Table 1

A modified version of the step-by-step working process of the GC method described by Källman et al,17 as implemented in the PACU

1. Identification of the risks or patient injuriesRisks or injuries are documented using the detailed report form by the healthcare professional who discover them. This can be anonymous or signed. The PSIs written within the last 24 hours are read aloud each morning for the nurses (daily safety briefings).PACU nurse reports: Patient from OR wakes up at the PACU, laying on the hard transfer board. This was only discovered when the patient was sent to the ward.
2. Assessment of seriousnessThe healthcare professional who discovered the PSI assesses the severity and colours it accordingly in the detailed report form: red, orange, yellow and green denote serious patient injury, patient injury (not serious), risk of patient injury and no event, respectively. The PACU staff discusses severity of the PSIs each morning (daily safety briefings). Subsequently, the severity of the most serious PSI is illustrated on the basic GC template (figure 1), with a relevant colour code for the concerned date.The PSI is read aloud in the daily safety briefing.
Manager: Does everyone agree that this is a yellow incident?
Staff: Yes. This could cause pressure ulcer.
The basic GC template is then coloured yellow.
3. Reporting of injuriesAll patient injuries (red/orange) are reported in the hospital’s electronic IRS.Not reported in the IRS, as this is a yellow category incident.
4. Improvements of work/interprofessional weekly QI meetingsSystematic daily work on improvements is performed using interventions to address risks once they are identified or during the weekly interprofessional QI meetings (30 min). The detailed report form becomes part of the monthly summary and raises awareness of what the PACU needs to focus on to enhance patient safety.The PSI is discussed in the GC interprofessional QI meeting. Conclusion: This has happened several times before.
5. Follow-up and learningFollow-ups occur in the weekly interprofessional QI meetings and in the daily work on improvements.
All events noted in the detailed report form are summarised monthly to visualise the outcomes and identify the problem areas. Based on the monthly summaries, long-term measures are taken to prevent the events from repeating.
  • One surgical nurse brings this information back to the OR

  • Learning through focus on PACU staff education day

  • Learning through information in weekly PACU-bulletin

  • GC, Green Cross; IRS, incident reporting system; OR, operating room; PACU, postanaesthesia care unit; PSI, patient safety incidents; QI, quality improvement.