Checklists in the Medical Field

All organizations embrace the use of checklists or protocols in their processes. These common tools prevent or minimize damages caused by human errors in complex areas of work. In the medical field, the introduction of a checklist enhances communication between physicians and nurses, thus improves patient outcomes. Checklists also decrease the number of medical complications. The World Health Organization (WHO) created a Surgical Safety Checklist (SSC) to guide healthcare professionals in patient operations. Moreover, hospitals increasingly design patient care checklists to facilitate better patient care. These protocols are only beneficial if implemented correctly and with discipline. This paper discusses the use of checklists in medicine and their impacts on standard patient care.

In general, checklists bring about numerous advantages in the medical field. First, they provide confidence in the healthcare worker, because they take all the right steps in patient treatments. The use of protocols in inpatient care reminds physicians of all the diagnosis and treatment methodologies required to prevent damage on the patient. Secondly, checklists significantly reduce medical risks. They also lower litigation costs in times of error. For instance, a mistake in a surgical procedure may cause legal issues to the physician. However, using the checklist to explain that the error occurred in spite of following all the right steps could potentially eliminate legal action. Also, protocols provide technical solutions to technical problems. They allow doctors and nurses to find concrete remedies to salve specific medical difficulties. Finally, checklists are free and are of no monetary bindings to the user.

WHO encouraged the implementation of the SSC in healthcare organizations to remind the OR team of all details relevant to the surgery (World Health Organization, 2009). Moreover, the SSC act as tools to encourage better communication and teamwork among nurses, surgeons, and anesthetists. The WHO SSC contains three parts; before anesthesia (sign in), before skin incision (time out), and before the patient leaves the operating room (sign out). Steps in the sign in process include verifying that the patient has confirmed their identity, site, procedure, and given consent to the operation. Furthermore, an anesthesia safety check is conducted, a verification of the patient’s allergies, and other factors like aspiration risks are analyzed. The first step also confirms if the patient is at risk of a high blood loss (above 750Ml).

The second step (time out), confirms that all team members introduce themselves and their roles in the surgery. The surgeons, anesthetist, and nurse ought to confirm the patient, site, and procedure. Moreover, the surgical team critically analyzes the anticipated critical events like steps during anticipated blood loss, patient-specific concerns, and the administration of antibiotics. The sign out step is mainly a nurse’s duty to verbally confirm the procedure undertaken, perform an instrument count and countercheck the specimen labeling, and address any equipment issues. The entire team then discusses the key concerns in the patient’s recovery (World Health Organization, 2009).

According to Ambulkar, Ranganathan, Salunke, and Sararkar (2018), complications occur in approximately 3 to 16% of all surgical procedures. These complications may cause permanent disability, or increased mortality rates between 0.4 to 0.8%. Moreover Ambulkar, Ranganathan, Salunke, and Sararkar (2018) state that more than half of surgical errors are avoidable. Therefore, the use of a checklist would mitigate these errors and enhance patient safety.

The SSC identifies key processes in the operation process that affect patient outcomes. A research conducted by Ambulkar, Ranganathan, Salunke, and Sararkar (2018) on the implementation of WHO SSC protocols in cancer ER’s. The research showed several differences in the use of SSC. The sign in stage, for example, was carried out by high volumes of medical staff in the institution. Nurses, surgeons, and anesthetists are relatively unoccupied during this time and thus, easily cooperate in completing the checklist. The second stage, however, is usually performed by few healthcare workers. Physicians and nurses often highly concentrate on the operation at this stage and forget about using the checklist.

The third step is the most overlooked stage of the SSC. In this stage, the surgical team is exhausted after hours of meticulous work and hence, do not complete the checklist. Although the third stage of the checklist is taken with the lowest compliance by medical experts, it prompts the highest change in their behavior. The change is often because the sign out stage requires action maximum times. Ambulkar, Ranganathan, Salunke, and Sararkar (2018) assert that 23.5% of the operation’s success requires the implementation of this stage. For instance, in a scenario that the surgical team forgets to perform an equipment count, they may later find that they forgot equipment such as scissors in the patient’s body. Such sentinel events could damage the patient’s health and destroy the hospital’s credibility. Therefore, it is essential for the surgical team to follow all steps involved in the checklist.

The medical hierarchy poses significant challenges in the implementation of the SSC. In all medical institutions, doctors are considered ‘more powerful’ than other medical staff. In the Ambulkar, Ranganathan, Salunke, and Sararkar (2018) research study, surgeons initiated the checklist in 83.5% of the cases while anesthetists followed with 16.1%. Nurses were the least implementers with a 0.4 percentage of initiation. The research reveals that nurses feel inferior to doctors and anesthetics. In cases where doctors and anesthetics are ignorant about SSC implementations, nurses may not speak up. Therefore, for successful implementation of the SSC, all medical staff requires equal chances to initiate and complete the SSC. In addition, the SSC checklist may improve through a mandatory department wide training. The training would increase staff knowledge on the checklist and its merits. Also, all hospitals need a multidisciplinary team that identify and remedy barriers in the implementation of the checklist.

Pugel, Simianu, Flum, and Dellinger (2016) assert that there is a significant reduction in patient mortality and morbidity due to the utilization of the checklist. Therefore, to prevent any public health concern that may cause errors in the operation period, Pugel, Simianu, Flum, and Dellinger (2016) state that the surgical team must avoid communication lapses. The roles of surgeons, nurses, and aesthetics are interdependent in the operation room. Consequently, effective communication is vital in patient safety. The checklist ensures continuous communication in the team and thus, reduces complications such as unsuitable antibiotic administration and wrong site surgery. Timely antibiotic administration is incumbent in the avoidance of surgical site infection. Furthermore, since the checklist improves communication in the OR, it inadvertently leads to better colleague relations in other sectors of the hospital.

Several healthcare workers argue that a checklist causes disruptive standard care (Dharampal, Cameron, Dixon, Ghali, & Quan, 2016). These workers argue that checklists lack clinical specification. They state that ticking a box in a checklist does not help in patient treatment. Also, the SSC causes a shift in the perioperative culture, which disrupts previous surgical processes. However, these woes are insignificant compared to the merits brought about by medical checklists.

Checklists are critical in standard patient care. Their benefits vary from better patient results to improved communication among hospital staff. Moreover, checklists improve compliance with vital medical metrics like decreased delays in the operation schedule or reduced time spent gathering surgical supplies outside the OR. Disciplined implementation of these checklists may lead to maximum patient care.

References

Ambulkar, R., Ranganathan, P., Salunke, K., & Sararkar, S. (2018). The World Health Organization surgical safety checklist: An audit of quality of implementation at a tertiary care high volume cancer institution. Journal of Anesthesiology Clinical Pharmacology, 34(3): 392–398. doi: 10.4103/joacp.JOACP_328_17

Dharampal, N., Cameron, C., Dixon, E., Ghali, W., & Quan, M. (2016). Attitudes and beliefs about the surgical safety checklist: Just another tick box? Canadian Journal of Surgery, 59(4): 268–275. doi: 10.1503/cjs.002016

Pugel, A., Simuianu, V., Flum., D., & Dellinger, P. (2016). Use of the surgical safety checklist to improve communication and reduce complications. Journal of Infection Public Health,8(3): 219–225. doi: 10.1016/j.jiph.2015.01.001

World Health Organization. (2009). WHO guidelines for safe surgery 2009. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/44185/9789241598552_eng.pdf;jsessionid=D0D0DF1E673B823C57D5B74D20DDAD30?sequence=1