CLINICAL COMMISSIONING FOR SAFE

FACILITY OPENING
CARE NATIONAL HOSPITAL EXPERIENCE

LENY FORTALEZA , DON

RN, MBA, CPHQ, FAIHQ

DUBAI , 2015

OVERVIEW: CARE National Hospital

Built in 1967
First private hospital
50 beds
Expanded in 1986 to 124 beds
2010 Construction of the new tower
324 beds
CBAHI accredited ; ARAMCO Medical
designated facility in Riyadh ;
preparing for JCI accreditation

LEADERSHIP
VISION:
To be the preferred & most trusted hospital by the patients &
community in the region

MISSION:
Fully committed to provide high quality , cost effective health
care services through highly qualified staff & applying state of
the art latest technologies in a patient focused environment

Training
&
Education
Quality
Inspection

SCORE

PreOccupancy

Readiness

Planning

Testing

Occupancy,
Post
Occupancy
and
Stabilization

Transition

Facility Readiness:
Cleaning
QI Infection control, Safety, Environmental,
Nursing.
Building Management System report.
Technology commissioning
Equipment installation & testing

Department readiness
a. Site readiness check list from respective depts.
b. Site Handover and Clearance report for new facility from QI,
Operational Department, Contractor.
c. Technology Readiness IT department and Biomedical
Department.
d. Par levels of Medical Consumables
e. Equipment acceptance report and allocation
f. Training Task Force Report
g. Manuals for Internal Policies and Procedures for all
departments
h. Process flows

QUALITY REPORT

TESTING & transition

Preoccupancy
Score Implementation
Post occupancy
Stabilization

Pre Occupancy Requirements

Mock Movement Plan

Migration of Service plan

Timelines & pathways
Command center & teams
Mock movement scenarios,
execution& report
Nursing Assessment & transfer
checklist

a.
b.
c.
d.
e.
f.

Laboratory
Endoscopy
Radiology
Patient Services
Physiotherapy
Central Sterile Supply
Department
g. Out Patient Clinics

Pre Occupancy Requirements

Units that were moved :
Neonatal Intensive Care Unit/
Labor and Delivery/ Women
Care
Pediatrics/ Female MedicalSurgical
Emergency Room
ICU/Renal Dialysis Unit
Operating Room/ Post
Anesthesia Care Unit
Medical Surgical/ VIP

Simulation Scenarios (Full

Continuum of Care)- SCORE
Drills (Code Blue, Code Red,
Code Pink)
Patient Flow Process
Medication managment
Move day
Emergency code activation
Transfer in & out
Admission to in patient units

Movement Plan & Report

DATE : AUGUST 11, 2013

Modalities

FROM UNIT : WEST-B1

TO UNIT : WOMENS CARE-B2

Number of Patients for transfer : 3 PATIENTS

Wheelchair : 3

Stretcher : 0

Start Date & Time : AUGUST 11,2013 AT 0800H

End Date & Time : AUGUST

11,2013 AT 0815H

Bed: 0

Planned duration of movement :15MINUTES

Movement Team : MARIEVIN

Transport Incubator: NONE

Team Leader: RITA HORCABAS

Receiving Team: RINCY

Crib: 0

ROOM #

MR #

From

To

Acuity
Transfer
level Nurse/Team

Transfer
modality

Time
Start

End

Receiving
Team/Nurse

Remarks

142536

173

203

MARIEVIN

WHEELCHAIR 0800H

0805H

RINCY

NONE

141516

179

204

ARRIANE

WHEELCHAIR 0805H

0810H

RHEA JOAN

NONE

635241

172-A

213-B

DEBBIE

WHEELCHAIR 0810H

0815H

CATHERINE NONE

NURSING ASSESSMENT & PATIENT TRANSFER CHECKLIST

From Room #:
173
Patient name:
Ziksarat Adel
MR #
:
1142528
Endorsing unit : Wing C- West
ITEM

To Room # : 203

Date: August 11, 2013

Time: 0800H

Receiving unit : Womens Care

ITEM

ITEM

Patients acuity level

1
3
2
4
Transport modality
stretcher with side rails up
wheelchair with foot /arm rest in place
bed with side rails up
crib with side rails up
incubator
assistive devices (pls. specify)____________
none

Patients medical record

current file only
with old /thinned out files
Patients XRAY films
complete (pls. specify # of XRAY films available) none
with pending XRAY films(pls. specify reason for
unavailability)_____________________________________

Sitter bed needed

YES
NO
Additional assistance during transport
one person to assist in transport
needs two or more persons in transport

Valuables :
None
with patient
given to relatives
endorsed to nurse

Laboratory :
all Lab results in __________________________________
with Pending results _______________________________
for extraction _____________________________________

Written Physicians Approval for transfer :

YES
NO

Physician informed of Patients new

Location :
YES
NO

Medical equipment/ support

Oxygen
suction machine
portable ventilator
IV stand
Infusion pump
syringe pump
ambubag
pressure reduction mattress
none
OTHERS_______________

Drains/Catheters secured:
NGT
Foleys Catheter
JVAC/JP Drains
YES
YES
YES
NO
NO
NO
IV cannula gauge____22__ patent
YES
NO
Central line patent
Chest tubes _________(specify site)
YES
YES
NO
NO
None
OTHERS : _____________

Vital Signs :
Pre- Movement
Post Movement
Temp : 36.8 C
Temp : _______
Pulse : 91 bpm
Pulse : ________
Respiration : 20 breaths/min
Respiration: _________
O2 sat : 95%
O2 sat: __________
Pain score : 1/5
Pain score : __________
Blood Pressure : 120/70mmHg
Blood Pressure : ___________
_________________________________________________
MEDICATIONS GIVEN :

Safety straps attached

YES
NO
Restraints applied
YES
NO

Patients medications
Current medications available and complete
With pending medications from pharmacy__________________
With medications from home available
IVF : _None_

Name of Medication

Time of Last Dose

Tab Disflatyl 2 X 3
Syr. Duphalac 30 ml at HS
Inj. Voltaren 75 mg IM BID
Inj. Zinoxime 1.5 gms IV every 12H
Inj. Clexane 40 mg SC every 24H

0600H
2100H
0600H
0600H
0600H

CLINICAL OPERATIONAL COMMISSIONING

- ensures

that the staff can perform the work

processes safely & efficiently within the building

- it utilizes scenarios that depict real life situations

analyze how processes will work & if any risks to
quality & safety exists

SCORE
Safe Clinical Operations
Readiness Evaluation Simulation
Source Joint Commission Resources
www.jcrinc.com/
21

READINESS AND
PREPARATION

What is SCORE?
Assessment of organizations readiness to provide safe
care through the key healthcare flows for:
- Patients,
- Providers,
- Visitors,
- Supplies,
- Equipment,
- Medication
- Information

Integration of multiple processes simultaneously that

reflect actual operations in a simulation mode
Staff preparation provided in simulated real life
scenarios.

When to use SCORE?

Ideal time is two weeks prior to opening re :
Time to resolve any critical failures or potential failures
within the processes
Staff should be hired, trained and ready for activating
the facility
Equipment installations are completed
Information Systems have been installed and are
operational

How to use SCORE ?

Identify key flows for patient safety
Define successful process flows
Build scenarios incorporating the flows
Create Simulation Schedule for event

SCORE SCENARIO: ER
SCENARIO
DESCRIPTION

Emergency Department management for three acuity levels of patients from arrival to
discharge

PATIENT
TYPES

Trauma Patient: Vehicular accident with head trauma and crushing injury to R Tibia family arrives
Acute Patient: MI Patient Presents with crushing chest pain and diaphoresis
Minor Patient: Pediatric patient presenting with cough and fever accompanied by mother

STAFF
REQUIRED

Patients and Family: 3 Patient Parent for Peds, patient 3-4 family members for Trauma patient,
Spouse for MI patient
Staff Members: Red Crescent ambulance and staff for trauma, Triage staff, patient services staff,
customer care, ED physician(s), Phlebotomist, Treatment nursing staff, respiratory therapists-2,
Intensivist, Area Manager, Code Team

OBSERVERS

Triage

Main Room Pediatric

Flow
Patient

Minor Patient
3 year old presents with mother to
Triage desk with history of fever 101105 for the last two days. Patient
began coughing one day ago and is
coughing up greenish-yellow sputum.
Patient driven by father who is parking
car.

Acute Patient
56 y.o. male presents Information desk in
front lobby asking to find the ED.

Trauma Patient
Patient arrives by Red Cresecent from
vehicular accident. Injuries reported are
patient found unresponsive with bone
fragments protruding from a major laceration
on right lower leg.

Key Processes
to Test

Parking for family

Triage
Infection Prevention
Pediatric Treatment Area
Registration
Radiology Test for Chest x-ray
Admission to Inpatient Unit
Isolation
Respiratory Therapy

Signages
Triage
Relative Waiting area
Adult Treatment
Cardiac Work up with Lab
Code in ED
Code Communications
Transfer to ICU
No Aspirin Response

Ambulance arrival and management

Trauma Room and Treatment
Code Blue in Radiology
Transfer to OR
Blood Bank

Equipment
Focus

Triage Equipment
Nurse Call
Monitors
IV Pumps
Radiology Room
Phone System

Triage Equipment
Nurse Call
Monitors
IV Pumps

Nurse Call
Monitors
IV Pumps
Trauma Equipment
CT
PACS

Supplies

Staff can find appropriate supplies

Staff can find appropriate supplies

Staff can find appropriate supplies

Visitor/Family Appropriate care for Family

Appropriate care for Family

Appropriate care for Family

Providers

Appropriate use of equipment

Locating Supplies
Exhibit Patient/Family
Centered Care
Procedural Compliance

Appropriate use of equipment

Locating Supplies
Exhibit Patient/Family Centered
Care
Procedural Compliance

Appropriate use of equipment

Locating Supplies
Exhibit Patient/Family Centered
Care
Procedural Compliance

Medication
Management

Pediatric Dosages
Medication storage and
access
IV calculations

Cardiac Meds
Medication storage and access
IV calculations
IV Pump set ups

Medication storage and access

IV lines for Trauma
IV calculations
IV Pump set ups

Information

Triage information
Handovers
Communication System
Patient Record

Triage information
Handovers
Communication System
Patient Record

Handovers
Communication System
Patient Record

CRASH CART REPLENISHMENT FLOW

PHARMACIST
ENTERSTHE
MEDICATIONS
IN THE
LOGSHEET
WITH BATCH
NUMBER AND
EXPIRY

STAFF NURSE AND

PHARMACIST
CHECKS AND
BOTH SIGNS THE
LOGSHEET, LOCKS
THE CRASH CART
TRAY AND WRITE
THE SERIAL
NUMBER OF THE
CRASH CART TRAY
LOCK

STAFF NURSE
RETURNS THE
REPLENISHED TRAY
TO CRASH CART,
LOCKS THE CRASH
CART TROLLEY AND
REQUESTS
REPLACED MEDS
THROUGH SYSTEM

NO GO SCENARIO
Major internal disaster
Major external disaster
Utility Failure in the new building
Major Staff sickness episode that will
affect operation
Significant flaws found in the process

Operation Optimization

STABILIZATION
INITIAL DASHBOARD
ITEM

DETAIL

FOLLOW - UP

TEMPERATURE TOO
CALIBRATION OF BMS/AIR
COLD
BALANCING
PNEUMATIC TUBE
2. SYSTEM / TECHNOLOGY
UNDER FINAL STAGE OF TESTING
NON FUNCTIONING
1. FACILITY

3. SUPPLIES / LINENS
4. PHARMACY
5. SECURITY
6. ENVIRONMENTAL
SERVICES
7. FOOD SERVICE
8. WORK FLOW

Linen cart

Missing linen cart on 3rd Floor

RESPONSIBLE
PERSON
Engr. Sulaiman
Project Engineer
Engr. Jihad
Biomedical
Mr. Khalid Rubaiq
Support Services

Delay in receiving medicines from

Engr. Mubarak
Medication delivery
Pharmacy
IT
Improve card filler system
Floor Access &
No infant security system
Mr. Khalid Rubaiq
Infant Security Doors are not manned by Security
Support Services
Delay in after discharge cleaning
Mr. Khalid Rubaiq
Rooms
Slow turn over time
Support Services
Trays not pick up before the
Mr. Khalid Rubaiq
Tray Pick Up
Doctors Rounds
Support Services
Discharge Process needs to be Mr. Arahman Warwari
Reception Desk
improved/reduce waiting time
Patient Services

Post Occupancy Assessment

NOT SUCCESSFUL

SUCCESSFUL

CRITICAL SUCCESS
FACTOR

LESSONS LEARNED

"What was done well and

should be replicated?"

"What should we do
differently?"

DATE :
1

Department Readiness

Technology Readiness
Operation Readiness

Staff Readiness

Timely recruitment &

coordinated supply chain
management; complete all
change requests like
handwashing facilities
Ensure complete delivery of
Early allocation & staff
equipments; inconsistent
training
vendor training schedule
Early involvement of staff; Identify area of risk and provide
implementation of SCORE; focused readiness attention;
completed manuals, P/P
complete all process flows
Equipment orientation &
Early recruitment to complete
training; Scavenger hunt;
manpower requirements &
service access pathways ;
meet internationall standards
frequent team meetings

Early access of staff to the

facility to support
Department Readiness and
Transition

Transition

Mock moves and Simulation

scenarios

reliable communication tools

Stabilization

Senior management
engagement and support

Anticipate capacity issues.

Summary:
Clinical commissioning is essential in safe , efficient & effective operation of the facility.

Meeting the requirements for each stage ( planning, testing & transition ) were crucial
to assure the planned care environment is ready to receive patients & can continue to
support safe patient care
Facility commissioning & clinical commissioning are interdependent & can lead to
better outcomes for health care organizations .
Conducting Simulation scenarios ( SCORE ) identified opportunities for improvement of
our processes , patient care & experience .

Summary :
Post simulation , occupancy & stabilization reports ensured that
issues were prioritized & addressed appropriately.
Early involvement of staff promoted general ownership &
commitment & allow the staff to work with confidence in the new
working environment.
Mock movement plan & execution were critical in ensuring safe
patient transfer.

CONCLUSION :

Our experience with SCORE simulation formed a strong base in

taking occupancy of Care National Hospital in the most efficient,
safe , & cost effective manner for patients , families , visitors &
staff.