“In order to have safe patients, we need safe staff,” says Lorrie Laframboise, Manager of Nursing on 5A Surgery at St. Paul’s Hospital (SPH).

Every day at 7:30 a.m., the 5A team – including the manager, co-ordinator, educator, nursing staff, aides and housekeepers – meets for a short but informative five minutes to debrief about the previous evening and to discuss the upcoming day’s business.

Some members of the SPH 5A Surgery team wearing their “A-Team” jackets, from left to right: Aaron Zepick, Christine Zielke, Sheryl Burke, Feng Dai and Phoebe Chometa.

Some members of the St. Paul’s Hospital 5A Surgery team wearing their “A-Team” jackets, from left to right: Aaron Zepick, Christine Zielke, Sheryl Burke, Feng Dai and Phoebe Chometa.

“We also talk about the hazards for staff in the workplace. We know what the patient hazards are, but what about the staff hazards?” asks Laframboise. “Usually, staff will bring up things like watching out for the floor cleaning machine because the floors get slippery. We talk about how we can distribute the workload correctly, so we’re not rushing, and who is going to partner with whom to help move patients, so our staff doesn’t get injured.”

“5A Surgery is a unit with an environment that fosters teamwork and safety. Every member of the 5A team works together to ensure the safety of our patients, our coworkers and our unit as a whole – I love being part of the 5A team!” Christine Zielke, BSN, RN

The team meets in front of a board, where they record all of 5A’s patient and staff safety concerns. Each week, the concerns are transferred to a communication book for staff to reference. To make it even easier, Laframboise is in the process of converting the book to an e-communication.

“The team on 5A has an excellent safety culture. I think the reason that my staff is so safe is because they’re engaged,” says Laframboise.

5A Surgery’s safety initiatives

In addition to discussing both patient and staff safety every morning, Laframboise employs a number of strategies to ensure that her staff remain safety-focused. Some of these strategies include:

  • Spot the Hazard: A safety exercise that challenges staff at random to look for hazards in unlikely places. For example, “I might put an oxygen tank in our equipment room, randomly grab people and ask them, ‘Can you spot the hazard?’ so they’re always thinking from a safety perspective,” says Laframboise.
  • Quiet Time: SPH 5A Surgery has designated quiet time from 1 to 2 p.m. every day. “At one o’clock we dim all our hallway lights and shut the end doors to take the noise level down. This not only allows our patients to rest, it also provides my nursing staff with an opportunity to sit down and chart. It’s a chance for them to catch their breath before the mid-afternoon rush.”
  • Overcapacity Plan: The team has pre-designated pods and spaces for overcapacity beds and a board that clearly states when the unit is at overcapacity. “Our unit looks a lot different from other units when we’re in overcapacity. My staff remains calm – you won’t see them unsettled and running all over the place. I always remind them to deal with patients one at time. This focus allows my staff to avoid cutting corners, making more errors and being less safe.”
  • Theming Safety Alert System Reports: The 5A Surgery team is working with one of the Safer Every Day teams to create a tool that will organize their safety alert calls into themes, allowing staff to analyze the reports from a risk management perspective. “We’re looking at how we can create a report that will group similar information so that we can see on a weekly or monthly basis how we are doing in regards to safety. For example, the report might show that distraction is the primary cause of medication errors. Once we have this information at our fingertips, we’ll be able to determine how we can work with staff to decrease errors.”
  • Training for Charge Nurses: Laframboise organizes four hours of training for charge nurses in addition to the training provided by the Region. “During our four-hour in-house workshop, we talk about different safety scenarios. My charge nurses are very well trained and will call additional safety meetings if needed.”
  • Fostering Team Spirit: “We always joke around that we’re ‘The A-Team,’” Laframboise says, in reference to a television series about a special forces team. The team has created their own symbol, which they’ve placed on black jackets as a representation of their solidarity and commitment to work as a team to be safer every day.

“Some of the things we do might be a little different, but they work,” Laframboise says, smiling.

“Our team is not scared to fail forward fast,” she adds. “We’ll try it and if it doesn’t work, we’ll try something else. I have a lot of leaders on my team who want to see each other do well.”