Important facts about different checklists, and how to use them successfully, you can read here:
1. Inadequate Completion of Checklists and Air Accidents
Checklists are one of many tools, which a team applies, in order to maximise safety. Even if pilots have already mastered numerous take-offs and landings successfully, they will never waive their checklists in the process.
Both phases of a flight require many single steps to be taken. Omitting a single one of these, for instance, setting the flaps correctly, may have fatal consequences. Unfortunately, air accidents have already happened due to this very cause. Thus, we comprehend easily, why the verification of every single step of the procedures according to the respective checklist is indispensable.
2. Risky Situations in Modern Medicine
Below, we will look at risky situations in the medical daily routine, which occur partly due to the countless possibilites to make momentous errors in a complex work environment. Of course, such mistakes may not endanger the safety of our patients, but have to be detected early by the team in charge.
2.1. The Right Patient Must Be Operated on the Right Side of the Body
Unfortunately, the wrong lower leg of a patient has already been amputated. How could such a mistake, fraught with consequences for the respective patient, happen? How do we ensure as a team that we avoid this?
2.2. We Secure the Airway of an Unconscious Patient
Especially in the prehospital emergency service, securing the airway through the induction of general anaesthesia and intubation is risky. The patients are not fasting, and there is no previous examination of the anatomy of their airways. Sometimes, we have to deal with alcoholised patients, or ones who have already vomited. Moreover, the evironment and the illumination may be disadvantageous.
So, we have to prepare everything we will be needing for the technical monitoring, the induction of the general anaesthesia, as well as the intubation, in a sometimes challenging situation nonetheless. Then, we have to carry out both measures step by step.
3. The Checklists Which Are Applied in Aviation
There are several possibilites to categorise checklists. Here, we will look at one which is commonly used.
3.1. Types of Checklists
Checklists are widely used during routine operations in aviation. The so-called normal checklists comprise the two categories "Read and Verify", as well as "Challenge and Response". For procedures during emergencies, there are particular checklists which are classified as "Read and Do".
Read and Verify
In these checklists, the necessary actions are mentioned in the correct order. Usually, these checklists are completed from memory whilst the respective actions are performed. The actual checklist is only used to ensure its total completeness. For example, pilots employ such checklists during their preparations before their flight.
Challenge and Response
Here, one team member asks another one about certain facts, the second one confirms them, or reacts accordingly if one item has not yet been completed, or has been done incorrectly. One example of this are single parameters, to which the crew has to pay attention during the landing.
Read and Do
These checklists are applied during emergencies in aviation, for example, during an incident. Immediately, pilots perform the first measures from memory in order to control the situation. Then, they apply the right checklist for the incident, read the items on it, act according to them, and check their first actions once more.
3.2. The Correct Use of Checklists Is Vital for Success
In order to be really successful, checklists should be applied continuously, i.e. every time the regarding procedure is carried out. In addition, checklists have to be checked for their actuality regularly. Moreover, it is important to really check the various items on them.
It is not very helpful if, for instance, one item on a checklist for the preparation of a surgical procedure reads "check the identification mark on the site of the body, on which surgery will be performed", but the anaesthesia nurse only reads from the patient record without really examining the patient to verify the mark.
In our hectic daily work, we are constantly interrupted during a course of action, also when completing a checklist. Nonetheless, we have to ensure that we have considered all items on it.
If we are interrupted during the completion of a checklist, we should resume it deliberately and go back three items.
3.3. How to Compile Checklists
It is of utmost importance to compile a checklist in a sensible order and containing all items right from the start. In addition, once it is ready to use, the checklist should be easy to apply in order to provide support. It shouldn´t consume the team members´ concentration, which they need for their actual work.
4. Examples of Checklists Used in Medicine
As CRM made its way into medicine, the use of checklists was adopted, as well. Using the two examples above, namely taking a patient into the operating theatre and securing the airway, we will now elucidate, which checklists a team can apply beneficially during these processes.
4.1. Checklists During Pre-Surgical Preparations
Pre-surgical checklists, which anaesthesiologists and surgeons complete jointly, are an important tool to ensure that the right patient will receive the right procedure on the right side of his or her body.
When a patient is received in the operating theatre by an anaesthesiologist, a "Read and Verify" checklist is helpful. It needs to contain a few items only, which can be completed from memory. Amongst these are:
- the patient´s identity, preferably confirmed by the patient him- or herself
- checking the patient wristband and the patient record
- if possible, the patient is asked to name the planned procedure
- checking the identification mark applied with a waterproof pen to the respective part of the body
- asking about allergies
- in addition, the patient´s position on the operating table, the anaesthesiological procedure, and special requests should be checked
During the so-called team-time-out, in which the surgeons and the anaesthesiologist go through the important items together once more, the same checklist can be applied, or a "Challenge and Response" checklist can be used. This time, the surgeons name the patient, the procedure, allergies, as well as special requests. The anaesthesiologist confirms, or corrects the facts accordingly to ensure that absolutely all items are accurate.
4.2. An Extraordinary Checklist for the Intubation
For the preclinical intubation, The Red Cross Academy in Tyrol, Austria, has developed a particularly canny checklist: IN-GE (Intubations-Geräteunterlage, German for intubation equipment cloth), a cloth for single use onto which the utensils needed for an intubation are sketched. When all of them are laid down on their respective spot on the cloth, the team is certain that it hasn´t forgotten anything.
4.3. Cookbook Medicine Only?
Time and again, we meet freethinkers who feel restricted in their work by checklists. How can we tell them about the benefits which checklists bring?
First of all, there are many situations in which quick and creative thinking, as well as rapid actions are required, for example, in the case of unusual diagnoses, unclear cases, or during incidents. This is exactly when we need our free spirit, for these situations we should preserve it well.
If we can enhance our patients´ safety by using our checklists correctly to avoid mistakes, we should opt for this.
5. How to Establish Checklists at Your Workplace Successfully
If checklists are new to you, we will go through how you write and use them successfully, using the items mentioned above. If you have been applying checklists industriously already, what can you imagine in additon to the following steps?
5.1. First, You Identify Possible Areas of Use
During what tasks and procedures do you easily forget subitems? Typical examples comprise procedures for which certain utensils have to be prepared. We all know situations from our day-to-day lives, or from exams, in which we could remember almost all items, save a particular one, or we left out a different one as the last one each time. In addition, procedures, which consist of many steps, are perfectly suited.
5.2. What Type of Checklist Is Most Suitable?
Using the checklists described above, you can decide, which one you need for what task. Do you even encounter extraordinary situations, in which you have to deal with an emgercency swiftly?
5.3. How to Write Useful Checklists and Keep Them up to Date
Contemplate all the important steps, or subitems which you may not leave out under any circumstances and arrange them in a sensible and easy to complete manner.
Has anything changed in your workflow? There are many reasons for this. For instance, new procedures are introduced, or new products are integrated into workflows. Now, you need to adapt the existing checklists accordingly.
5.4. How to Integrate the Use of Checklists Into Your Daily Work
How about integrating your team in the compilation of your checklists, or suggesting the creation of checklists as a team member? Important questions could be:
- Who has noticed what weaknesses where in the workflow?
- What is forgotten most often?
- At which points is such a neglect momentuous?
- Does it lead to safety risks?
- Might a customer be angry, or will you lose a lucrative order?
When you have localised the points at which you would like to apply checklists, you need to decide what type of checklist you want. Make sure to keep a manageable balance concerning the number of checklists, as well as the number of subitems on them.
Decide as a team how you would like to use the checklists. After all, you not only need to read the items on your checklists, or memorise them, but also to really check or perform them.
You should also agree together on how you would like to measure your success. Have you erased the weaknesses successfully? If not, why? How will you address the identified shortcomings? If you have, congratulations, and I wish you every success for your work in the future, too!
6. In the Next Blog Article, We Will Concern Ourselves With SOPs
You might at least have heard the term standard operating procedure, SOP, in your professional life. Some of you might use these actively already. We will elucidate what SOPs are, and how to write them, where to use them, and how to keep them up to date.
Author: Eva-Maria Schottdorf
Date, January 28th, 2023
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