Patient Safety Checklist Research Articles

An embedded checklist in the Anesthesia Information Management System improves pre-anaesthetic induction setup: a randomised controlled trial in a simulation setting

BackgroundAnaesthesiologists work in a high stress, high consequence environment in which missed steps in preparation may lead to medical errors and potential patient harm. The pre-anaesthetic induction period has been...

Office-based anesthesia: safety and outcomes.

The increasing volume of office-based medical and surgical procedures has fostered the emergence of office-based anesthesia (OBA), a subspecialty within ambulatory anesthesia. The growth of OBA has been facilitated by numerous trends, including innovations in medical and surgical procedures and anesthetic drugs, as well as improved provider reimbursement and greater convenience for patients. There is a lack of randomized controlled trials to determine how office-based procedures and anesthesia affect patient morbidity and mortality. As a result, studies on this topic are retrospective in nature. Some of the early literature broaches concerns about the safety of office-based procedures and anesthesia. However, more recent data have shown that care in ambulatory settings is comparable to hospitals and ambulatory surgery centers, especially when offices are accredited and their proceduralists are board-certified. Office-based suites can continue to enhance the quality of care that they deliver to patients by engaging in proper procedure and patient selection, provider credentialing, facility accreditation, and incorporating patient safety checklists and professional society guidelines into practice. These strategies aiming at patient morbidity and mortality in the office setting will be increasingly important as more states, and possibly the federal government, exercise regulatory authority over the ambulatory setting. We explore these trends, their implications for patient safety, strategies for minimizing patient complications and mortality in OBA, and future developments that could impact the field.

Ensuring a proactive, evidence-based, patient safety approach to patient assessment.

To argue that if all nurses were to adopt the primary survey approach (assessment of airway, breathing, circulation and disability) as the first element of patient assessment, they would be more focused on active detection of clinical deterioration rather than passive collection of patient data. Nurses are the professional group that carry the highest level of responsibility for patient assessment, accurate data collection and interpretation. The timely recognition of, and response to deteriorating patients, is dependent on the measurement and interpretation of pertinent physiological data by nurses. Discursive paper. Traditionally taught and commonly used approaches to patient assessment such as 'vital signs' and 'body systems' are not evidence-based nor framed in patient safety. The primary survey approach as the first element in patient assessment has three major advantages: (1) data are collected according to clinical importance; (2) data are collected using the same framework as most organisation's rapid response system activation criteria; and (3) the primary survey acts as a patient safety checklist, thereby decreasing the risk of failure to recognise, and therefore respond to, deteriorating patients. The vital signs and body systems approaches to patient assessment have significant limitations in identifying clinical deterioration. The primary survey approach provides nurses with a consistent, evidence-based and sequenced approach to patient assessment in every clinical setting. All nurses should use a primary survey approach as the first element of patient assessment in every patient encounter as a patient safety strategy.

ABSTRACT 796

Background and aims: Latent safety threats may contribute to medical errors and have a significant impact on patient safety. We describe identified latent patient safety threats during in-situ-simulations in German pediatric hospitals. Aims: Development of a patient safety checklist for pediatric emergencies in children´s hospitals to avoid common deficits in patient care. Methods: The feedback evaluations of 19 in-situ courses (each 2.5 days) at non-affiliated children´s hospitals in Germany were analyzed after informed consent relating to the incidence of latent safety threats by observing equipment (e.g. special equipment for airway- or circulation management, emergency backpack or case, storage,..), logistics (e.g. emergency call, emergency room), medication and both technical and non-technical skills. Results: 431 latent patient safety threats were detected. All 431 safety threats were summarized in 66 different categories. Most mentioned logistic items were things like equipment storage in different places and oversupply of emergency equipment. In the medication category, mistakes in the attenuation of epinephrine and storage of similar sounding medications side by side were most prevalent. Regarding the technical skills, impart knowledge of the current guidelines and lacks in the use of technical equipment (i.o.-access, defibrillator) were observed. Conclusions: The identified latent safety threats in pediatric emergency care show a high rate of previously unidentified items. According to these results a patient safety checklist must be established to avoid these common deficits in the patient care. We developed a safety checklist regarding our results combined with already published data and guidelines. This checklist will be tested for practicability by using in in-situ-trainings and by evaluation with a Delphi procedure.

Comprehensiveness of Delivery Notes for Shoulder Dystocia

INTRODUCTION: Shoulder dystocia is an unpredictable obstetric emergency with the potential for significant morbidity. Accurate and comprehensive documentation is critical for clinical decision-making and risk management. This study evaluates physicians' shoulder dystocia delivery notes to assess for comprehensiveness and identify potential areas for improvement. METHODS: Physician narrative delivery notes for vaginal deliveries complicated by a shoulder dystocia at a single academic institution from 2006 to 2011 were evaluated. Delivery notes were analyzed for comprehensiveness based on their inclusion of intrapartum elements (20 elements) from the American College of Obstetricians and Gynecologists Patient Safety Checklist for documenting a shoulder dystocia. RESULTS: Sixty-six narrative delivery notes were analyzed. On average, delivery notes documented 11 (58%) elements. None of the notes included all 20 elements, and one delivery had no delivery note documented. Head-to-body interval was recorded in only 58% of notes. Commonly recorded elements (75% of notes or greater) were the date and time of delivery (96%), obstetric maneuvers used to relieve the affected shoulder (91%), maternal gravidity and parity (86%), Apgar scores (80%), and neonatal birth weight (77%). Infrequently recorded elements (25% of notes or less) included documentation of the anterior fetal shoulder (21%), estimated fetal weight (7%), patient counseling about the shoulder dystocia after delivery (4%), adequacy of the maternal pelvis (2%), and whether fundal pressure was or was not applied (1%). CONCLUSION: Physician narrative delivery notes lack many critical elements for documentation of a shoulder dystocia delivery. The use of standardized forms to improve comprehensiveness of delivery should be evaluated.

Educational Exhibit Abstract No. 432 - Patient safety checklist in interventional radiology: are they being used and do they work?

Educational Exhibit Abstract No. 432 - Patient safety checklist in interventional radiology: are they being used and do they work?

Educational Exhibit Abstract No. 429 - Endovascular management of uterine arteriovenous malformations: causes, clinical presentation, technique and outcomes

No. 430 Comparison of procedure cost of various percutaneous tumor ablation modalities: microwave ablation, radiofrequency ablation, cryoablation, and irreversible electroporation S. Astani, M.L. Brown, T.M. Getzen, K. Steusloff; Radiology, Henry Ford Hospital, Detroit, MI Purpose: Microwave ablation, radiofrequency ablation, cryoablation, and irreversible electroporation (Nanoknife ablation) are four percutaneous ablation modalities commonly employed to treat tumors. Cost of similarly effective procedures can be an important factor in choosing a treatment option. There is paucity of data regarding the cost of aforementioned ablation modalities. In particular, no prior study has directly compared the cost of these procedures. We compare the procedure cost of treating the same lesion with each of the 4 modalities. Materials and Methods: An interactive model was created for each ablation modality, estimating the cost of treating a tumor based on the number of probes required, which is estimated by the tumor size. Total cost of treating a 3 cm kidney lesion with each modality was separately calculated by mapping out the operation process, material and equipment required as well as time and contribution of involved personnel.In order to validate the cost modules, 62 cases of various percutaneous ablations performed by interventional radiology treating a variety of lesions from July 2010 to March 2012 were identified retrospectively. Cost of each procedure was determined and then compared with the estimated cost based on the modules developed. Results: The cost of treating a 3 cm kidney lesion is $8,123 for microwave ablation, $8,289 for radiofrequency ablation, $10,103 for cryoablation, and $12,984 for irreversible electroporation. There was a strongly positive and statistically significant relationship between estimated cost based on the cost modules and actual cost for all procedures combined, microwave ablations, radiofrequency ablations, cryoablations, and irreversible electroporations. Conclusion: Number of required probes is the most variable and dominant factor in determining the cost of an ablation procedure. In average, cryoablation requires a greater number of probes than microwave or radiofrequency ablations, and is therefore more expensive. Irreversible electroporation requires more ablation probes than cryoablation for the same lesion, which makes it the most expensive procedure between the four ablation modalities. Educational Exhibit Abstract No. 431 Treating complex vascular anomalies with novel techniques D.J. Aria, S. Vatsky, R. Kaye, C. Schaefer, R.B. Towbin; Phoenix Children0s, Phoenix, AZ Learning Objectives: To highlight the use of a minimally invasive novel technique for treatment of a large, symptomatic portacaval shunt.To offer a less costly and time-consuming alternative to traditional surgery/intravascular coil embolization. Background: An 8 year-old girl with a complex medical history including trisomy 21, multiple cardiac anomalies, and chronic anemia of mixed etiology, presented with gastrointestinal bleeding. Over the preceding year, she had become cyanotic and on physical examination, digital clubbing was noted. Laboratory evaluation revealed elevated serum ammonia levels. Abdominal ultrasound demonstrated a congenital portacaval shunt. Clinical Findings/Procedure Details: Due to the large size of the shunt, traditional embolization agents such as coils could not safely be utilized. Although not generally used for this purpose, the decision was made to occlude the fistula with a 14mm Amplatzer ASD occlusion [clamshell] device. The Amplatzer device was deployed at the inferior vena cava and portal vein communication without immediate complication. The patient’s post-operative course was uneventful and the patient was discharged on post-operative day #2. Follow-up visits demonstrated resolution of the clinical signs and symptoms and imaging demonstrated closure of the shunt. Conclusion and/or Teaching Points: This experience highlights the use of a novel technique for treatment of a large, symptomatic portacaval shunt. Educational Exhibit Abstract No. 432 Patient safety checklist in interventional radiology: are they being used and do they work? S. Byott, A. Craig; NHS, Manchester, United Kingdom JVIR ’ Posters and Exhibits S187

Board 269 - Program Innovations Abstract The Effect of Hard Stop Implementation of a Pre-Induction Checklist on Resident Performance During a Simulated Anesthetic (Submission #1296)

Introduction/Background Surgical safety checklists have been shown to reduce patient complications and improve communication in the operating room.1,2 Checklists have also been shown to improve the management of operating room crises in high fidelity simulation studies.3,4 The pre-anesthetic induction period has been identified as a time in which medical errors can occur.5 The Anesthesia Patient Safety Foundation (APSF) has developed a pre-anesthetic induction patient safety (PIPS) checklist.6 Using full environment simulation (FES), we hope to detect a significant reduction in missed steps during the pre-anesthetic set up when using this checklist. All participants in this study will be exposed to the same clinical scenario but one group will experience a “hard stop” in the documentation workflow. We hope to use the Results of this study to validate the simulated environment as an effective and novel way to inform the implementation and further study of patient safety and quality improvement initiatives that may be difficult to clinically test. Methods Using a randomized, controlled, observer-blinded design, we compare performance of anesthesiology residents using the APSF PIPS checklist in completing a thorough pre-anesthetic induction evaluation and setup, to residents with no checklist.6 The study is performed using the METI high-fidelity simulator. The simulated OR is set up to represent a previously used anesthesia machine/cart that has not been set up for a new anesthetic, and is missing the components highlighted in the PIPS checklist. The residents will be called in to provide anesthesia for a case that was booked initially as a case only requiring local anesthesia. The surgeon will create time pressure for the residents to induce anesthesia prematurely in this entirely elective setting. In the experimental group, the electronic medical record will create a “hard stop” in which the APSF PIPS checklist is displayed and must be checked and signed off on before any further documentation of the anesthetic can occur. In the control group, this “hard stop” will not be present in the electronic medical record. The simulation will end when the resident provides any medication to the patient, and missed steps will be recorded at that time. The hypothesis is that the required use of the APSF PIPS checklist prevents missed steps in the pre-anesthetic set up under time pressure in a simulated operating room. Results: Conclusion Our study illustrates the importance of the simulated environment in evaluation of new patient safety and quality improvement initiatives as the specific situations in which such initiatives are likely to increase patient safety can never be ethically or successfully replicated in real life.

Efeitos e desafios da implantação de um sistema de verificação de segurança cirúrgica: revisão integrativa

Objective: to identify the effects of the using of a surgical safety checklist, as well as implantation challenges when assessing available literature. Methods : we performed an integrative literature review , consulting the databases : MEDLINE , LILACS, SciELO and Cochrane Library using the descriptors : Patient safety and Perioperative care and Checklist . We included articles published between 2007 and 2012 in English, Spanish and Portuguese . Results: the six articles that answered de research’s question bring the effects’ categories: Injuries’ reduction, Health care improvement and Team’s relationship improvement. Challenges seem to be cultural barriers between operating room teams. Final considerations: it is believed that surgical safety checklist brings better health care results, but it needs a solid implantation and a continuous accompaniment to ensure its full performing.

Educational Exhibit Abstract No. 268 - The time is now: a proposed team-centered approach to a patient safety checklist for interventional radiology procedures

Learning Objectives 1) Highlight the importance and demonstrate the need for patient safety checklist in IR procedures. 2) Describe the WHO surgical checklist that is recommended to reduce complications associated with surgery. 3) Demonstrate how these concepts can be applied to the field of Interventional Radiology (IR), and introduce the importance of a team approach to improving patient safety. Background Extensive outcomes research in the surgical community has demonstrated a 3-17% risk of major complications and that approximately 50% of all surgical complications are avoidable. There has been little corresponding research for IR. A team at the World Health Organization (WHO) has designed a 19-item checklist to reduce the rate of surgical complications. Implementation of the checklist was associated with a 36% drop in post-operative complications and death. The purpose of this electronic exhibit is to describe a proposed patient safety-oriented, team-centered checklist for use in IR. Clinical Findings/Procedure Details Utilizing WHO criteria, we have adapted the checklist to emphasize a team approach to patient safety, divided into three major categories. 1) Preprocedure briefing : All members of the IR team meet as a team at the beginning of the day, including: nursing staff, technologists, physician assistants, trainees, and attendings. In order for the Pre-Procedure Briefing to have maximum impact, every member must be prepared to discuss all patients. All nursing staff review the pertinent medical and procedural history, and history of prior sedation use. All physicians review patient history and relevant imaging studies. 2) Time-out : The purpose of the time out is to confirm the patient identity, site, and procedure. At this time, all present parties have an opportunity to re-address present specific concerns regarding the procedure. 3) Postprocedure sign-out : During this time period, the team should review the key concerns for post-procedure patient recovery. Conclusion and/or Teaching Points 1). Patient safety is paramount. 2). Utilizing a checklist has been shown to improve surgical outcomes. 3). A three-step approach involving physicians, nurses, and technologistsworking together as a team can be utilized to implement the procedure checklist.

Patient Safety Checklist No. 9

Patient Safety Checklist No. 9

Patient Safety Checklist No. 8

Obstetrics & Gynecology 120(5):p 1254-1255, November 2012. | DOI: http://10.1097/01.AOG.0000422588.22542.e0

Patient Safety Checklist No. 6

© 2012 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Patient Safety Checklist No. 7

Patient Safety Checklist No. 7

A checklist to improve patient safety in interventional radiology.

PurposeTo develop a specific RADiological Patient Safety System (RADPASS) checklist for interventional radiology and to assess the effect of this checklist on health care processes of radiological interventions.Materials and MethodsOn the basis of available literature and expert opinion, a prototype checklist was developed. The checklist was adapted on the basis of observation of daily practice in a tertiary referral centre and evaluation by users. To assess the effect of RADPASS, in a series of radiological interventions, all deviations from optimal care were registered before and after implementation of the checklist. In addition, the checklist and its use were evaluated by interviewing all users.ResultsThe RADPASS checklist has two parts: A (Planning and Preparation) and B (Procedure). The latter part comprises checks just before starting a procedure (B1) and checks concerning the postprocedural care immediately after completion of the procedure (B2). Two cohorts of, respectively, 94 and 101 radiological interventions were observed; the mean percentage of deviations of the optimal process per intervention decreased from 24 % before implementation to 5 % after implementation (p < 0.001). Postponements and cancellations of interventions decreased from 10 % before implementation to 0 % after implementation. Most users agreed that the checklist was user-friendly and increased patient safety awareness and efficiency.ConclusionThe first validated patient safety checklist for interventional radiology was developed. The use of the RADPASS checklist reduced deviations from the optimal process by three quarters and was associated with less procedure postponements.

EACTS guidelines for the use of patient safety checklists

The Safety Checklist concept has been an integral part of many industries that face high-complexity tasks for many decades and in industries such as aviation and engineering checklists have evolved from their very inception. Investigations of the causes of surgical deaths around the world have repeatedly pointed to medical errors that could be prevented as an important cause of death and disability. As a result, the World Health Organisation developed and evaluated a three-stage surgical checklist in 2007 demonstrating that complications were significantly reduced, including surgical infection rates and even mortality. Together with the results from other large cohort studies into the utility of the surgical checklist, many countries have fully implemented the use of surgical checklists into routine practice. A key factor in the successful implementation of a surgical checklist is engagement of the staff implementing the checklist. In surgical specialties such as our own it was quickly seen that there were many important omissions in the generic checklist that did not cover issues particular to our specialty, and thus the European Association for Cardio-Thoracic Surgery embarked on a process to create a version of the checklist that might be more appropriate and specific to cardiothoracic surgery, including checks on preparations for excessive bleeding, perfusion arrangements and ICU preparations, for example. The guideline presented here summarizes the evidence for the surgical checklist and also goes through in detail the changes recommended for our specialty.

Thinking in three's: Changing surgical patient safety practices in the complex modern operating room

The three surgical patient safety events, wrong site surgery, retained surgical items (RSI) and surgical fires are rare occurrences and thus their effects on the complex modern operating room (OR) are difficult to study. The likelihood of occurrence and the magnitude of risk for each of these surgical safety events are undefined. Many providers may never have a personal experience with one of these events and training and education on these topics are sparse. These circumstances lead to faulty thinking that a provider won't ever have an event or if one does occur the provider will intuitively know what to do. Surgeons are not preoccupied with failure and tend to usually consider good outcomes, which leads them to ignore or diminish the importance of implementing and following simple safety practices. These circumstances contribute to the persistent low level occurrence of these three events and to the difficulty in generating sufficient interest to resource solutions. Individual facilities rarely have the time or talent to understand these events and develop lasting solutions. More often than not, even the most well meaning internal review results in a new line to a policy and some rigorous enforcement mandate. This approach routinely fails and is another reason why these problems are so persistent. Vigilance actions alone have been unsuccessful so hospitals now have to take a systematic approach to implementing safer processes and providing the resources for surgeons and other stakeholders to optimize the OR environment. This article discusses standardized processes of care for mitigation of injury or outright prevention of wrong site surgery, RSI and surgical fires in an action-oriented framework illustrating the strategic elements important in each event and focusing on the responsibilities for each of the three major OR agents-anesthesiologists, surgeons and nurses. A Surgical Patient Safety Checklist is discussed that incorporates the necessary elements to bring these team members together and influence the emergence of a safer OR.

Patient Safety Checklist No. 3

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.

Patient Safety Checklist No. 1

Obstetrics & Gynecology: November 2011 - Volume 118 - Issue 5 - p 1203-1204 doi: 10.1097/AOG.0b013e31823b17f3

Zero CAUTIs Over 33 Months as a Result of Low Urinary Catheter Utilization Rates

Methods: Infection Prevention (IP) staff evaluated TICU patients for VAP using the National Healthcare Safety Network criteria. A VAP Performance Improvement project was initiated in the TICU in January 2009. Primary prevention efforts were led by a physician champion and an engaged nurse manager. The physician champion emphasized the importance of oral care with medical and nursing staff on rounds. Intubated patients had their teeth cleaned with toothbrushes and a rinse with a chlorhexidine gluconate (CHG) solution. The nurse manager conducted rounds using a patient safety checklist that included VAP prevention elements such as head-of-bed audits and documentation of sedation holds. IP staff also began reporting VAP rates to the TICU monthly. Prior to January 2009, the TICU was notified of their VAP cases quarterly.