Process Action Team

The toxicity associated with SM is quite profound. The Army s Chemical Defense Equipment Process Action Team estimated in 1994 that a 900 mg-min/m SM vapor exposure would be lethal in 2-10 min, based on animal studies (National Research Council Review, 1997). Fortunately, in the battlefield, lethality has been limited. Only 1-3% of exposed soldiers died from SM exposure after WWI, and mortality mostly was not a direct consequence of SM, but rather the indirect effect of secondary respiratory infections. The 1999 Material Safety Data Sheet, put out by the US Army Soldier and Biological Chemical Command, USA Edgewood Chemical Biological Center, has estimated the LD50 of a skin exposure to sullur mustard as lOOmg/kg. This roughly translates into as little as 7 ml of neat SM (i.e. 8.9 g) spread over the skin resulting in the death of a 80 kg adult (Department of the Army, MSDS, 1999). The cornea, of course, is more sensitive than the skin. Below we review three chief toxic effects of severe SM exposure to the cornea. 

The FOCUS-PDCA/PMAIO Process Improvement Model is a statistical-based quality-control method for improving processes. This approach to problem solving could be used by all process action teams to ensure uniformity within an organization. FOCUS-PDCA/PMAIO is as follows ... 

Firstly, the PhRMA established a working team to address the need for improved BRA in 2005. The PhRMA working group developed the Benefit-Risk Action Team (BRAT) framework (Coplan et al. 2010), a general platform that seeks to incorporate all relevant aspects of the BRA. The BRAT framework consists of six steps as summarized in Table 15.1. The framework focuses on describing the BRA process that structures and assists decision making, but does not replace clinical judgment. 

Casey Hooke, advanced practice nurse and creator of the Safety Action Team (SAT) concept, defines SATs as department- or unit-based interdisciplinary work groups that provide a "think tank" for staff to identify safety concerns, process them, and brainstorm new ways to address them (Hooke, 2002). Group membership varies according to individual needs, but SATs strive to include members who represent the continuum of care for the patients they serve. SATs include registered nurses, physicians, pharmacists, respiratory care practitioners, child-life specialists, unit service coordinators, and members of the management team. The group is chaired by a staff leader, or sometimes by two staff leaders who share the responsibility. 

The CEO is chair of the Corporate Safety Review Board. The board is made up of all Senior ce Presidents from all divisions. All divisions and departments participate through their safely action teams. Note until the CEO is part of the process, you only have safety change functions. Until you have all divisions inclnded, you only have a partial program. SMS requires everyone to complete all three steps. 

Ideally these teams will be cross-functional and will have access to all the skills necessary to undertake the detailed analysis and implementation involved in the supply chain risk management process. The team should maintain a risk register , which identifies the possible points of vulnerability along with the actions that are to be taken to mitigate that vulnerability. 

An overall review of the management of change documentation package should be performed to ensure documentation update items (including material safety data sheets) are addressed and that PHA action items are complete. This can be done by one person but is often best achieved by a PSSR Team. The process needs to account for ... 

Operations The QRA team will need specific data on how the system is actually operated. For example, are the bypass valves normally left open to increase throughput, what happens when the high level alarm sounds, or do operators bypass interlocks to continue production Human actions/errors are usually dominant contributors to the real-world risks, and truthful data on actual process operations are vital to credible QRA results. Expect to commit one full-time equivalent for the life of the project. 

Step 5 Establish the Basis for the System Parameters. Is the process steady-state, or do the parameters represent transient or intermittent conditions These considerations qualify the nature of the operation, and ultimately qualify the conditions under which corrective actions are taken in any P2 activities the team recommends. 

The audit team, through its systematic analysis, should document areas that require corrective action as well as where the process safety management system is effective. This provides a record of the audit procedures and findings and serves as a baseline of operation data for future audits. It will assist in determining changes or trends in future audits. 

The audit includes a review of the process safety information, inspection of the physical facilities, and interviews with all levels of plant personnel. Using the procedures and checklist, the team systematically analyzes compliance with the PSM Rule and any other relevant corporate policies. The training program is reviewed for adequacy of content, frequency and effectiveness of training. Interviews determine employee knowledge and awareness ofthe safety procedures, duties, rules, and emergency response assignments. The team identifies deficiencies in the application of safety and health policies, procedures, and work authorization practices to determine live actions. 

PSM Action Plan —Task team formation Process overview —Benefits... 

Remember, there is no substitute for judgment and experience. Consider these quantitative exercises as toois or methods to guide your team s determination of the right priorities, not as absoiute formuias. in addition, keep in mind that your goai is to improve the overaii status of process safety as part of a continuing effort—not as a singie action, event, or siiver builet. ... 

If the pattern does not fit into an immediately identifiable pattern, the process worker may then consciously apply more explicit "if-then" rules to link the various symptoms with likely causes. Three alternative outcomes are possible from this process. If the diagnosis and the required actions are very closely linked (because this situation arises frequently) then a branch to the Execute Actions box will occur. If the required action is less obvious, then the branch to the Select/Formulate Actions box will be likely, where specific action rules of the form "if situation is X then do Y" will be applied. A third possibility is that the operating team are unable or imwilling to respond immediately to the situation because they are uncertain about its implications for safety and/or production. They will then move to the Implications of plant state box. 

Operator action event trees are treelike diagrams that represent the sequence of various decisions and actions that the operating team is expected to perform when confronted with a particular process event. Any omissions of such... 

The nursing process is a framework for nursing action consisting of problem-solving steps that help members of the health care team provide effective patient care. It is both a specific and orderly plan used to identify patient problems, develop and implement a plan of action, and then evaluate the results of nursing activities, including the administration of drug . 

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