MinnesotaAlliance for Patient Safety

Scheduling/Verification Pilot Project

Status Report

Hospital/Clinic Team:Internal Planning Start Date:

Report Date:Implementation Target Date:

Implementation Steps - Infrastructure / Current Status / Planned Actions/Who’s Responsible?
-Recruit Team Members
-Recruit Clinic Champion
-RecruitHospital Champion
-Select Project Lead
-Schedule Planning Meetings
-Develop Strategy for Staff “Buy-in”
-Develop Policies and Procedures for Pilot
-Develop Scheduling Form(s)
-Develop Auditing Strategy and Tools
-Plan Education and Training for Staff
-Complete Education and Training for Staff
-Develop Communication Strategy for Implementation “kick-off”
-Begin Pilot
Implementation Steps - Clinic / Current Status / Planned Actions/Who’s Responsible?
Clinician performing the procedure completes the “Critical Components” on the scheduling form prior to seeing next patient.
The procedure is not scheduled if the “Critical Components” are not completed by the clinician performing the procedure.
The surgery scheduling form is either sent to the hospital/sx center scheduler prior to scheduling the procedure or sent later in the day.
The clinic scheduler and hospital/sx center scheduler perform a “read back” of the procedure “Critical Components” if the procedure is scheduled by telephone.
Implementation Steps – Hospital/Sx Center / Current Status / Planned Actions/Who’s Responsible?
If sent later in the day, the hospital/sx center scheduler verifies scheduled procedure against clinic scheduling form.
A minimum of 24 hours prior to the scheduled procedure (ideally 3 days) the informed consent document and/or the physician order indicating the procedure to performed as well as the laterality/location completed by the clinician performing the procedure must be sent to the hospital/sx center where the procedure is to be performed.
If diagnostic studies have been performed, a copy of the studies along with the report must also be sent to the facility where the procedure will be performed.
Prior to the procedure day, hospital/surgical center staff will verify the scheduled procedure against source documents.
If the minimum source documents, 1) informed consent document and/or physician order completed by the person performing the procedure indicating the procedure and laterality/location; 2) relevant diagnostic studies and reports, have not been received at least 24 hours prior to the procedure, the procedure will not move forward and may need to be rescheduled (exceptions for emergent situations).
Clinician performing the procedure:
-Completes the procedure information on the informed consent form by verifying “Critical Components” against source documents
Clinician performing the procedure:
-Re-verifies “Critical Components” against source documents prior to marking the procedure site, if site marking is applicable for the procedure.