Behaviour Based Safety Observation (BBSO):

Proactive Approach for Promoting Safe Sharp Handling Culture

in Operating Theatre

LAW  NGAI WAN

APN

ANAESTHESIOLOGY AND  OPERATING  THEATRE  SERVICES

QUEEN  ELIZABETH  HOSPITAL

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Sharp injury

• Increasing trend in sharp injury

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Contact sharp objects directly with bare hand

Lack of communication during transfer of sharp instrument

Inappropriate use of sharp safety 

devices

All these causes of injury are preventable

• Green staff• Suture handling • Standard practice 

was not followed

3

4

Teamapproach!Worktogether!

◦Meeting with Hospital OSH team and ICT team in May 2016

Continuous monitoring  by BBSO 

Standardpractice

Staff engagement

1. Reduce sharp injury rate

2. Enhance staff awareness in safe sharp handling

3. Promote and sustain safety culture

Promotestaffawarenessandengagement

•Launch slogan design competition in June2016

•Kick off ceremony 15 July 2016• Management commitment signing & support 

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• Photos of standardized practice delivered to all staff, COS for promulgation to surgeons and anaesthetists

• Video uploaded to department website for training & easy access

StandardizedPractices

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Trainingworkshop•Demonstration and return demonstration on practical skill  of sharps handling

•Target for staff under 3 years OT experience

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Behaviour‐BasedSafetyObservation(BBSO)

•Process focuses on safe acts/behaviours and unsafe acts/at risk behaviours,

•Proactively address all unsafe acts, not just those which result in incidents/injuries,

•Process provides positive feedback and reinforcement on safe acts,

•Promote staff awareness on safety culture,

•Sustain culture change by continuous safety observation.

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BBSOchecklist

Adobe Acrobat Document

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StepsinObservation1) Introduce yourself and explain purpose of observation

2) Use Observation Checklist as a guide

3) Observe the surgical  team activity (safe behaviour and at‐risk behaviour)

4) Feedback to observees: positive reinforcement on safe behavior, reflection on unsafe acts/at risk behaviour

5) Perform data analysis, find out causes of unsafe acts 

6) Communication observation results (safe & unsafe acts)

7) NO BLAME, NO NAME 

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BBSOresults

89.8%

96.2%94.7%

96.2%

97.8% 97.6% 98.1%

84.0%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

Mar‐17 Apr‐17 May‐17 Jun‐17 Jul‐17 Aug‐17 Sep‐17

SBISafe Behaviour Index

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Scalpel Blade

Syringe needle

Suture needle

Overall

0

1

2

3

4

5

6

7

8

9

10

item1

item2

item3

item4

item5

 item6

 item7

item8

item9

item10

item11

item12

item13

item14

item15

Numberofat‐riskbehaviors

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Atriskbehaviour

Item 9: Give verbal announcements when passing sharps

Item 8: Avoid putting fingers inside or immediate above transferring dish when  passing sharps to surgeon

Item 11: Use appropriate instrument for pointing the sharps items during counting procedures

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1

2 3

Continueimprovement

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Sharpinjuryincidentrate

17

8

0

2

4

6

8

10

12

14

16

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Mar‐Sept 2016 Mar‐Sept 2017No.of injury

Pre BBSO implementation   Post BBSO implementation 

52%

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Challenges

3TTime constrain (manpower)Timely feedback Time for cultural change

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KeystoSuccess

Communication

Teamwork

Compliance

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Acknowledgement

COS: Dr. S Wong

DOM: Ms SH Chan   NC: Ms C Yip

WMs: Ms A Che, Ms P Lee, MsMS Ma

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BBSO Observers TeamMr Fung Hing Man   Ms Chu Wai Ling  Ms Choi Shuk Mei   Ms Ho Kit Ying Ms Hui Mo Yin  Ms Lai Hoi Yan     Ms Leung Chow Ming   Ms Lui So Han

Sharp Injury Prevention Workgroup Members

Law Ngai Wan: blnwz02@ha.org.hk

Reference

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L. Spruce. “Back to Basics: Sharp Safety.” AORN Journal, vol.104, pp. 30‐45, July 2016.

R. Berguer & P.J. Heller. (Sept 2004) “Preventing Sharps Injuries in the Operating Room.” American College of Surgeons. Internet: 199(3), pp.462‐467. Retrieved from: https://pdfs.semanticscholar.org/6fee/a3e27ed045883b71e0c34546d328bd45b1f4.pdf (3 March 2018). 

WSH Guide To Behavioural Observation and Intervention. Workplace Safety and Health Council in collaboration with the Ministry of Manpower, April 2014.  Retrieved from: https://www.wshc.sg/files/wshc/upload/cms/file/2014/WSH_Guide_to_Behavioural_Observation_Intervention.pdf (25 April 2018).