My husband was, for many years, a private pilot. Although I could never get comfortable flying in such small compartments, I did travel with him many times and every time he went through a page of equipment checks before take off. Occasionally on business travel I have peeked into the open door of the cockpit to find commercial pilots using a similar list to work through standard system checks before taxiing to the runway. After thousands of hours in the air, why would professional pilots need to review a list of checks? In the risky business of air travel, nothing can be left to chance or memory. Requiring pilots to work through a list of standard safety checks before every flight has saved many lives and reduced inflight emergencies.
The patient safety movement has embraced the use of checklists in the clinical setting since Gawande published research on the use of checklists to reduce clinical error in the book “The Checklist Manifesto”. Working with the World Health Organization (WHO), Gawande implemented a simple pre-surgical checklist in 8 hospitals and found a 36% decrease in major post-operative complications and a 47% decrease in post-op mortality. Since then WHO has developed checklists for safe childbirth, trauma, and H1N1. The Agency for Health Care Research and Quality (AHRQ) provides a clearinghouse of evidence for the positive outcomes of checklist use in health care.
Checklists improve safety in highly specialized and technical settings where repetitive functions lead to complacency. Fragmented and chaotic care environments are filled with interruptions and distractions that can generate omissions of important steps in a clinical process. How might checklists help us stay on track in the correctional healthcare setting? Here are a few of my thoughts:
- Suicide Watch Release: What are the steps to clear an inmate from suicide watch? Who needs notified and who needs to sign-off on the release?
- Chronic Care Visit Prep: What should be available for a chronic care visit? Are the labs back? How about specialty consults and diagnostic studies? What patient teaching materials are needed?
- Post Emergency Response: What forms need completed? What needs documented in the chart? How about replacement of medications used during the event? Who needs contacted? What is the disposition of the patient?
- Return from an Outside Appointment: Was the medical record returned? Did the specialist send instructions? Does the provider need contacted? Is there a follow-up visit requested?
We can learn much from the patient safety movement. By evaluating and applying successful strategies from traditional settings, we can improve the effectiveness and efficiency of our care behind bars.
Do you use checklists to stay on track in your clinical setting? Share your experiences in the comments section of this post.
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