Checklists? Check!
One simple tool – a checklist – is known to reduce the risk of costly mistakes, strengthen patient care, and improve overall patient health outcomes. A recent study in the New England Journal of Medicine found that using the World Health Organization’s (WHO) “Surgical Safety Checklist”– which requires surgical teams to complete certain tasks before “sign-in”, “time-out”, and “sign-out”– can reduce both post-op complications and death rates by about 36%. Surgical patients are not the only ones who benefit from checklists. HMC Partner hospitals have demonstrated success with checklists for hourly rounding and whiteboard content among others. It’s safe to assume that checklists of all varieties are in wide usage throughout hospitals, right?
The best answer to that question might be “maybe”. HMC Partner hospitals use a wide variety of checklists including surgical safety checklists (see “The Checklist” Survey for details). Only 20% of US hospitals, however, are known to be using the WHO checklist. Some hospitals have embraced checklists and others are using them while working through resistance and pushback, stemming from another step added to an already confusing array of patient care. Still others are in various stages of developing, implementing, and/or monitoring checklist usage. In a recent article, checklist advocate Dr. Peter Pronovost notes: “I am heartened by the growing use of checklists in hospitals, and flattered to see that leading medical journalists, such as Atul Gawande, are supporting our work and helping us spread the word”.
Checklist Questions and Caveats
In the same Huffington Post article cited above, Dr. Pronovost goes on to mention that checklists alone will fail at improving anything if there is poor communication between doctors and nurses. A paper checklist will work best for a well organized, cohesive patient care team that fosters open communication and encourages input from all members. In this setting, the checklist serves as a reminder to those doing patient care and takes the burden of remembering everything off the individual(s) performing a procedure, rounding on patients, or any other task that can be written up as a checklist. Without a checklist, the individual performing any action must remember all the steps associated with that action. With a checklist, pressure is removed as steps that formerly had to be committed to memory are now committed to paper (or electronic records). In addition, more than one person sees the steps written out on the checklist, reducing the room for errors.
HMC Partners can find additional information and checklist successes in this related HMC white paper.
Michelle Gray-Bernhardt is a Knowledge Manager at HMC. Reach her at mgray@HMCCentral.com or 262-242-9471 for information about joining the HMC KnowledgeWeb for Nurses.
