Health-System Pharmacy Department Safety Huddles: An Evaluation of Current Practice and Perceived Best Practice

A majority of pharmacy departments are presently conducting safety huddles within their teams.

ABSTRACT

Purpose

Daily safety briefings, also referred to as “huddles,” are conducted within hospitals in efforts to minimize errors and improve patient safety. These briefings are intended to be quick, efficient, and meaningful to health care workers. The purpose of this research is to assess current and perceived best practices related to safety huddles in health-system pharmacy departments, including timing, location, persons involved, and topics covered.

Methods

A web-based survey tool (RedCap) was utilized to distribute a survey evaluating current huddle practices and perceived best practices among health-system pharmacies. The survey was submitted to the University of Missouri-Kansas City Institutional Review Board (UMKC IRB) and approved as quality improvement.

Results

The survey received 311 responses outlining current practice, perceived best practices, and outcomes linked to pharmacy safety huddles. Of the 311 respondents, 76.8% confirmed their institutions were conducting daily safety huddles at the corporate level and 74.6% currently conduct huddles within the pharmacy department.

Conclusion

Overall, current literature supports daily briefings as a widely accepted practice and a method to improve patient care and minimize error. Based on 311 survey responses, a majority of pharmacy departments are presently conducting safety huddles within their teams. Results demonstrated current practice includes a daily huddle of 5 to 10 minutes in duration. Varieties of topics are covered and several team members are involved in the discussion (technicians, pharmacists, and leadership). Interestingly, questions related to perceived best practice aligned with activities that are currently in place at most institutions.

Key points

Many institutions lack guidance on the optimal strategy for implementing daily safety huddles. Literature surrounding safety huddles in the health-system pharmacy department setting is deficient. Based on this survey, a majority of pharmacy departments are presently conducting safety huddles within their teams.

Introduction

Patient safety and reduction in avoidable errors continues to be a focus across the health care spectrum. Many safeguards have been implemented over the decades in efforts to provide appropriate, safe care to patients.

Although the advancement of technology has had a positive impact on minimizing errors, poor communication among health care staff continues to be an issue. Daily safety briefings, also referred to as huddles, are meetings conducted within hospitals in efforts to minimize errors and improve patient safety.

Recently, The Joint Commission deemed daily safety huddles to be a component of high reliability organizations.1 These briefings are intended to be quick, efficient, and meaningful to health care workers. Many institutions lack guidance on the optimal strategy for implementing daily safety huddles. Several barriers exist including multiple shifts of health care workers, interference with patient care, and lack of buy-in.

Current literature addressing safety huddles in a health care setting outlines common huddle characteristics including involved parties, timing, content, follow up, duration, and assignment of tasks. Associated outcomes reported include the following:

  • Improved availability of ICU beds2
  • Improved communication and teamwork among team members3-7
  • Improved situation awareness and decreased serious safety events8,9
  • Decreased operating time and improved personnel exiting behavior10
  • Identification of electronic health record-related safety concerns11
  • Improved admission times from the ED to the inpatient unit12
  • Improved culture of safety13,14
  • Reduced number of medication errors15-17
  • Reduced rate of patient falls18,19
  • Improved patient satisfaction20

Overall, it is apparent the implementation of daily safety huddles has a significant impact on communication and ultimately patient safety events. Unfortunately, a “best practice” has not been determined related to the implementation of safety huddles in the health care setting.

The purpose of this survey is to assess current and perceived best practices related to safety huddles in the health-system pharmacy departments. The survey also sought to identify the current structure (timing, location, persons involved, and topics covered) of safety huddles in health-system pharmacies.

Methods

A 22-question survey was developed using a web-based survey tool (Redcap). The survey was structured to gain information on demographics, pharmacy department demographics, safety huddle characteristics, and known impact of current safety huddles.

Questions were developed to identify timing, location, persons involved, and topics covered during safety huddles. Questions could not be skipped, however, if a question was not relevant (i.e. answered no); the participant was able to move to the next section.

This survey was submitted to the University of Missouri-Kansas City Institutional Review Board (UMKC IRB) and approved as quality improvement.

Study Participants

A diverse population was targeted to complete the safety huddle survey. In efforts to gain a wide perspective, regional and national organizations were utilized to post the survey link. Access to the survey was distributed to the following:

  • Vizient Communities
    • AMC Pharmacy Residency Program Directors and Coordinators
    • AMC Pharmacy Network
  • American Society of Health-System Pharmacists Communities
    • Pharmacy Technicians
    • Medication Safety
    • Residency Program Directors (ASHP Accredited)
    • Section of Inpatient Care Practitioners
    • Section of Pharmacy Practice Leaders
  • Local health-system Directors of Pharmacy
  • American Association of Pharmacy Technicians
  • Mid-American Service Solutions Pharmacy Network

All roles within the pharmacy team were encouraged to participate (pharmacists, technicians, managers, directors, and buyers). An active link to the survey was available for 4 weeks prior to closing.

Results

A total of 311 surveys were completed during the open 4-week period. Several demographic questions were included to assess geographic location, hospital characteristics, role within the pharmacy, and pharmacy department characteristics.

Most (49.2%) of the survey respondents are located in the Midwest region (Northeast 16.7%, South 20.6%, West 13.5%). Surveyed hospital characteristics include teaching institutions (yes, 51.1%), licensed beds at practice site 0-199 (37%), 200-399 (28.9%), more than 400 (34.1%); availability of specialty services such as Neuroscience, Transplant Services, Trauma Services, Cancer Center, etc (yes, 76.8%); and services provided to neonatal or pediatric patients (yes, 72%).

Pharmacy department characteristics included role, department size, shift changes within a 24-hour period, and staffing model. Of the 311 survey respondents, the roles within the pharmacy department were distributed as such: technician (20.6%), pharmacist (30.9%), manager (27.3%), and director (21.2%).

Pharmacy department size was not equally represented with 42.4% of respondents coming from a department of 0-49 employees. Most departments experience 3 shift changes per 24-hour period (57.9%) using a mixed staffing model (59.8%). Figures 1-6 reflect the demographic data described.

Survey respondents were asked to provide information specific to the frequency, duration, participation, and content of daily safety huddles within their departments. Of the 311 respondents, 76.8% confirmed their institutions were conducting daily safety huddles at the corporate level and 74.6% currently conduct huddles within the pharmacy department.

Questions related to current practice of safety huddles within pharmacy departments include involved personnel, duration of huddle, content reviewed, and follow up. Of the respondents, 232 currently conduct huddles within the pharmacy department.

Frequency of huddles were as follows: each shift change 22%, daily 59.1%, weekly 14.2%, less than weekly 4.7%. More than half (61.6%) of the departments are conducting huddles between 5 and 10 minutes in duration. Tables 1 and 2 outline current practice related to involved personnel and topics covered.

More than half of the survey respondents confirmed follow up occurs on active issues during the next huddle. Of those departments, the team members providing the follow up include pharmacy leaders (44.7%), assigned team member based on original huddle (40.8%), and the next team member leading the huddle (14.5%).

All survey respondents were presented with questions identifying perceived best practice and those results are outlined in Table 3.

The final section of the survey prompted respondents to share outcomes identified by their departments secondary to safety huddles. Outcomes were shared by 229 respondents and included the following: improved communication and teamwork, improved situation awareness, decrease in serious safety events, increased identification of electronic health record-related safety concerns, improved culture of safety, reduced number of medication errors, and improved employee engagement.

Discussion

Daily safety huddles continue to be a feature of high reliability organizations per The Joint Commission. Many organizations have implemented this practice in a variety of ways, including weekly huddles, post-event huddles, pre-surgery huddles, etc. The direction provided by the Joint Commission gives organizations a starting point to develop and implement the huddle process. Available literature outlines the variety of practices currently in place and the positive outcomes resulting from the huddle process.

Based on 311 survey responses, most pharmacy departments are presently conducting safety huddles within their teams. Results demonstrated current practice includes a daily huddle lasting 5 to 10 minutes in duration.

A variety of topics are covered and several team members are involved in the discussion (technicians, pharmacists, and leadership). Interestingly, questions related to perceived best practice aligned with activities that are currently in place at most institutions. A summary of current practice compared to perceived best practice is provide in Table 4.

Health-system pharmacy departments are commonly involved in high-risk and/or high-alert practices that can greatly influence patient care. In line with the recommendations of The Joint Commission and the results of this survey, departments of pharmacy should implement a pharmacy safety huddle. Recommendations that reflect the perceived best practice and should be considered when structuring the pharmacy safety huddle can be found Table 5.

About the Author

Catherine E Korte, PharmD, MHA, BCPS, BCCCP; Director of Pharmacy at Truman Medical Center Lakewood; Kansas City, MO.

REFERENCES

  1. The Joint Commission, Division of Healthcare Improvement. (2017). Daily Safety Briefings – A hallmark of high reliability. Retrieved from https://www.jointcommission.org/assets/1/23/Quick_Safety_Issue_34_2017_Safety_briefings_FINAL.pdf.
  2. Ryckman, F. C., Yelton, P. A., Anneken, A. M., Kiessling, P. E., Schoettker, P. J., & Kotagal, U. R. (2009). Redesigning intensive care unit flow using variability management to improve access and safety. Joint Commission Journal on Quality and Patient Safety, 35(11), 535–543.
  3. Donnelly, L. F., Cherian, S. S., Chua, K. B., Thankachan, S., Millecker, L. A., Koroll, A. G., & Bisset, G. S. 3rd. (2017). The Daily Readiness Huddle: A process to rapidly identify issues and foster improvement through problem-solving accountability. Pediatric Radiology, 47(1), 22–30. https://doi.org/10.1007/s00247-016-3712-x
  4. Doyle, J., Silber, A., & Wilber, A. (2017). Bedside Safety Huddles to Manage a Complex Obstetric Case. Nursing for Women’s Health, 21(3), 166–173. https://doi.org/10.1016/j.nwh.2017.04.004
  5. Martin, H. A., & Ciurzynski, S. M. (2015). Situation, Background, Assessment, and Recommendation-Guided Huddles Improve Communication and Teamwork in the Emergency Department. Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association, 41(6), 484–488. https://doi.org/10.1016/j.jen.2015.05.017
  6. Melton, L., Lengerich, A., Collins, M., McKeehan, R., Dunn, D., Griggs, P., Bugajski, A. (2017). Evaluation of Huddles: A Multisite Study. The Health Care Manager, 36(3), 282–287. https://doi.org/10.1097/HCM.0000000000000171
  7. Trimble, A. N., Bishop, B., & Rampe, N. (2017). Medication errors associated with transition from insulin pens to insulin vials. American Journal of Health-System Pharmacy : AJHP : Official Journal of the American Society of Health-System Pharmacists, 74(2), 70–75. https://doi.org/10.2146/ajhp150726
  8. Brady, P. W., Muething, S., Kotagal, U., Ashby, M., Gallagher, R., Hall, D., Wheeler, D. S. (2013). Improving situation awareness to reduce unrecognized clinical deterioration and serious safety events. Pediatrics, 131(1), e298-308. https://doi.org/10.1542/peds.2012-1364
  9. Cropper, D. P., Harb, N. H., Said, P. A., Lemke, J. H., & Shammas, N. W. (2018). Implementation of a patient safety program at a tertiary health system: A longitudinal analysis of interventions and serious safety events. Journal of Healthcare Risk Management : The Journal of the American Society for Healthcare Risk Management, 37(4), 17–24. https://doi.org/10.1002/jhrm.21319
  10. Prager, J. D., Ruiz, A. G., Mooney, K., Gao, D., Szolnoki, J., & Shah, R. K. (2015). Improving operative flow during pediatric airway evaluation: A quality-improvement initiative. JAMA Otolaryngology-- Head & Neck Surgery, 141(3), 229–235. https://doi.org/10.1001/jamaoto.2014.3279
  11. Menon, S., Singh, H., Giardina, T. D., Rayburn, W. L., Davis, B. P., Russo, E. M., & Sittig, D. F. (2017). Safety huddles to proactively identify and address electronic health record safety. Journal of the American Medical Informatics Association : JAMIA, 24(2), 261–267. https://doi.org/10.1093/jamia/ocw153
  12. McBeth, C. L., Durbin-Johnson, B., & Siegel, E. O. (2017). Interprofessional Huddle: One Children’s Hospital’s Approach to Improving Patient Flow. Pediatric Nursing, 43(2), 71–76.
  13. Setaro, J., & Connolly, M. (2011). Safety huddles in the PACU: when a patient self-medicates. Journal of Perianesthesia Nursing : Official Journal of the American Society of PeriAnesthesia Nurses, 26(2), 96–102. https://doi.org/10.1016/j.jopan.2011.01.010
  14. Weaver, R. R. (2015). Seeking high reliability in primary care: Leadership, tools, and organization. Health Care Management Review, 40(3), 183–192. https://doi.org/10.1097/HMR.0000000000000022
  15. Keiffer, S., Marcum, G., Harrison, S., Teske, D. W., & Simsic, J. M. (2015). Reduction of medication errors in a pediatric cardiothoracic intensive care unit. Journal of Nursing Care Quality, 30(3), 212–219. https://doi.org/10.1097/NCQ.0000000000000098
  16. Lisa, M., Nixon, C., & Giarrusso, M. (2011). The Chemo Huddle: A Strategy to Minimize Errors and Maximize Chemotherapy Safety. European Journal of Oncology Nursing, 15(3), 278–278. https://doi.org/10.1016/j.ejon.2011.02.017
  17. McClead, R. E. J., Catt, C., Davis, J. T., Morvay, S., Merandi, J., Lewe, D., Adverse Drug Event Quality Collaborative. (2014). An internal quality improvement collaborative significantly reduces hospital-wide medication error related adverse drug events. The Journal of Pediatrics, 165(6), 1222-1229.e1. https://doi.org/10.1016/j.jpeds.2014.08.063
  18. Hoke, L. M., & Guarracino, D. (2016). Beyond Socks, Signs, and Alarms: A Reflective Accountability Model for Fall Prevention. The American Journal of Nursing, 116(1), 42–47. https://doi.org/10.1097/01.NAJ.0000476167.43671.00
  19. Leone, R. M., & Adams, R. J. (2016). Safety Standards: Implementing Fall Prevention Interventions and Sustaining Lower Fall Rates by Promoting the Culture of Safety on an Inpatient Rehabilitation Unit. Rehabilitation Nursing : The Official Journal of the Association of Rehabilitation Nurses, 41(1), 26–32. https://doi.org/10.1002/rnj.250
  20. Cruz, L. C., Fine, J. S., & Nori, S. (2017). Barriers to discharge from inpatient rehabilitation: A teamwork approach. International Journal of Health Care Quality Assurance, 30(2), 137–147. https://doi.org/10.1108/IJHCQA-07-2016-0102