Rule breaking and normalisation of deviance |
Rule breaking and normalisation of deviance |
Rule breaking and normalisation of
deviance |
1 |
People |
Requirements for induction of new staff
and communication of changes to existing staff should include simulated
walkthroughs of critical tasks and multimodal communication tools (e.g.
email, WhatsApp groups, staff briefings). Where tasks are likely to be
low frequency, they may be supported by SOPs. Ensure staff coming to the
centre understand that the use of checklists is ‘business as usual’ in
OxCRF and direct them to guidance and training available for bespoke
checklists. |
2 |
Task |
Clarify and standardise PPE requirements
throughout OxCRF, focusing on likely points of proximity to pathogens,
as well as specific tasks. Requirements may vary according to activity
in OxCRF. This could be communicated at daily briefings. |
3 |
Tools |
Standardise the format of signage for key procedures in the
OxCRF. Consider utilising technology to support standardised, visual
confirmation throughout OxCRF that higher risk trial processes are
underway (e.g. lit signs in radiology when x-ray is in
use) |
Standardisation and use of checklists |
Standardisation and use of checklists |
Standardisation and use of checklists |
4 |
People |
Review of training offered in the OxCRF
including frequency, types of training (e.g. online, in-situ simulation)
and quality assurance processes. Ensure training is offered in the use
of checklists. |
5 |
Task |
Standardise the anaphylaxis box and
instructions with those in use in the OUHFT |
6 |
Tools |
Develop an OxCRF template for checklist
design. Trials teams should be encouraged to design checklists for
safety critical procedures using guidance in current SOPs. Ultimately a
‘quick reference handbook’ (QRH) much like the national QRH for
anaesthetics could be developed |
Work system factors – PETT scan |
Work
system factors – PETT scan |
Work system factors –
PETT scan |
7 |
People |
Team communication to include review of
activities at daily briefing (a “safety huddle) which specifies
adaptations to activity required e.g. adjusting pathogen collection
times to avoid scheduled lab meetings. |
8
|
Environment
(physical)
|
Working with study teams, consider if there is better placement
within room of key items (e.g. the clock). Explore if doors in OxCRF
have option to remain open without need for physical contact.
|
9
|
Environment
(physical)
|
Consider changes to the environment that would improve visibility and
audibility during procedures e.g., adapt CCTV technology already in use
to allow better monitoring of procedures during the project. An intercom
system between participant’s room and corridor would support key tasks,
and if more harmful agents being tested, would improve communication
with the participant.
|
10
|
Environment
(physical)
|
Review of possibilities for donning and (more importantly) doffing PPE
in an alternative area.
|
11
|
Environment
(physical)
|
Review facilities for staff on site in collaboration with study
teams
|
12 |
Task |
Consider detailing ‘go, no-go’ criteria for every study
group, and ensure they are understood by all members of the team.
Specific communication options (e.g. buzzer) could be used as
alerts. |
13 |
Tools |
Switch to electronic recording system for sample
storage |
14 |
Tools |
Use simulation as a tool to explore pathways and novel
procedures and understand latent risks before they become
real |