All Entries Tagged With: "checklist"
Lancet op-ed says checklists are good, but not healthcare’s savior
In the past couple of years, much has been made of the use of checklists in the medical field to bring about better patient outcomes and keep patients safe. The most successful project to date that used checklists was the Keystone project in Michigan which used evidence-based methods to sharply reduce the central line infection rate in more than 100 ICUs in that state.
A new op-ed from The Lancet says that while this project showed how a checklist could be used to reduce infection, it was not simply the checklist that accounted for the project’s success. Many other factors worked together with the use of a checklist to reduce the infection rate; since the story was made public through the media, however, most of the project’s success has been attributed to using a checklist. The authors of the op-ed, Charles Bosk, Mary Dixon-Woods, Christine Goeschel, and Peter Pronovost, suggest that using this idea, that checklists are a simple solution to many patient safety problems, actually puts more patients’ safety at risk because of the lack of understanding of the many other factors that made this project a success.
The authors discuss the many factors that were a part of the project’s success: a commitment from each hospital’s leadership team, hours of research and learning on the part of the team leaders identified by hospital leaders, months of meetings to hash out the best plan for moving forward, data collection and reporting on the part of infection control practitioners, and finally the cheklist as a means of keeping team members on track and fostering a good culture of safety.
Additionally, the op-ed’s authors bring up the point that not all problems can be solved even partially by using a checklist–it’s just better suited for some issues and not others.
You can read the full op-ed here (free registration may be required). It’s an interesting take on an idea that’s been well publicized and praised in the past couple of years.
WHO publishes checklist for treating patients with H1N1
Although H1N1 has not been prominently featured on this blog, this checklist from the World Health Organization (WHO) caught my eye because it goes over important infection control and prevention techniques that should be used with every possible H1N1 patient that enters your facility. The WHO Patient Care Checklist: new influenza A (H1N1) released last month by the WHO, can be modified to fit any local practices your facility has also incorporated into treating flu patients. It was tested at facilities around the globe, including Brigham and Women’s Hospital in Boston, MA.
For development of the checklist, the WHO sought advice from experts in:
- infection control
- clinical management of pandemic-prone Influenza
- health care checklists
To read more about the checklist, and to find a version written in Spanish, click here to go to the WHO’s Web site.
CNN is reporting that a vaccine for H1N1 will be made available in the U.S. by October. Today, secretary of health and human services Kathleen Sebelius spoke at a “flu summit” mandated by the Obama administration in an effort to launch a national campaign about H1N1. Experts worry that the flu will spread faster once the fall hits and the normal flu season begins.
To read more about today’s summit, click here.
Has your hospital struggled to prepare for an influx of H1N1 cases? Do you anticipate more training in the future?
Does “ethics checklist” have a place at your hospital?
In the last year, much has been made of the power of checklists. Peter Pronovost and his team from Johns Hopkins succeeded at proving a checklist used in Michigan ICUs helped reduce or prevent central line infection rates. Recently this was replicated in hospitals around the country. The World Health Organization (WHO) Surgical Safety Checklist was proven to reduce surgical errors by one third in operating rooms around the country, and has been incorporated into the IHI’s latest campaign.
Last month the British Medical Journal published a study about a new type of checklist–an ethics checklist. This article in American Medical News provides a more in-depth look at the checklist and uses. Some interesting questions come out of the use of this new checklist, which is currently being piloted at Washington Hospital Center in Washington, D.C. One of these is are checklists becoming an of-the-moment solution for many patient safety concerns?
The American Medical News article contains feedback from both Pronovost and Atul Gawande, director of the WHO initiative. Both agree that checklists alone will not change the behavior of healthcare workers. For specific interventions they have succeeded because of commitments to culture change and an understanding of why the checklist is useful.
The ethics checklist contains items such as ensuring patients’ ideas about treatment , end-0f-life wishes, and family situation/ interactions are all clear. Those who are piloting the checklist are excited about the potential it has to integrate ethics questions more easily into patient care.
