Safer Systems Saving Lives Resource Catalogue
'Safer Systems * Saving Lives' is a national project initiated by the Australian Council (now Commission) for Safety and Quality in Health Care. The aim of the 'Safer Systems * Savings Lives' project is to implement six key interventions for which there is clear evidence of impact on improvement in health outcomes when applied consistently and comprehensively. The 'Safer Systems * Saving Lives' project is based on the 100,000 Lives (or 100K Lives) Campaign, an initiative by the Institute for Healthcare Improvement (IHI) in the USA. The IHI care bundles and measures have been adapted to suit the Australian context with the assistance of expert clinician panels. Through the implementation of the six interventions the 100K Lives campaign aimed to avoid 100,000 deaths in the USA by June 2006, and every year thereafter. By linking to this program it gives Australia the opportunity to join an international collaborative to improve health outcomes for patients in Australian hospitals using international evidence of what works in these areas. This project concludes in February 2007.
Launched in February 2006, there are 10 NSW teams from both regional and metropolitan sites participating in the 'Safer Systems * Saving Lives' project.
Quicklinks
- INTERVENTION: Prevention of Adverse Drug Events
- INTERVENTION: Preventing Ventilator Associated Complications
- INTERVENTION: Prevention Central Venous Catheter Related Blood Stream Infections
- INTERVENTION: Prevention of Surgical Site Infections
- INTERVENTION: Implementing a Rapid Response System
- INTERVENTION: Improving Care for patients with Acute Myocardial Infarction
INTERVENTION: Prevention of Adverse Drug Events
- Warfarin Management Guidelines
- Liverpool Hospital **
- A resource designed to address warfarin management in acute stroke patients. It includes guidelines for staff to ensure best practice prescribing and management, a discharge checklist and information for patients and carers
- Pharmacy Warfarin Education Stickers
- Liverpool Hospital **
- This sticker lists key activities related to patient education It is inserted into patients medical records for sign off by pharmacist when activities attended
- Warfarin Alert card
- Liverpool Hospital **
- A wallet sized card including patient ID, Warfarin dose, INR and medical contacts.
- Medication History and Reconciliation on Admission
- Liverpool Hospital **
- A modification of the Qld Health Medication Reconciliation Form
- Medication Risk Screening Tool
- Liverpool Hospital **
- This form builds on findings from the Medication History and Reconciliation Admission
- Medication Communication Fax Form
- Liverpool Hospital **
- This form facilitates communication with the GP in relation to medication reconciliation
** The team working on ADE at Liverpool acknowledges the Medication Safety Collaborative for providing the initial impetus for work undertaken during SSSL.
- Medication History & Reconciliation Form
- Royal North Shore Hospital
- An adaptation of the form developed by the Queensland Health Safe Medication Practice Unit
- Medication Reconciliation Audit Tool
- Coffs Harbour Base
- A simple audit tool designed to raise awareness of the benefits of reconciliation and to identify opportunities to address the reconciliation process. This was part of a strategy involving ASET Nurses in the ED and a defined patient population
- Medication History on Presentation
- St. Vincent’s
- A tool modified from the QLD Health Medication Reconciliation Form to address medication history and risk assessment
- Improving Medication History
- St. Vincent’s
- A poster providing instructions on use of the Medication History on Admission Tool
- Alert sticker for medical record
- St.Vincents
- Used by pharmacist to alert staff to findings of reconciliation process
- Medication History,Confirmation and Reconciliation Process Flow Chart
- St.Vincents
- A tool to facilitate the process of medication reconciliation on admission
- Medication Reconciliation Discrepancy Stickers
- St.Vincents
- Used in conjunction with above Flow Chart to alert medical staff to discrepancies in confirmation process
INTERVENTION: Preventing Ventilator Associated Complications
- Protractor – a tool for managing head of bed elevation
- Liverpool Hospital
- Version A
This is a paper based version that can be laminated and attached to each ICU bed. - Protractor – a tool for managing head of bed elevation
- Gosford Hospital, Hornsby Hospital
- Version B
A plastic ruler used in conjunction with spirit level and attached to ICU bed - FASTHUGS checklist
- Liverpool Hospital
- Checklist identifying evidence based care components for management of ventilated patients. The checklist provides details of care activity and provides a trigger for performance and documentation
- FASTERHUG
- Hornsby Hospital
- An adaptation of the FASTHUGS checklist
- VAC Checklist
- The Tweed Hospital, Gosford, Lismore
- Several sites developed checklists either as stand alone for the purposes of the project or more commonly as an amended version of an existing ICU Care Plan. The purpose was twofold
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- to ensure delivery of evidence based care and
- provide a process for continuous audit
- VAP Criteria
- Hornsby
- A Flyer alerting staff to criteria for screening for VAP
INTERVENTION: Preventing Central Venous Catheter Related Blood Stream Infections
- FASTERHUG
- Hornsby Hospital
- An adaptation of the FASTHUGS checklist
- CVC Checklist
- St Vincent’s, The Tweed Hospital, Hornsby
- Several sites developed checklists either as stand alone for the purposes of the project or more commonly as an amended version of an existing ICU Care Plan. The purpose was twofold
- to ensure delivery of evidence based care and
- provide a process for continuous audit.
- CVC Trolley /Pack
- Gosford, POW, Hornsby
- These were developed by several teams to ensure access to appropriate equipment and ensure adherence to evidence based guidelines. The packs contained and audit tool to reinforce adherence to guidelines and to facilitate audit
- Date/Time stickers for CVC Dressing
- POW private
- Designed to facilitate monitoring of insitu days for CVC
- Exclusion Criteria for Subclavian Site
- Gosford
- This was a local response to the concern that some patients were not suitable for subclavian site insertion It was promoted through in-service for nursing and medical staff in ICU
Full Length Drape A full length drape is now available at this site and is included in CVC Insertion Packthat is assembled by volunteers
INTERVENTION: Prevention of Surgical Site Infections
- Patient Education Resource
- Coffs Harbour
- This booklet is given to patients contemplating LSCS prior to delivery date advising the correct procedure for pre-operative skin hygiene and post operative wound management
- Patient Wound Care Diary, Protocol for management of patients with wound infection post discharge
- Hornsby
- Developed to enable follow up and timely intervention for patients following LSCS and for staff to monitor incidence of wound infection within 30 days post op. There is a privacy policy attached to the use of this diary. Complementary to the above this flow chart describes management of a patient who identifies a wound infection in the 30 day period post discharge
- Information Sheet for Patients (and families ) undergoing Caesarean section
- Hornsby
- Designed to address pre- op skin preparation and post discharge wound management op
- Antibiotic Guidelines
- Lismore
- A laminated version of AB guidelines was prepared and displayed in each anaesthetic bay in OT
INTERVENTION: Implementing a Rapid Response System
- ICU Liaison Nurse for ICU Transitional Program
- Liason Nurse Role, Transition Program Form
- Lismore
- This involved the deployment of an ICU nurse in a liaison role during change of shift between am & pm when there is a staff overlap. The role was designed to provide support and f/up for staff caring for patients recently discharged from ICU. The resource includes Role Description and Guidelines for implementing the transitional program
- Code Blue
- POW
- Development of CODE Blue criteria designed to assist in the early identification of a patient in crisis.
INTERVENTION: Improving Care for patients with Acute Myocardial Infarction
- Fridge magnet
- Gosford
- This addresses key components of lifestyle management in Heart Disease and was designed to be a prominent reminder for the patient
- Lifestyle education audit
- Gosford
- Addition of footer on patient list and handover sheets reminding staff to complete patent education
- Risk prevention counselling information adapted to include alcohol and smoking management.
- AMI pathway
- Coffs Harbour
- A modification of the TASC pathway for addressing management of Acute Coronary Syndrome.
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