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Introducing the Checklist 101: Hard Lessons Learned From Life. Bill Berry, MD, MPH Sunil Eappen, MD Lizzie Edmondson. Topics. Safe Surgery 2015: South Carolina Keys to introducing the checklist Monitoring the checklist at your hospital The call series

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Introducing the checklist 101 hard lessons learned from life l.jpg
Introducing the Checklist 101:Hard Lessons Learned From Life

Bill Berry, MD, MPH

Sunil Eappen, MD

Lizzie Edmondson


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Topics

Safe Surgery 2015: South Carolina

Keys to introducing the checklist

Monitoring the checklist at your hospital

The call series

Your involvement in checklist implementation

Next steps


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Safe Surgery 2015: South Carolina

By the end of 2013 every patient undergoing surgery in the state will have a modified version of the checklist used during their operation.


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The Checklist

How many of you know the background of the WHO Surgical Safety Checklist?

How many of you are using a modified version of the checklist at your hospital?

How many of you tried using the checklist at your hospital, but weren’t able to get others to do it?


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CEO Participation

We asked your CEO to do the following:

Engage Executive Leadership

Gain the endorsement of the Hospital Board and Medical Executive Committee

Meet with clinical leadership to ensure that they are committed to working on this project

Identify individuals that will serve as the checklist implementation team in collaboration with clinical leadership



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Make an Implementation Team

Nursing

Administration

Anesthesia

Surgery


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Find Clinical Champions

The nurses will know

Pick those who are respected and who will be supportive

The support of “formal” leadership is absolutely necessary but those leaders are often not the ones who should guide this effort directly


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Start Small – Make Mistakes Small

Only expand when you are ready

Do not tie yourself to a firm timeline – be flexible

Keep pressure on yourself to move forward but remember . . . .no preconceived plan ever survives contact with reality


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Preparation is Everything

Careful preparation is much easier than repairing the damage of moving too quickly


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Modify and Trial the Checklist

Modify the checklist (Tips on next slide)

Practice using the checklist outside of the OR and modify as needed

Use the modified checklist in one case with one enthusiastic team

  • Each team member should be engaged and briefed ahead of time – make sure you talk to everybody

    Debrief and modify the checklist as needed

    Use the checklist for one day in every case with the same team

    Debrief and modify as necessary


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Modification Tips – The Basics

  • One size doesn’t fit all

  • Can create buy-in

  • Remove items that are adequately checked and measured by established safety systems

  • Don’t remove teamwork items:

    • Introduction of team members by name and role

    • All items in the briefing and debriefing sections


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Focused

Avoid adding too many items:

  • Each section should have 5-9 items

  • Only add items that are not adequately checked by other mechanisms


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Brief

Each section should take < 1 minute

The checklist should never take longer than the procedure


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The Goal is Two-Fold

To improve the performance of processes in the OR that every patient should have done

To improve communication and teamwork in the OR


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Don’t Modify


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"

“Will everyone please state name and role?”

"Confirm all team members have introduced themselves by name and role”

"We'll start by introducing ourselves and our roles”

"Team members introduced themselves by name and role"

"Confirm all team members have been introduced and actively participate"


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Surgeon says: “If anyone on the team sees something that the team should know about, please speak up”

Surgeon declares: “If anyone on the team sees something that the team should know about, please speak up anytime during the procedure

Surgeon states,“ Remember that all are free to voice any concerns at any time throughout the procedure”

Surgeon states, “If you see, suspect, or feel that patient care is compromised, will you speak up?”

Surgeon states, “Remember that all are free to voice any concerns at any time throughout the procedure”

Surgeon states, “Does anyone have concerns? If you think there is a problem, please speak up”


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When We Use the Checklist:

Does the entire team stop all activity at the three critical points in care?

Does the team verbally confirm each item on the checklist?

Are the items verified without reliance on memory?

Does the checklist promote teamwork?


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This is Not a Quality Improvement Effort That Can Be Meaningfully Accomplished By the Nursing Staff Alone

Avoid the temptation to take the easy way out

A checklist that becomes a tick box exercise is no checklist at all

Do not count on an “IT” system or electronic documentation to make this effort a success


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Educate. . .Educate. . .Educate Meaningfully Accomplished By the Nursing Staff Alone

In a “team”

Everyone separately


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Meaningfully Accomplished By the Nursing Staff AloneEveryone” Gets Personal Contact

Mass emails do not suffice

Talk to people

  • Peer to Peer

  • Nurse to Physician

    Do you have a good enough relationship to have this discussion?

    “Everyone” includes:

  • Anesthesiologists, CRNAs, Nurses, Scrubs, Surgeons, and techs

    Use a script to guide the discussion


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Make A Video Meaningfully Accomplished By the Nursing Staff Alone

Film it in an empty OR

Use someone's flipcam or camcorder

Many videos are available online, but one from your own place has the most impact


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Exempla St. Meaningfully Accomplished By the Nursing Staff AloneJoseph Hospital

Checklist Video


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How NOT to Use the Checklist Video Meaningfully Accomplished By the Nursing Staff Alone


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Train and Use Coaches Meaningfully Accomplished By the Nursing Staff Alone

Same people can do observations

Trusted and respected

Best if known by most


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Start Where It Meaningfully Accomplished By the Nursing Staff Alone’s Easiest

Use this rule at the beginning and all the way through

Start with the “willing”

Don’t try to fix problem staff and clinicians


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Collect Stories Meaningfully Accomplished By the Nursing Staff Alone

Share stories when you educate

Post the stories in a prominent shared space

An “IHI” story


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Advertise Meaningfully Accomplished By the Nursing Staff Alone

You cannot spread the word too much

Support from the highest places is valuable

Support from respected clinicians is essential


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Monitoring the Checklist Meaningfully Accomplished By the Nursing Staff Alone


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Performance of Checklist Observation Tool Meaningfully Accomplished By the Nursing Staff Alone


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Performance of Checklist Observation Tool Meaningfully Accomplished By the Nursing Staff Alone


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Surgical Teamwork Meaningfully Accomplished By the Nursing Staff AloneObservation Tool


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Surgical Teamwork Meaningfully Accomplished By the Nursing Staff AloneObservation Tool


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Option 1: Meaningfully Accomplished By the Nursing Staff Alone

Monitoring the Checklist at Your Hospital

BRING YOUR OWN DATA TOGETHER AND ANALYZE IT YOURSELF

Use all or some of the tools to monitor your progress.


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Option 2: Meaningfully Accomplished By the Nursing Staff AloneParticipate in a Research Study

YOU WILL HELP US LEARN AND IMPROVE SURGICAL CARE WORLDWIDE

Use the tools to collect data and send it to HSPH

We analyze the data for you

We benchmark the data to other SC hospitals

No cost to you


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Safe Surgery 2015: South Carolina Meaningfully Accomplished By the Nursing Staff AloneCall Series


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Safe Surgery 2015: South Carolina Meaningfully Accomplished By the Nursing Staff AloneCall Series

Step by step instruction on checklist implementation from experienced faculty

Office hours to work through barriers with individual hospitals

Materials to assist with implementation

Discussion of measurement tools and use

Review of progress and opportunities to improve the implementation


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Your Involvement as an Implementation Leader Meaningfully Accomplished By the Nursing Staff Alone

Participate on the call series, even if your hospital uses the checklist

Coach individuals at your hospital on how to use the checklist

Track your hospital’s use of the checklist

Give us feedback


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What Do You Do Now? Meaningfully Accomplished By the Nursing Staff Alone

Return to your hospital and see what steps your CEO has taken

If needed help them build the checklist implementation team

Schedule a large meeting to educate as many surgical personnel as possible – anytime after June 28th


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Materials and Resources: Meaningfully Accomplished By the Nursing Staff Alonewww.safesurgery2015.org


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