Mistake Proofing Healthcare. Poka Yoke Presented by: Harjeet Bajaj
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1 Mistake Proofing Healthcare Poka Yoke Presented by: Harjeet Bajaj
2 A LITTLE HISTORY POKA YOKE was developed by Shigeo Shingo in the 1960 s s. POKA (inadvertent mistake) & YOKE (prevent)
3 Basically it is any mechanism that either ih prevents a mistake from being made or makes the mistake obvious at a glance.
4 ALIAS s MISTAKE - PROOFING DUMMY DUMMY- PROOFING DEFECT PREVENTION ZQC (ZERO QUALITY CONTROL) FAIL FAIL-SAFING ZERO DEFECTS
5 they are inevitable* MISTAKES: people are human and can t be expected to concentrate on the work in front of them 100% of the time* DEFECTS: Defects are a direct result of allowing a mistake to reach the customer* defects are entirely avoidable* * taken from the book, Shingo 1986 p.50 customers implies internal or external
6 CHARACTERISTICS OF A GOOD POKA-YOKE DEVICE 1. They are simple and cheap. If they are too complicated or expensive, their use will not be cost-effective 2. They are part of the process, implementing what Shingo calls 100% inspection 3 They are placed close to where the mistakes 3. They are placed close to where the mistakes occur, providing quick feedback to the workers so that the mistakes can be corrected
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8 A PREVENTION DEVICE MAKES IT ALMOST IMPOSSIBLE TO MAKE A MISTAKE AT ALL EXAMPLE: THE USB DRIVE THE DESIGN MAKES IT IMPOSSIBLE TO INSERT THE USB THE WRONG WAY
9 A DETECTION DEVICE SIGNALS THE USER WHEN A MISTAKE HAS BEEN(OR WILL BE) MADE EXAMPLE: A CAR BEEPS IF YOU LEAVE THE KEYS IN THE IGNITION THUS WARNING OF THE PENDING MISTAKE OF LOCKING YOUR KEYS IN THE VEHICLE
10 How to Design an Effective Mistake Proof Tool
11 KEEP IT SIMPLE
12 Supplement Process Flow Doctor or Dietitian Referral W ritten Post Referral (Nursing) ASU Clerk picks up labels form edits Tues/Thurs Takes labels to ASU Tuesday Thursday Make required changes Print labels Deliver copy of edited labels to F&N Lab deliv main F&N Mgr. Processed Referral yes Referral Read Manualy Update Labels Write changes on Cardex take referral to Office Update spread sheet xls Update labels for printing and post in F&N Update Purchasing form update picking form Document on referral File white copy resident's chart Shredding yellow copy Pick product for next day No Create new labels F&N FSW in Servery Notify FSW Create a label and notify on white board Stock? No Yes pour and labels nourishment Call kitchen line Answer? Yes No FSW in Kitchen W ait for Porter to come to unit Notified of supplement(s) required Returns to kitchen pick up supplement supplement delivered to unit deliver supplement and labels next morning Nursing Document in NPCR Report to Charge Nurse Distribute to resident Prepare cart for distribution Note:: Eve supplemen are taken f fridge by nu Too many steps
13 Eliminate the Root Cause of The Errors Eliminate Non-Value Added Decisions
14 EXAMPLES
15 Detection Medication is placed in order of the MAR Medication is placed in order of the MAR (Medication Administration Record) so it is easy to find and
16 Detection Red = Hospital registered patient/community (stat) specimens. Green =Community specimens. (SHR) Tube racks color coded to match vacutainer tops and test so that they do not get mixed up (FHHR)
17 This sign reminds staff to send a report at the certain time of a day Detection
18 Detection Tote Specimen Map & Instructions ti In an effort to improve efficiency and client Service we ask that you group specimens by patient. t Start point Please stack requisitions in same order as specimens, held together with a paper clip and placed on top of sterilite container. Foam Rack Sterilite Container - Please keep RGH and provincial lab samples separate of MJUH. Indicate designation on a piece of tape affixed to the RGH / Provincial Lab foamies. - Put frozen label on outside of tote to indicate status. This shows staff how to - All requisitions must have: o First and last name of fdoctor and initials. i i properly pack a tote for o Actual full patients name (not alias or nickname), DOB, PHN, and gender. o Out of province patients must have province indicated on requisitions Please Do Not: o Fold requisitions or tie to specimen. o Do not tape plastic containers closed. o Do not complete two requisitions for blood and microalbumin (one req. is only required) shipping so that mistakes are reduced from none standard operations Always refer to FHHR Laboratory Reference Manual & Specimen Procurement and Handling Manual
19 Detection Visual reorder lines tell staff when supplies are needing to be ordered based on delivery time.
20 Detection Description: The tool will be put back in its proper location as the picture matches the item
21 Detection FHHR Medication Reconciliation: During your visit you will be asked about the different types of medications you may be taking; please review the list below to help identify the many options. By giving a complete and accurate list it will help ensure the best possible care is given to you. Five Hills Health Region Prescription Medication: anything that a Doctor may have prescribed to you Ears - Drops By mouth Liquid or pills Legend Nurse Doctor Anesthesiologist All PIP Form Usage Instructions Patient Name and Address Verify Right Person Over the counter: Anything you may buy to treat yourself example Aspirin, vitamins Samples: Anything you may have been given to try and cure a condition or improve your health Herbal remedies: Anything that you may take to improve your health or fitness Nose - Sprays Injections - Needle Skin Lotions or creams By Mouth - Inhaler Skin - Patches Suppositories How do you take your medications? Verify that the client is on all the medications strike a line through any that no longer apply and write N/A Note the dose i.e. 4 pills and the interval i.e. 3 x daily Include any addition medication history in these spots. Note source of information Your Name Date Anesthesiologist will indicate here when patient should stop taking any medication When patient returns for procedure the nurse will check mark the box to verify compliance Input Weight and Height Post operatively the Physician will check either continue or stop box. Any changes will be written in the comment box Anesthesiologist notes must be signed not initialed to prevent confusion Physician will sign off in this location in OR prior to patient returning to ward
22 Prevention Description: NG Tube - Shows how NG tube cannot be connected to an IV port
23 Prevention Description: A single action one hand sharps protection to prevent the user from being poked
24 WHY?
25 WHY?
26 0.6 Number of Errors per Resident # Errors Dietary Flow 0.1 Data Entry Minutes per Resident Resident Assessment Instrument 2 Minimum January 2010 April Data Set Daily Care Recording 0 MDS sheet error rate 1 Facility Space Constraints 0 Leadership Communication Challenges Dietary Supplies Ordering System s Minutes January 2010 April 2010 MDS Sheet minutes per Res
27 Missed Appointments July Dec 2008 (psychiatry not removed from baseline) bf AF ments 70 Dietary 60 Flow 50 Resident Assessment Instrument Minimum 40 UCL=41.7 Data 30 Set Daily Care Recording _ 20 X=22.4 Facility 10 Space Constraints LCL=3.2 0 Leadership Communication Challenges July Aug Sept Oct Nov Mar Nov Nov Nov Nov Dec Dec Dec Dec Dec Time frame Dietary Supplies Ordering System numbe er of appoint
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