03-01-2010 01:45 PM
There is a great article by Atul Gawande in the New Yorker titled The Checklist. One suggestion I would have for a checklists would be looking at the dating on MDV's. If you are interested in the article, please follow this link. The Checklist
03-02-2010 11:02 AM
we have a checklist for several things:
* keep track of clinical monitoring (so that a pharmacist can see if someone did/didn't do any of the report monitoring - i.e. when evening person comes in they can see all in house warfarin (PT/INR) was checked, vanco/a.gly labs/monitoring, et cetera)
* monthly nursing station inspections/outdates/ADM machine outdates/cleaning was done
* IV room was cleaned, hoods cleaned, checked, monthly HEPA check/change done.
I feel they are very important as they not only remind people what needs to get done, but gets away from the 'but i did it last time'... or 'i thought X was going to do it' et cetera. everyone can easily see what was done or needs to get done and just initials it.
03-02-2010 11:56 AM
I just boarded a plane back to Seattle last night and stood on the gate/ramp watching the pilot checking off all the various things they have to do. Checklists are so common in other industries where safety is absolute and routines need to be failsafe.
I think the concept of MUE/DUE is essentially a clinical checklist, in a way. I remember when surfactants first came out for use in NICU babies. They were very expensive and we put together a checklist to make sure that criteria for use were being met. It was essentially a DUE.
03-02-2010 08:54 PM
Thanks for the link. It was seeing and hearing Dr. Gawande on shows about his book (not read yet) and reading reviews of the book that initially got me interested in the subject. I had not read his New Yorker article on this subject, but had read others he has written. His article on medical utilization in (I think) June, 2009, was, like this article, very well done.
Today I saw an ICU order set that contained some pretty rudimentary steps. I wondered which physicians needed to be reminded about the appropriate target range for a CVP, when I realized that this was just another check-list, and evidently, these work. I have some trouble in envisioning how check-lists can be folded into the clincial pharmacy work-flow, but some responders to this posting have given me some useful examples. Unlike Dr. Provonost, I don't great every idea with a vigorous, "I like that," etc., but I am trying to come around,
03-09-2010 02:23 PM
I understand the reason behind checklists and think they can offer a significant safety benefit. With that said, I think they can be overdone and need to be used in moderation to continue to provide a real benefit. There isn't a pharmacist out there that isn't familiar with alert fatigue. We just need to make sure that the lists we create are justified so we can avoid creating "list fatigue".
I think lists and flowchart are most beneficial when used for: 1) complex and/or dangerous processes and 2) processes that is rarely used, i.e. could be forgotten.
Just a thought.
03-10-2010 07:32 PM
03-11-2010 03:33 PM
Dr. Gawande's book was an excellent read. His writing style is engaging, and his stories are memorable and relevant. I pulled his book onto my Kindle because I was interested in the efficiency gains that checklists seem to offer. I'm glad to say that I learned a great deal not only about checklists, but about the mechanisms of human error that checklists can help overcome.
While I agree with the concept that checklists can be overdone, I've found that the place where they go too far isn't in the number of places that they get used, but in the number of items they contain. According to Gawande's book, Boeing has determined that the number of items on a checklist (and they literally have binder-loads of them for each model of aircraft they produce) should be between 4 and 9. Any more than that, and people start to gloss over steps, defeating the purpose of the checklist.
The book is well worth the time it will take to read. After I mentioned it to my manager, I was asked to give a short presentation on checklists during a team meeting, which was well-received. I think it could spark similar discussions in any pharmacy, and woud probably lead to the creation of very useful tools!
03-15-2010 11:20 AM
I think checklists are an excellent area for technology to come into play.
I have always wondered about the appropriate size of checklists, and now that you cite that it is between 4 and 9, the wheels in my head start turning. I have built checklists electronically for our pharmacies, and to me, the biggest advantage of an electronic checklist is that I can interactively display which questions appear based on previous answers (for example, if there is a check list asking the user to enter the temperature reading of a refrigerator, the form can determine if it is out of range, alert the user that it is, and ask for additional information regarding what steps the user did to put the temperature back in range. None of this would be displayed if the temp was within range). This way, we can keep the actual number of questions within the 4 to 9 range, but allow for additional questions should the need arise without the user having to "grow tired" of the same non-applicable questions. The fact that the data from checklists can be compiled into a database and crunched on a macro level without looking at paper is simply icing on the cake.