Making a list,
Checking it twice,
Don’t want to kill a patient,
That wouldn’t be nice…
According to Dr. Atul Gawande, the average patient in an ICU requires “a hundred and seventy-eight individual actions per day, ranging from administering a drug to suctioning the lungs, and every one of them poses risks. Substantial parts of what hospitals do – most notably, intensive care – are now too complex for clinicians to carry them out reliably from memory alone. ICU life support has become too much medicine for one person to fly. Any of us who’ve worked in the ICU shouldn’t be surprised by Dr. Gawande’s assertations. But what to do about it?
Here at Vickie Milazzo Institute we use checklists for everything. There’s not a major project, including the National Alliance of Certified Legal Nurse Consultants (NACLNC®) Annual Conference (801 action items) that doesn’t have a major checklist. We find it not only keeps us from reinventing the wheel each time we start a new project (saving us time and money) but it also ensures that no moving parts are missed when we put something together. We even joke that we have checklists to make sure we have all our checklists!
Think about your life – you probably send your hubby to the grocery with a checklist. (Car keys – check. Checkbook – check. Grocery list – check). You (at least I do) pack for a trip with a checklist. (Bathing suit – check. Sunscreen – check. Mirrored shades to check out the hunky lifeguards – check). Checklists are part of everything I do and probably a large part of what you do on a daily basis also. Tom even has a checklist to make sure that he’s included all the proper clauses in the contracts that he writes (yawn).
How about using checklists to ensure safety instead of making sure you’ve got the loaf of bread, pound of pastrami and jar of mayo? This really isn’t a new idea. Since 1935 pilots have been using checklists to cover just about every aspect of flying an airplane, starting with the pre-flight inspection, taxiing, take off and landing. (Wings on – check. Wheels down – check. Dinner reservations at destination – check). Millions of passengers are delivered safely to their destinations each day thanks to simple checklists.
Now ask yourself as a Certified Legal Nurse Consultant, “how many patients are harmed because doctors (and maybe even nurses) don’t use checklists when doing complex medical procedures or simply treating patients?” The answer is, too many. Consistent protocols for patient care have been advocated by physicians since 1600 B.C. (Linen robe on – check. Snake-headed staff in hand – check. Leeches on patient – check.), but it wasn’t until 2003 that Dr. Peter Pronovost came up with a simple checklist to help reduce line infections in the ICU. That list was so successful that line infections in his hospital were reduced to almost 0%. Buoyed by this success he created other checklists which eventually were adopted by the state of Michigan for use in its ICUs. The results from implementation of those lists were so successful that Dr. Pronovost ended up publishing them in The New England Journal of Medicine in 2006.
In the almost three years since that study, not much else has happened with checklists. Apparently simple common sense just isn’t exciting enough for cutting-edge healthcare providers. You’d think that the medical and nursing professions would have expanded the use of checklists, but this hasn’t happened on a wide scale other than when you check-in at the hospital. (Insurance card – check. Ability to pay – check.)
That might be about to change though. The New England Journal of Medicine recently published the results of a study that involved using a simple, 19-item surgical checklist. The results were stunning: mortality rates in surgical patients were reduced by almost 50% and the same reduction was mirrored in nonlethal complications. With these sorts of results I hope that we’ll see a profusion of checklists in healthcare. The cost savings alone should get the attention of somebody. Perhaps checklists might be a simple way to reform healthcare. (Patient on table – check. Correct patient on table – check. Anesthesiologist sober – check.)
We know here at the Institute that a simple printed list can make a big difference, in time and money. Now healthcare providers are learning that checklists can save lives too. It’s time for healthcare to catch up with grocery shoppers. Next time you work up a case, have your attorney-client ask the healthcare providers for any checklists used in treatment of the patient. They should also ask each provider during deposition, how they ensure that they take each and every one of the proper steps in treating that patient. With such a line of questioning I can guarantee the jury will wonder why, in a world where a pilot won’t land an aircraft based solely on “memory,” a healthcare provider would do a risky procedure (e.g. brain surgery) on memory alone.
When you are consulting with attorneys on medical-malpractice cases helping to prepare interrogatories, requests for production and deposition questions be sure to ask about the use of relevant checklists in the healthcare setting.
Success Is Inside!
P.S. Comment and share checklists used in your healthcare facility.
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P.P.S. |
Mother’s Day is just around the corner and I’m feeling nostalgic. Here’s an article I did for my Legal Nurse Consulting Ezine in 2008: What, Only One Day a Year for Mom? How CLNC® Moms Can Squeeze Out Time to Pursue Their Personal Passions. Remember to give your mom the perfect gift. |
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