WHO Patient Safety Curriculum Guide, Multi-professional Edition What is it? How to use it? Merrilyn Walton Professor of Medical Education(Patient Safety) Faculty of Medicine University of Sydney Australia WHO Patient Safety Curriculum Guide Underpinning Principles Capacitybuilding is integral to curriculum change A flexible curriculum Easily understood language A guide for all countries, cultures and contexts A guide based on learning in a safe and supportive environment WHO Patient Safety Curriculum Guide Structure of the Guide Part A: Teachers Guide • Designed to build capacity for patient safety education and program planning and design. Part B: The curriculum • One stop shop • Flexible- can enter at any stage • Complete curriculum or use selective topics on case by case basis PART A: TEACHERS GUIDE  Designed for faculty staff and clinician teachers  Provides step by step tutorials  Easily adaptable for all health-care professionals and levels  Designed to assist, facilitate and guide faculty in their approach to patient safety education WHO Patient Safety Curriculum Guide Contents of Part A: Teacher’s Guide How to evaluate patient safety curriculum Rationale for the topics Aims of the guide Web based tools and resources Activities to assist patient safety understanding How to foster & engage in a transnational approach to patient safety Implementing the guide How to integrate patient safety into your curriculum Educational principles essential for patient safety teaching & learning How to assess patient safety Part B: WHO Curriculum Guide Topics What is patient safety Why applying human factors is important in patient safety Understanding systems & the effect of complexity on patient care Part B: WHO Curriculum Guide Topics Being an effective team player Learning from errors to prevent harm Understanding and managing clinical risk Part B: WHO Curriculum Guide Topics Using quality improvement methods to improve care Engaging with patients and carers Infection prevention and control Part B: WHO Curriculum Guide Topics Patient safety and invasive procedures Improving medication safety Structure of each topic › Topic title › Rationale › Learning outcomes - Knowledge requirements - Performance requirements › How to teach this topic - Strategies & activities - Tools & resources › How to assess this topic › How to evaluate the teaching session How is your curriculum delivered? Simulation learning/skill laboratories Lectures Problembased learning ( PBL) Clinical placements Small group tutorial teaching Online activities On the ward activities Implementing the curriculum • What are you already teaching? - Communication techniques? hand washing protocols? • Build on what is already there - Enhance existing material rather then introduce new material. - Map topics in your curriculum Clinical skills development, health law, doctor and patient subjects can all be modified to include patient safety knowledge skills or attitudes. Example of template for mapping ( Sydney Medical School) Session or area in curriculum Year Where is the potential for patient safety content Potential patient safety learning Ethics 1 Respect for Honesty after patient adverse autonomy events How is /could patient safety being taught How is/could Patient safety being assessed Comments Lecture Ethics essay, MCQ,OS CE Many patient safety principles have an ethical basis that can be made explicit during the patient safety lesson Integration into existing curriculum How a patient safety topic ( correct patient identification) has specific applications in numerous disciplines in health care Discipline Patient safety application Midwifery and Obstetrics How are newborn babies identified as belonging to their mother so that babies are not accidently mixed up and leave hospital with the wrong parent (s)? Surgery If a patient needs a blood transfusion what checking processes are in place to ensure they receive the correct blood type? All professions: Ethics How are patients encouraged to speak up if they do not understand why the health professional is doing something to them that they are not expecting? Integration into existing curriculum Patient safety topic Subject that could house patient safety topics Infection prevention and control Microbiology Procedural skill training Infectious diseases Clinical placements Improving Pharmacology medication safety Therapeutics Clinical placements What is patient safety? Ethics Introduction to the clinical environment Clinical and procedural skills training Linking patient safety education with new knowledge and performance elements Patient safety competencies for a topic can be divided into knowledge, and performance requirements...for example – correct Patient identification Domain Patient safety example Broad knowledge Understanding patient identification mix ups can and do occur, (when care delivered by team) . Learning what situations increase chance of misidentification (2 patients with same condition, patients who cannot communicate, interruptions, language and poor literacy) Applied knowledge Understand importance of correct identification when taking blood for cross matching-how errors occur when doing this, learning about strategies for preventing errors Performance Demonstrating how to correctly identify a patient by asking the patient their name as an open-ended question, What is your name? Rather than a closed ended question- Are you.. WHO Patient Safety Curriculum Guide Culture change Area or Attribute Infallibility of health professionals Attitude to Mistakes Example Old way New way Mistakes are only made by people who are incompetent or unethical. Accept the culture that says people who make mistakes are ‘bad’ or ‘incompetent’. Understand that everyone will make mistakes at some time and that the causes of errors are multifactorial involving latent factors not immediately obvious at the time the error was made. Good health professionals do not make mistakes. Try harder to avoid making a mistake. Remain silent, or find someone or something else to blame when you have made a mistake. Look at the mistakes others make and tell yourself you wouldn’t be that stupid. Look after your patients, yourself and your colleagues in the event of an error and actively promote learning from error. Where and how we teach Patient Safety in the senior years: Sydney Medical School On completion of topic • Attend 4 face-toface sessions of 60-90 minutes. • Tutor facilitated during core blocks. 8 topics with 9 tasks • completed over the last 2 years of the medical program Topics are student initiated on the wards or during rotations • Obtain sign-off by clinician for 4 wardbased activities • Write and submit 1 case report which raises ethical issues Pilot: 4 day experiential Preparation of Safe Practice as an Intern WHO topics in the Sydney Medical Program Understanding systems and the effect of complexity on patient care Being an effective team player Infection control and prevention Understanding systems and the effect of complexity on patient care Read Learning topic on line Follow a patient from the time they enter hospital until discharge or a clear outcome Use the template to make notes on the above Assessment Tutor sign-off of satisfactory student participation and performance in face-to-face session (or clinician sign-off of activity completion in the event of no face-to-face session). Stage 3: Topic 1: Understanding systems & the effect of complexity on patient care --------------------------------------------------------------------Student name___________________________________ Student number_________________________________ Date of activity_________________________________ Summary of the patient journey: 3 main observations: 3 most important things you learned: Position of person signing-off on completion of activity Name (print):__________________________________ Signature _____________________________________ Position_______________________________________ Date signed________________________________________ University of Sydney WHO topics in the Sydney Medical Program Patient safety and invasive procedures Learning from errors to prevent harm Improving medication safety Deeper understanding of consent 4 day experiential 6 theme areas: The deteriorating patient •clinical emergencies Preparation of Safe Practice as an Intern ( PSPI) program Procedures Clinical challenges – case management problems •skills for discrete procedures Organisational skills Self-management •clinical clerking – working safely and effectively within the system •behaviours directed as self-regulation & professionalism Case-based learning; simulations; workshops; role plays Clinical Challenges Minimising Adverse Events in Acute Pain Management Anticoagulation Delirium IVF/urinary output/hyponatraemia MET call scenarios/O2 therapy BSL management Review of clinical challenges Procedures Indwelling catheters Venepuncture/ labeling specimens/blood cultures Nastrogastric tubes DETECT scenarios: managing the deteriorating patient Non-clinical but important Simulation centre team work games Self management Managing fatigue Medico-legal matters Complaints, regulatory obligations Tips: Take care to:Focus on patient centred care for context of the discussions. Address positive aspects of the area:- Remember patient safety is about making care better • Quality care and treatment • Less adverse events • Better outcomes for patients Remind students of the success of the majority patient care episodes Present solutions to problems Equip students with concrete strategies to improve their practice Blueprint for developing capacity for patient safety education Review and improve Evaluation Integration into existing curriculum Capacity building Patient safety curriculum development & consensus Commitment & priority Patient safety Curriculum frameworks FACULTY WHO validated patient safety curriculum accreditation requirements Web sites › National Patient Safety Education Framework http://www.health.gov.au/internet/safety/publishing.nsf/Content/C06811AD746228E9CA2571 C600835DBB/$File/framework0705.pdf › Australian Curriculum Framework for Junior Doctors http://www.cpmec.org.au/curriculum/index.cfm › The Patient Safety Education Project (PSEPTM) ( USA) http://www.northwestern.edu/aging/projects.htm#psep › WHO Patient Safety Curriculum Guide for Medical Schools http://www.who.int/patientsafety/activities/technical/medical_curriculum/en References 1. Walton M, Woodward H., Van Staalduinen S,3 C et al for and on behalf of the Expert Group convened by the World Alliance of Patient Safety, as Expert Lead for the Sub-Programme Republished paper: The World Health Organization (WHO) Patient Safety Curriculum Guide for Medical Schools Postgraduate Medical Journal 2011; 87:31 2. Walton M, Woodward, Van Staalduinen S et al for and on behalf of the Expert Group convened by the World Alliance of Patient Safety, as Expert Lead for the Sub-Programme The World Health Organization (WHO) Patient Safety Curriculum Guide for Medical Schools Qual Saf Health Care 2010;19:542-546 3. Walton M, Barraclough B, Van Staalduinen S & Elliott S. An Educational Approach to Improving Healthcare Safety and Quality Journal of Evidence-Based Medicine 2009 Volume 2 Issue 3, Pages 136 - 142 4. Runciman B Merry A Walton M Safety and Ethics in Health Care: A Guide to getting it right Ashgate Publisher 2008 5. Emanuel L, Berwick D, Conway J, Combes J, Hatlie M, Leape L, Reason J, Schyve P, Vincent C, Walton M. What exactly is patient safety? In: Henriksen K, Battles J B, Keyes MA, Grady ML, eds. Advances in Patient Safety: New Directions and Alternative Approaches. Rockville: Agency for Healthcare Research and Quality August 2008. 6. Emanuel L, Walton M, Hatlie M, Lau D, Shaw T, Shalowitz J, Combes J. The Patient Safety Education Project: an international collaboration. In: Henriksen K, Battles JB, Keyes MA Grady ML, eds. Advances in Patient Safety: New Directions and Alternative Approaches. Rockville: Agency for Healthcare Research and Quality. August 2008 7. Graham I Gleason A Keogh G Paltridge D Rogers I Walton M et al Australian Curriculum Framework for Junior Doctors Medical Journal of Australia 2007; 186(7):S14-19 8. Walton M, Elliot E Improving safety and quality: how can education help? The Medical Journal of Australia 2006; 184:S60-S64. 9. Walton M, Shaw T, Barnett S, Ross J Developing a National Patient Safety Education Framework for Australia. Quality and Safety in Health Care 2006 15:437-42