Blog from James Coulston: Implementing the Safety Checklist in ED

We spoke to James Coulston, Consultant Vascular Surgeon at Musgrove Park Hospital about the Safety Checklist QI project he is taking part in, demonstrating how QI can help enhance patient care. Jame Coulston completed our Accelerated Patient Safety Programme in 2015.
James explains: “Our project is based on the ED Safety Checklist from the ‘Shine Project’, which was produced by a quality improvement team in the ED at Bristol Royal Infirmary (BRI) in collaboration with The Health Foundation in order to improve safety in Emergency Care. The checklist we want to put together will be a minimum standard practice for patients in A&E – so in essence – a set of checklists for every patient that will stay with us.
The team at BRI designed a checklist which followed a specific timeline of jobs on an hour by hour basis, to be signed off when completed. It addresses basic nursing care and acts as a prompt or reminder of what should be and needs to be done for patients.
After implementation of the checklist, the BRI noted significant improvement in pain scoring/analgesia and compliance with recording observations. Deteriorating patients were identified much sooner, there was a reduction in serious incidents and a reduction in complaints. There was no improvement on 4hr target, however, despite increase demand and pressure, while the safety and quality of patient care improved.
We have been supported by the SW AHSN to produce our own version of the ED Safety Checklist, so we are going to be using the same processes used by BRI, in order to produce something that we can then share with the CQC. This is a team approach including: Gillian Bryce (ED Consultant), Helen Gilliland & Laura Tennet (Senior RNs ED) and Amy Leitch – ED RN. We also aim to reduce the current volume of documentation with ED to allow a smoother approach to patient care.
Our main tasks at this stage of the project are: establishing current practice, setting out KPIs and reviewing them through retrospective audit and establishing what we want to achieve. We are currently creating one double sided page for what we need and we will be using the Life System (link) to process the data.
We are trialling the checklist and refining it based on process, data and feedback from staff, and we’re carrying out a range of training, communication and education for ED & ward staff.
We’ve engaged with the whole team and have carried out a range of communications to encourage support from all the team, which is absolutely vital. We will be consulting staff who use the checklist and encouraging feedback. We’re really excited about the project, and the so pleased to take ownership of the form and be involved in its creation.
We really hope that once we’ve implemented the checklist, we will see an improvement in the safety and quality of care in the ED, resulting in standardised care for all patients. We are also hoping that this will lead to a reduction in paperwork, and the list will be an excellent handover tool, as well as a good ‘To Do List’ for Bank/Agency new to the department.”
In the South West region the checklist is also being tested by Yeovil District Hospital NHS Foundation Trust. The team have so far found that by including the checklist in nursing documentation it has improved compliance via PDSA cycles. They are in the process of sampling data as evidence of ongoing and sustained improvement.
If you are interested in using safety checklists in the South West, please feel free to contact Joanna Pendray for more details: Joanna.pendray@swahsn.com
West of England AHSN and West of England Patient Safety Collaborative have developed a tool kit to support ED teams across the U.K implement the check list. You can find the tool kit here.