Posted 16th Jul 2011 in Reducing Perioperative Harm

New Zealand has been a leader in the introduction and use of the Checklist. Auckland City Hospital was one of the original eight pilot sites internationally, and an early adopter of the Checklist.

Nevertheless, the use of the Checklist by clinicians in the operating room is variable. To be effective, the Checklist needs to be used properly. A clinician simply reading out the Checklist is not proper use – it is important to take the opportunity to stop and think about what is actually being done, why, and what might be about to go wrong.

It is one thing to implement a safety initiative. It is another to embed it.

It is up to senior clinicians to make this approach work. The Royal Australian College of Surgeons, the Australia New Zealand College of Anaesthetists, the New Zealand Nurses Organisation, and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists have all endorsed the Checklist. Local modification is encouraged. Much of what the Checklist requires is commonsense - checking that everyone knows each other at the outset of a procedure, checking that you have the right patient, checking you will be carrying out the correct operation. But it is common sense that could save lives or protect someone from needing additional carer.

Wrong patient operations do occur in New Zealand, and they are not something to be complacent about. Checking allergies and the airway before giving drugs to render a patient unable to breathe is obviously pretty important. For patients that need them, timely antibiotics really matter. It is about making sure the basics are right so that all the skill and expertise that characterises our surgery, anaesthesia and nursing is not wasted.

I am aware that some anaesthetists and surgeons are uncomfortable with discussing aspects of the checklist in front of awake patients.  In fact, it makes sense to involve the patient in checks that relate to their identity and the procedure they are having, and the Checklist also provides an opportunity to show patients how much care the team is taking.  The Commission is looking at involving and empowering consumers more, so they expect these checks to undertaken and are concerned when they are not.  

I would ask that you read the papers that present the evidence about the effectiveness of the Checklist that are attached to this article, and the links that are provided below. I also encourage you to read Atul Gawande’s book Checklist Manifesto, which gives great insight into why this approach works.

Alan Merry

Chair

Health Quality & Safety Commission 

Useful links:

The WHO Surgical Safety Checklist

Royal Australasian Colleges Checklist

WHO Implementation Plan

National Patient Safety Agency (NPSA) Checklist for radiological interventions

NPSA Cataract Checklist

NPSA Maternity Checklist

Worldwide Modifications

PowerPoint Presentation

Case Studies

You can also view the following attachments:

Journal articles about the checklist

  • A Surgical Safety Checklist to Reduce Morbidity and Mortality in a Global Population, New England Journal of Medicine 2009, Haynes
  • Strategies for Improving Surgical Quality — Checklists and Beyond, New England Journal of Medicine 2010, Birkmeyer
  • Effect of a Comprehensive Surgical Safety System on Patient Outcomes, New England Journal of Medicine 2010, de Vries
  • Association Between Implementation of a Medical Team Training Program and Surgical Mortality, JAMA 2010, Neily

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