resident-wellness/ /

16. Clinical RiskAnd Patient Safety

17. Learn a bit about the Safety & Risk side of healthcare • Know who to call when you need someone right away • Understand how we (all of us) can make OHSU safer

18. What are we talking about, exactly? • Safety of patients as relates to; • The National Patient Safety Goals • Safe Medical Practices • Ethical Practices • Mitigation of Risk; • Risk Mitigation involves efforts taken to reduce either the probability or consequences of a threat. • These may range from • physical strategies (washing your hands), • to process strategies (the pre-procedural time out), • to resource strategies (alarms on ventilators).

19. Now Let’s Re-live the Events of 1999 • November 1999: Institute of Medicine published the results of their study, To Err is Human • According to the report 98,000 – 120,000 people die each year from medical errors • The costs for medical errors range from $17-$29 million annually • Additional hospital days = 2.4 annually • Significant emotional impact for patients, families and staff

20. The newest Stats indicate an Epidemic • In American hospitals, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. • Of these infections: • 32 percent → UTIs • 22 percent → surgical site infections • 15 percent → pneumonia • 14 percent → bloodstream infections

21. The Joint Commission’s NPSGs • There are 18 NPS Goals and 3 Standards of the Universal Protocol we are measured against • What is the focus of the goals? • Patient Identification • Communication • Medication Safety and Reconciliation • Infection • Falls • Population Risks • Response to Patient Condition

22. The National Patient Safety Goals • They are national so they don’t vary in concept from location to location • HOWEVER, they may vary in details • At OHSU you need to know some specifics… • 2-patient identifiersalways name and birth date (medical record number if a conflict) • Expect, request read back of telephone orders. Keep verbal orders to absolute emergencies only! • At OHSU our providers use their initials to mark the site. • We have differentabbreviations that are not allowed; check the Pharmacy website

23. Critical Tests and Critical Results Policy: Critical Test Results (Clin 01.08) • Critical Tests: those tests that will always require rapid communication, even if the results are normal. • Radiology; all EE(extreme emergent) tests • Laboratory; frozen sections • Critical Results (values):Sometimes called panic values, are results that fall significantly outside the normal range and may represent life-threatening values even if from routine tests (non-critical tests). • If on the hospitals’ list of critical values, they require rapid communication

24. And … • There is aResident hand off communication tool • Hand washing is notoptional • Other Infection Control Practices; • No fleece in the O.R. • No hair showing in the O.R. • Wash your white coats (thus the word ‘white’), clothing, and stethoscopes, and have your ties cleaned! • Medication Reconciliation is a PHYSICIAN’S responsibility; if you use Epic correctly it is a piece of cake. • *most frequent error is forgetting to hit the ‘reviewed’ button

25. Finally … • CONTENT OF THE TEAM PAUSE • Patient identification; use the two identifiers • Procedure(s) as listed on the consent • Site/side marked … which is ALWAYS done by the Provider or Resident involved in the case • Correct position of the patient • Relevant images and test results labeled and displayed? • Need to administer antibiotics or fluids for irrigation? • Have we taken all safety precautions based on patient’s history and medication use? • ADDITIONAL QUESTIONS OR CONCERNS? • We have an amazing Rapid Response Team (RRT); use them! • The Universal Protocol applies to all high risk and/or invasive procedures in any location of OHSU • Even if you are doing it alone, you need to • Complete the ‘pre-procedural checklist’ in EPIC • Mark the site using your INITIALS with a permanent marker (and visible when draped) • And do the ‘team pause’ AND DOCUMENT IT (with dot phrase or Epic record), verifying the following:

26. What to do when an event occurs • Care for the patient • Contact your attending • Fill out a Patient Safety Net (PSN) report (on-line) • Access via EPIC • Page the Clinical Risk pager, day or night, at 17049. • Or Call Risk Management • Care for yourself!

27. Electronic Reporting system used since 2006 • Know how to access it • And then ACCESS it!

30. Monthly – Total Number of Patient Event ReportsJune 2009 – May 2010 Confidential document for the improvement of patient care protected pursuant to ORS 41.675

31. PSN Reports Submitted by Physicians

32. Human Error • Root Cause Analysis • A problem solving method to systematically answer why the event happened, how it occurred and how to prevent it from recurring in the future. • By directing corrective measures at root causes the likelihood of problem recurrence will be minimized.

33. Human Error Swiss Cheese Effect • Not the cause of the failure, but a symptom of the failure • Should be the starting point of the investigation, not the end-point • Influencing behaviors: Policies, Culture, Work- Flows, Technology & Environment

34. 2008-2010 Compare * Behavioral: Patient self-harm in psychiatric unit

35. Case Study • Sept. 2008 Root Cause Analysis conducted • Three-month delay in read of an MRI • Issues: • On-going issue of delay in radiology reads. • Delay of this read in patient with a spinal tumor. • Change over from one technical support to a different system → eliminated back-up system for tech verification errors. • Changes: • Assigned a radiologist from each section to ensure all exams are read within 5 days of exam. • Policy developed to resolve unread exams. • On-going tracking and trending of reads and reporting to department.

36. Results • Recent tracking for March 2009 = 15 unread exams

37. “The strength of the team is in each individual member… the strength of each member is the team.” Phil Jackson as coach of the Chicago Bulls I am from Massachusetts and NOT a Lakers fan… that is why the print is so very small

38. One more story • You all know the story • Jan. 2009, New York, Hudson River 36° • US Airways to Charlotte NC w/ 155 passengers and crew • Sully the captain of US Airways plane • Another hero….

39. Learnings from the Story • Sully was not alone…. • Air traffic controller told him to turn back and had the runway cleared while communicating with him • Air traffic controller told him to go to NJ, and while on the phone with Sully had their runway cleared. • When told by Sully he could only land in the H2O, Air traffic controller alerted Coast Guard and rescuers telling them to go to scene for rescue. • Without team work, hypothermia would have set in quickly and deaths may have resulted. • You are not alone….

40. The OHSU Culture of Patient Safety • Proactive approach to patient safety & clinical errors • Goal is to identify potential risk issues via early reporting before there is an adverse event • Non-punitive approach • Focus on identifying system issues that contribute to adverse events

41. Patient Safety Philosophy • Honesty • Expected when there is an adverse event • Patients expect you to tell them • It is the right thing to do!!!! • Supportive philosophy • You are not alone; we will support you through the process from start to finish

42. Professional Liability Claims Team Risk Management Main Line 4-7189 Risk Management Pager 12273

43. What should you report? • Unexpected patient death • Major permanent loss of function • Unexpected outcome/complication • Serious adverse event • Anytime you have a concern • Charting a patient’s dissatisfaction • If you are contacted by an attorney • If patient threatens a lawsuit

44. Reducing Risk Through Reporting

45. QUESTIONS?

46. Medication Use System& Pharmacy Services Joseph Bubalo, PharmD, BCPS, BCOP June 2010

47. Medication Errors • 1.3 million injuries annually from medication errors • 44-98,000 patient in-hospital deaths/yr from medical errors • Total national costs of preventable errors $17-28 billion/yr • Medication errors cause approx 7,000 deaths/yr • “More people die in a given year as a result of medical errors then from MVA, breast cancer, and AIDS combined.”

48. Medication Use System • Average admission has about 120 handoffs • ~4,000 orders/day = 1,460,000/yr • ~9,000 doses/day = 3.2 million doses/yr

49. Can You Read This? The pweor of the hmuan mnid. Aoccdrnig to rcesaerh at Cmabrigde Uinervtisy, it deosn’t mttaer in what oredr the ltteers in a wrod are, the olny iprmoatnt tihng is taht the frist and lsat ltteer be at the rghit pclae. The rset can be a total mses and you can still raed it wouthit porbelm. Tihs is bcuseae the huamn mnid deos not raed ervey lteter by istlef, but the wrod as a wlohe. Amzanig huh?

50. Paper Orders • Adults and Pediatrics Inpatient: • TPN • CRRT/Dialysis • Antineoplastics – Beacon module this fall • All other are CPOE CPOE – Computerized Provider Order Entry