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Digital Issues

Archive >  January, 2014 XV, No. 1

Safety: 7 Commonsense Checklist Enhancers

Follow these tips to eliminate surgical mistakes.

Stephen Harden

checklist CHECKING IT TWICE Checklists help your surgical team verify that critical safety steps haven't been missed.

Whether you're thinking of implementing a surgical safety checklist for the first time or looking to enhance the one you've been using for years, these 7 tips will improve the usefulness of this simple but highly effective patient protection tool.

check markMake it user-built and maintained
The people who actually do the work are best suited and most responsible for creating the standard for how the work is accomplished. Checklists created by other people at other facilities will rarely work well. There is no emotional investment and no pride of authorship in an "off-the-shelf" checklist.

check markKeep it short
Not everything has to be on a checklist. Checklists are used to verify only the critical items of a procedure. Critical items are those that if not done correctly will cause harm to patients or caregivers before that error can be stopped.

check markDon't confuse it with an audit tool
Checklists aren't about creating a paper trail; they're intended to help the team (not the individual) cross-check and verify, with 2 or more independent sets of eyes, that critical items haven't been missed.

check markInclude speaking parts
Effective checklists trigger a scripted conversation and verbal cross-check of critical steps in the procedure. The more speaking parts different members of the team have, the more engagement, mindfulness and involvement you'll have in the process.

check markUse standardized and scripted language
Speaking parts for team members only work if the exact language and words that should be used for each item on the checklist are crystal clear and standardized, down to the exact word or phraseology. Checklist dialogue should be scripted. This level of standardization eliminates confusion and error.

check markDesign it as a "read and verify" tool
With this method the team accomplishes critical and routine actions from working memory. They periodically pause and use the checklist to verify that the most critical actions have been accomplished. Used this way, it takes only seconds for the team to cross-check and verify that nothing critical has been missed. The speed and efficiency of this method will greatly reduce the resistance you experience with implementing a checklist.

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