How to standardize procedures JOB AIDS & STANDARD OPERATING PROCEDURES (SOPs) Oktober 2009

Transcription

1 How to standardize procedures JOB AIDS & STANDARD OPERATING PROCEDURES (SOPs) Oktober 2009

2 INTRODUCTION Why having written procedures? reliable and consistent results backbone of the quality system Verbal instructions: forgotten not heard ignored misunderstood

3 JOB AIDS

4 INTRODUCTION = INSTRUCTIONS Describes step by step what you should do to perform a procedure Is used on the job while performing the task at hand Tells when to take action Gives directions on what actions to take and how to do each action

5 DIFFERENT FORMATS 1. Cookbook format : describes all alternatives tells how and when 2: Decision table : lists the alternatives 3: Flowchart : goes through the alternatives tells how to think about a task

6 DIFFERENT FORMATS Example: we will improve the job aids below Hands are disinfected with either antimicrobial soap or alcohol. If hands are visibly dirty, they should always be washed with household soap first. Next,antibacterial soap should be used in case you have running water; if not, you should use alcohol.

7 DIFFERENT FORMATS Format 1: Cookbook format : Describes all alternatives Ex: 1. If your hands are visibly dirty, wash them with Household Soap. If your hands are visibly clean, go to step If there is running water, use Antimicrobial Soap. If there is no running water, use Alcohol.

8 DIFFERENT FORMATS Format 2: Decision Table : Lists the alternatives Ex:

9 DIFFERENT FORMATS Format 3: Decision Table : Goes through the alternatives Ex:

10 BENEFITS AND CONSTRAINTS Reducing errors + Reducing recall training Easier to perform complex tasks Motivate less experienced Easier to do tasks that are NOT done often Over simplify Require updating May not eliminate all training Cannot solve all performance problems Slow performance -

11 USE Use job aids when: Performance is infrequent Knowledge, education level is limited Procedures cover complex decision making Training resources are limited The consequences of errors are high (ex. job aids for treatment of spills or blood exposure accidents) Avoid the use of job aids: Masterful performance is needed Staff fears lack of credibility (towards patients or doctors) People don t how to use them

12 WRITING JOB AIDS How to write a good job aid: general rules 1. Give a Meaningful Title 2. Mention Author, Version number and Date 3. List the Materials 4. Describe the Action Steps 5. Have your job aids Read and Performed by a Colleague

13 1. MEANINGFUL TITLE The title must mention the content of the job aid. Ex: Do NOT give a title like Job Aids_ Medical Service_ 015/1 PREFER Title with meaning How to disinfect my hands

14 2. MENTION AUTHOR, VERSION NUMBER & DATE Put this information in the Header or Footer of your document. In this way, it will be visible on the printed page.

15 3. LIST THE MATERIALS List the Materials you need Distinguish between - Material provided (for example, in the test kit) - Materials not provided Ex: For washing your hands with antimicrobial soap, you need: Liquid antimicrobial soap in a dispense Running water Towels!! Use a Bulleted or Numbered list.

16 4. DESCRIBE ACTIONS STEPS Decide on the format: - Cookbook - Decision table - Flowchart Use simple style: 1. Number the steps 1,2,3, If > 10 steps, subdivide in topics One step describes 1 action of max 30 sec

17 4. DESCRIBE ACTIONS STEPS 2. Use Short and Simple Sentences: -Not more than 15 words 3. Use Short and Simple Words: - Avoid use of Acronyms, spell them out the first time you use them - Add list of Abbreviations -Use always same word or term Ex: USE always household soap and not bar soap

18 4. DESCRIBE ACTIONS STEPS 4. Use Active Verb, not passive voice Use Imperative, not verb or you Ex: NOT: you have to use household soap BUT: use household soap 5. Turn any list into a bulleted or numbered list 6. Stress important information: - use CAPITALS - use bold or italicized or underlined text - use Color

19 4. DESCRIBE ACTIONS STEPS 7. Put When s or Ifs before What s Ex: NOT: Use of towel to cover your hand in case you have to close the tap by hand. PREFER: If you have to close the tap by hand, use a towel to cover your hand. 8. Put warnings before the steps

20 4. DESCRIBE ACTIONS STEPS 9. Use pictures/drawings - Check if picture fits the text - Refer to the picture in the text - Put pictures on the left side of the paper, text on the right side - Use colours if needed

21 5. LET READ AND PERFORM BY COLLEAGUE 1. Ask a Colleague to Read the draft of your job aid and to give comments 2. Ask a Colleague to Perform the job with the draft - Do NOT help him/her - Do not give further explanations - Make notes of what should be added or changed - Make these notes on your copy of the job aid

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23 STANDARD OPERATING PROCEDURES (SOPs)

24 Introduction SOP definition: a written document describing all steps how to perform a procedure. part of quality assurance (QA) prevents mistakes (rather then detects) carried out without deviation by every member off staff Needs updating

25 Introduction Benefits: Minimize variability (person-to-person, test-to-test) Improve and maintain quality Consistent and reproducible results Training tool Continuity (personnel turn-over) Procedure review: optimalization of techniques identification of problems

26 Introduction Constraints for implementation: Time-consuming in preparation Often not kept up to date Who writes SOPs? The staff must not only understand, but also carry out. Those who do, should write (prevents unfamiliar SOPs) Improves sense of responsibility for using the SOP

27 Steps towards successful integration 1. Get support by all members of staff!! Implement appropriate SOP training Discuss on current procedures and their steps User-Author Principe 2. Ensure Readability SOPs must be crystal clear on who is to do what

28 Steps towards successful integration 2. Ensure Readability SOPs must be crystal clear on who is to do what Standard lay-out Simple words Short active sentences: do this, do that Instructions in the right order Separate general information (as a footnote or in different format) Diagrams and pictures

29 Steps towards successful integration 3. Authorizing of SOPs Decides on an appropriate method Agreement author - supervisor (specialist) Way to communicate to all staff 4. Training of SOP Staff should get familiar with the agreed procedure (documenting reading and training by staff members can help you in the follow-up)

30 Steps towards successful integration 5. Regulary Review and Update on regular basis by the author Communicate changes 6. Organization and archiving Only current version available in work (bench) area Document management Change control: withdrawal and archiving

31 Main reasons for SOP failure The SOP is written in difficult/foreign language difficult to follow difficult to locate (accessibility) Not used

32 Structure of SOP Two parts: 1. Info about the SOP 2. Description of the procedure per se 1. Info about SOP: Title Identification code + version Name of author and date of issue Name of authorizer Page number (with reference to total page number)

33 Structure of SOP 2. Description of procedure: Introduction Scope Equipment and reagent/materials Sampling Test procedure and QC Results and reporting Sources of error References

34 SOPs vs. Job Aid Which Format to use?

35 Which format to use? Depends on various factors: Setting Level: small field vs. reference laboratory Current status, already written procedures? And Expectations? Staff Education level and experience Motivation Resources Time and budget Type of process or procedure Frequency, complexity, performance needed

36 Summary and conclusion Get everyone involved Be ambitious but realistic Work step- by- step Priorities Include training Write down what you do, do what is written down!