New cutting-edge technologies, the uniqueness of patients, a constant increase in the volume of care, and the need for versatility among caregivers require our healthcare system to develop an organizational, vicarious, and multimodal network.
Pending the development of such a network, the increasing complexity of care activity combined with pressure on human resources increases the risk of adverse events.
Identifying and understanding these events through a systemic analysis is fundamental to learning from them (and ensuring they don't happen again).
RMMs (morbidity-mortality meetings) and CREXs (experience feedback committees) are meetings dedicated to sharing experience and analyzing events that may be accidents, incidents or near misses.
The analysis is also an opportunity to revisit key solutions such as teamwork.
CREXs are the result of a multi-disciplinary approach to the analysis of a specific event, leading to improvement measures. These committees, which generally meet on a monthly basis, are designed to complement RMMs by taking action on identified precursors, upstream of the incident.
Usethese meeting times to develop the right culture
According to the French National Authority for Health, a Morbidity and Mortality Review is a "collective, retrospective and systemic analysis of cases marked by the occurrence of a death, a complication, or an event that could have caused harm to the patient, with the aim of implementing and monitoring actions to improve patient management and care safety"*.
Specifically, it is a comprehensive analysis enabling a diagnosis of a team's functioning and the implementation of a program to improve practices. It moves beyond reflection focused solely on one or more individuals.
The High Authority for Health reminds us that it is about "searching for the causes and not who is at fault". This approach involves understanding what happened during the adverse event, without blaming professionals. Thus, the facilitator must know how to respect strict neutrality in the opinions heard and not have the role of a judge.
The analysis of adverse events improves the quality and safety of care and does not consist of blaming healthcare professionals or seeking a responsible party.
Following this analysis, lessons can be learned about existing strengths and vulnerabilities in order to carry out actions to improve the quality and safety of care.
For a successful MMR, it is essential to propose an approach based on objective analysis, founded on a fair and positive culture. An ethical commitment on the part of the facilitator and other participants is essential.
Respect for the confidentiality of the comments made by participants, as well as the cases studied, is essential.
Criteria of good conduct for a successful morbidity-mortality meeting: listening to other participants, respecting professional secrecy, respecting the confidentiality of what participants say, respecting the confidentiality of cases studied, no culprits, no judgments...
Key steps in CREX - RMM
Classically, these discussion periods follow different key stages:
- Reconstruction of the event timeline:
The care process is broken down into successive chronological steps.
When did it happen? Who are the actors involved (anonymously)? What actions (or omissions) have they taken? How were the actions (means used) carried out?
- Investigation of the causes of the event:
Numerous factors can explain why SAEs occur: the multiplicity of actors involved around the patient, their interactions, task interruptions, stress or fatigue management, etc.
Thus, upstream of the error, it is necessary to understand the malfunctions and identify all the causes (immediate and underlying) that contributed to the occurrence of the event. These are only revealed during an in-depth analysis of the causes.
- Analysis of safety barriers:
Safety barriers correspond to all human, technical or organizational means that make it possible to avoid the occurrence of a SADE, to catch it when it occurs or to mitigate the severity of its consequences.
- Action plan and follow-up:
Following this in-depth analysis of the EIAS, the next step is to choose the corrective actions to be taken, and how they are to be implemented.
During the analysis process, our experts believe that it is also very interesting to share successes or elements that have made it possible to recover a situation that was off to a bad start. Sharing successes also has the virtue of questioning what works rather than what did not work. The corollary of this question is to then protect the elements of success: briefing, checklist, clear distribution of roles, etc.
Simple things can help you analyze your experiences: favor questions that start with how rather than questions that start with why. The risk of questions that start with why is that they lead to a sterile search for causes for improving the care activity, while questions that start with how allow healthcare facilities to pinpoint the organizational functioning.
SafeTeam and the organization of a morbi-mortality meeting
The analysis of a medical incident cannot be improvised. To develop patient safety in your hospital and to be part of a modern risk management approach, it is necessary to evolve your meetings to make them multidisciplinary and informative.
With this in mind, the SafeTeam Academy has designed a training course on the organization and conduct of a Morbidity and Mortality Review. In this course, the learner will conduct or participate in an M&M following a medication error. They will be questioned about their skills in terms of safety culture and will systematically analyze their activity. At the end of the module, they will attend a presentation explaining the key steps of these "patient safety" meetings.
If you too would like to play your part in improving the reliability of care within your facilities, SafeTeam Academy training courses are for you! To find out more, write to contact@safeteam.academy.
