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Checklist Modification & Customization. Quick Review of Where We Covered in 2012. Webinar Content: Checklist Background and Development Checklist E vidence Building a Checklist Implementation Team Origin of Checklist Items In-Person Meeting Content: Coaching in the Operating Room
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Quick Review of Where We Covered in 2012 Webinar Content: • Checklist Background and Development • Checklist Evidence • Building a Checklist Implementation Team • Origin of Checklist Items In-Person Meeting Content: • Coaching in the Operating Room • One-on-One Conversations
Poll 1: Tell Us About Your Checklist Implementation Team • We haven’t had a chance to do anything yet. • We are just starting to build an implementation team and we are identifying people to be a part of it. • We have identified some core members of the team, but we are looking for physician champions. • We have an implementation team assembled that consists of at least one administrator/quality improvement officer, anesthesiologist/CRNA, circulating nurse, scrub tech, and surgeon
Meeting the Team Jennifer Greenhalgh, RN, BSN, CNOR Director, Quality Improvement Projects South Carolina Hospital Association
Today’s Topics • The importance of modifying the checklist for your hospital • Checklist Modification 101 • Performing a “Table-Top Simulation”
Checklist Modification 101 The Next Step in Your Journey: Make Me Your Own
This Checklist Is Not . . . • An algorithm. • A tool to train people how to do their jobs. • A “tick boxing” exercise. • A monitoring tool.
This Checklist is . . . • A reminder for the surgical team to perform/discuss critical safety steps for every patient every time. • Performed as a team and read aloud. Teamworkis Hidingin the Checklist
The Basics • One size doesn’t fit all. Every hospital should modify the checklist (more than one checklist might be needed ex: Cardiac & Ambulatory Surgery). • Checklist modification creates buy-in and ownership. • The checklist is designed to promote teamwork and communication . . . don’t remove teamwork/communication items.
Brief • Each section (Before Induction of Anesthesia, Before Skin Incision, and Before the Patient Leaves the Room) should take < 1 minute. • The checklist should never take longer than the procedure. • The checklist should fit on one page.
Items That Belong On A Checklist • Things that have serious consequences if they are missed. • Things that need to be done and are commonly missed.
Is this a critical safety step at risk for being missed? Examples: • Pulse Oximetry • Known Allergies • Essential Imaging • Antibiotic Prophylaxis
Is this a safety step that you might not notice if it is not done? Examples: • Iodine/Tinted Prep • Antibiotic Prophylaxis
Is this item discussed at a time when all relevant team members are present? Examples: • Surgeon Briefing • Expected blood loss
Is the checklist the best way to take care of it? Examples: • Glycemic Control • Blood Pressure • Fire risk Assessment • Hair Removal • Checking Pressure Points
Can something be done about it? Examples: • Hair Removal • Hypothermia
Before you remove an item make sure to ask . . . . “If the item will not help you, will this item help anybody here?”
Modifying Blood Loss • Are blood products required and available? • What is the EBL? • Blood (or cross-match) available if needed. • Is there a need for blood products? • Blood availability confirmed. • EBL/Blood Plan
Modifying Team Introductions • We will start by introducing ourselves by name and role. • Team introductions to patient, including name and role. • Are there any unfamiliar staff in the room? Please introduce yourself by name and role.
Modifying the Safety Statement • Surgeon says: “If anyone on the team sees something that the team should know about, please speak up” • Surgeon declares: “If anyone on the team sees something that the team should know about, please speak up anytime during the procedure.” • Surgeon states, “If you see, suspect, or feel that patient care is compromised, will you speak up?” • Surgeon states, “Remember that all are free to voice any concerns at any time throughout the procedure” • Surgeon states, “Does anyone have concerns? If you think there is a problem, please speak up”
When You Modify the Checklist with Your Implementation Team: • Discuss each item on the checklist using the guidelines that we previously discussed. • Ensure that the checklist follows your current flow in the OR. • Add your hospital logo to the checklist. • Test the checklist in a “Table-top” simulation.
Table-Top Simulation • An easy way to test the words on the checklist is by saying them aloud. Many times it looks good on paper and does not reflect what you would actually say during a case. • It is easy to test the checklist outside of the OR. • It doesn’t take a lot of time. • You can learn a ton. • Testing the checklist on a small scale can prevent you from making BIG mistakes.
“Table-Top” Simulation S Anes. Machine CN A SN Conference Room or an Empty OR
Our Patient • Age - 68 yr old male • Condition – Healthy patient with a right inguinal hernia • Procedure – Right inguinal hernia repair
After The Table-Top Simulation • Debrief, how did it go? What needs to be changed to fit the flow in your ORs? • Compare your modified checklist to the document “Does Our Checklist Meet the Goals of the South Carolina Checklist Template” to ensure the checklist will make the greatest impact.
Homework • Review the checklist modification guide and South Carolina Checklist Template. • Modify the checklist with your implementation teamusing the tools that we will send you after today’s call. • Perform a table-top simulation using your modified checklist. • Compare your modified checklist to the document “Does Our Checklist Meet the Goals of the South Carolina Checklist Template” to ensure your checklist has the greatest impact.
? Questions
Next Call:Testing the Checklist in the OR and Engaging Your Colleagues
Resources Website: www.safesurgery2015.org Email: safesurgery2015@hsph.harvard.edu
