Checklists are a terrific tool to help reduce adverse events and improve the quality of case management. They ensure that you don’t miss or forget apparently simple steps which may help tremendously. There is compelling evidence from human and veterinary medicine that checklists help. How do you go about making one?
While some checklists are designed to be used in different settings (e.g. the Safer Surgery checklist by the WHO), most agree that checklists must be modified or created to be specific to the setting where they are applied. Your clinic is different from any other clinic out there. It has unique approaches, problems, and strategies. So coming up with an individualized checklist may be better than applying a generic checklist. The checklist creation steps are: determine the problem, workshop solutions, try out the checklist.
Determine the Problem
The first step in any program to improve patient safety is to determine what problems you are experiencing. There are a few ways to do this. You can collect data over a period of time. You might ask your staff what they perceive the problems are which are facing the patients. You could look back at cases which didn’t do well to try and identify what happened and why. Figuring out which problem(s) you want to address is essential to your checklist process.
Once you have identified potential problems, sit down with the staff at a meeting and discuss each of them. Why do the staff think the problem happens? What do THEY think can be done to improve it? Another post will discuss implementing checklists, but getting buy-in is extremely important. Having the staff come up with solutions will help create effective, novel ideas to address problems and get buy-in. Ideally, the solution should be something that a person can check on a piece of paper (or digital equivalent). Do you want to make sure the nurse/techs always double-check the calculations on drug doses? Add a checkbox near where the calculations are done which they have to check before moving on.
Try It Out
Once you have some solutions that require checking a box or otherwise force people to make sure something is being done, put it into practice. Not every checklist will be perfect- you need to find out where the problems are with implementing your checklist and address them. You may have to go “back to the drawing board” after a couple of months and refine it. Don’t give up! It is normal to have a checklist not perform perfectly. For example, we didn’t come up with a mechanism for “patient falls off gurney” problem during the initial checklist creation, so decided to add that later.
Creating a checklist isn’t hard, but it does require a deliberate effort and discussion and interest in improvement. I think every clinic can improve their anesthetic practices, including small mixed-animal practice, large small animal practices, emergency clinics, university teaching hospitals, referral hospitals, and all the others. A checklist is a terrific tool to use to improve the clinic function and patient outcome.
Erik Hofmeister DVM Diplomate ACVAA & ECVAA MA MS
Professor of Veterinary Anesthesia