Using Patient Safety Checklists

An algorithmic checklist in many clinical settings can prevent the overlooking of vital steps of a process. Schematic behavior relates to tasks performed reflexively, while attentive behaviors deal with tasks requiring active planning and problem-solving. Refer to errors associated with 

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Watching teams and teamwork quickly reveals that a group of weU intentioned individuals does not make a team and furthermore, that teamwork has to be planned and organized. In this section we will review some apparently simple interventions, which turn out to have quite profound effects. Daily goals, preoperative and post-operative checklists seem mundane, and this partly accounts for clinicians resistance to their use. However, a checklist is not a piece of paper or even a list it is a team intervention which, used well, can affect the wider team functioning, the relationships across professions and hierarchies and even the values and safety culture of the team. To my mind, the impact of these simple tools on clinical processes and patient outcome suggests that their effect can only be fully understood by appreciating their wider impact on team performance. 

Launched as a rratiortal safety improvemerrt irritiative by the National Patient Safety Agency in 2009, the wide variation in approaches to its implementation provide a good case study about how safety crrltures vary across different hospitals. Implementation approaches for the WHO Srrrgical Safety Checklist have ranged from the please use this checklist in yorrr operating theatre from next Monday to, at the other end of the spectrurrr, well designed implemerrtation plans (Box 7.3). 

In the following chapters of this volume, experts present successful approaches and strategies to improve patient safety in vascular access patients. For example, Davidson et al. [pp. 97-106] discuss how team training and checklists can be used to improve safety in the OR, and Shemesh et al. [234-250] report about the important role of the hemodialysis patient in creating and maintaining safety. 

The peritoneal dialysis access catheter placement simulation is ideal to teach aviation safety principles emphasizing the importance of knowing basic facts, such as the tools and instruments needed for the procedure and how the use of checklists improves patient safety. An abdominal simulator is currently under development for the laparoscopic technique of placing the peritoneal dialysis catheter [12]. 

A safety culture is key. No matter how advanced the technological system, if humans are involved, errors are inevitable. The key to patient safety and accident prevention is managing the inevitable error by doing two things First, by training to use specific teamwork and communications behaviors, and second to implement safety tools (policy and procedures, protocols, checklists, briefings) to complement behaviors to detect and trap (small) errors before they become a chain creating a serious or even fatal accident (table 1). 

In general, checklists systematically organize your work to obtain a condition of efficiency, to identify team members roles and accountability. As a consequence of checklists, error rates will decrease and patient safety will be maximally ensured. In the broadest sense, checklists are used to describe the entire surgical procedure [18] or more specifically, critical segments of the OR procedures. In an international multicenter study of3,733 controls and 3,855 patients subjected to a simple checklist in 8 hospitals, mortality dropped from 1.5 to 0.8% (p = 0.003) and in-hospital complication rate fell from 11 to 7% (p = 0.001) [19]. 

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