Featured Research

from universities, journals, and other organizations

Making a better medical safety checklist

Date:
February 16, 2010
Source:
Johns Hopkins Medical Institutions
Summary:
In the wake of Johns Hopkins' success in virtually eliminating intensive-care unit bloodstream infections via a simple five-step checklist, the safety scientist who developed and popularized the tool warns medical colleagues that they are no panacea.

In the wake of Johns Hopkins' success in virtually eliminating intensive-care unit bloodstream infections via a simple five-step checklist, the safety scientist who developed and popularized the tool warns medical colleagues that they are no panacea.

"Checklists are useful, but they're not Harry Potter's wand," says Peter Pronovost, M.D., Ph.D., a professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine and a patient safety expert. "The science needed to best develop focused, unambiguous and succinct checklists for medicine's thousands of diagnoses and procedures is in its infancy, and there can be unintended consequences of reliance on simple tools."

In a review by Pronovost and other Johns Hopkins researchers recently published in the journal Critical Care, the authors say it's clear that use of aviation-like safety checklists based on scientific evidence can work, and that more hospitals should use them to help prevent errors and reduce costs associated with medical mistakes.

But says Pronovost, whose eponymous checklist is credited with preventing thousands of central-line infections at Hopkins, throughout the state of Michigan and elsewhere, they need to be accompanied by a "change in the culture of arrogance still widespread in medical care."

Culture change, he says, "insists," for example, that nurses are empowered to question doctors who don't follow the steps properly and that every single member of the health care team toss out long-held beliefs that infections are an inevitable cost of being in the hospital.

"Just having a checklist on a piece of paper isn't going to be enough," he says.

In the Critical Care review, Pronovost and his colleagues took a step back and applied a rigorous scientific analysis of checklists, looking especially for which ones have the potential to work best in varying situations.

For example, some checklists are like grocery lists, a basic catalog of what needs to be accomplished by just one person in order for a process or procedure to be completed properly. In an operating room, the anesthesiologist has a checklist that assists her in making sure that every step is followed to ensure the anesthesia machine is working properly before a patient is put under.

"But that sort of checklist doesn't work in all cases," Pronovost says. "Central-line infection checklists work best, for example, when there is what we call a challenge and response, in which one person reads a series of items and a second person verifies that each item had been completed. With the check and balance of another person, the list is more likely to be completed properly."

Pronovost also warns of checklist overload. "Creating too many checklists -- especially those that are not proven to improve patient safety -- or using checklists where they are not truly needed can be distracting and time-consuming," he says, "and over-reliance on them can lead to a false sense of safety."

"Each step in the diagnosis, treatment and monitoring process poses risks for error that we need to defend against," the Johns Hopkins researcher says. "We do not know how many checklists are too many, when they are most useful, when we have overloaded the checklist users or how strictly the benefits are being measured."

In fact, the Johns Hopkins team says, the underuse of checklists that do work is a problem in part caused by the paucity of scholarly research on how best to use them, how to build and implement them, how to measure their effectiveness in improving patient outcomes, and how they can best be sustained in a culture that is slow to change.

Pronovost's central-line safety checklist was created after reviewing the literature and guidelines on how to best prevent bloodstream infections in ICUs and selecting the five for which evidence showed they were most likely to accomplish that goal. The checklist was piloted in a small setting (one ICU at The Johns Hopkins Hospital) before undergoing a test on a larger scale (the state of Michigan's ICUs). After the work was published in the New England Journal of Medicine, he get calls from not only doctors asking him to design checklists for them, but CEOs, financial-industry executives and even a man who wanted a checklist for sailing a boat.

While standardization is at the heart of any checklist, Pronovost says checklists need to be continually assessed to be sure they are still accomplishing their goals -- in this case, keeping bloodstream infection rates near zero. It is important not only to be able to tell patients that the checklist is being used, but to be able to answer the bigger question: Am I safe in the hospital?

"There's a lot more research to do and a lot of work to be done," Pronovost says.

Other Johns Hopkins researchers on the paper include Bradford D. Winters, M.D., Ph.D.; Ayse P. Gurses, Ph.D.; Harold Lehmann, M.D., Ph.D.; and J. Bryan Sexton, Ph.D, M.A.


Story Source:

The above story is based on materials provided by Johns Hopkins Medical Institutions. Note: Materials may be edited for content and length.


Cite This Page:

Johns Hopkins Medical Institutions. "Making a better medical safety checklist." ScienceDaily. ScienceDaily, 16 February 2010. <www.sciencedaily.com/releases/2010/02/100216101206.htm>.
Johns Hopkins Medical Institutions. (2010, February 16). Making a better medical safety checklist. ScienceDaily. Retrieved July 23, 2014 from www.sciencedaily.com/releases/2010/02/100216101206.htm
Johns Hopkins Medical Institutions. "Making a better medical safety checklist." ScienceDaily. www.sciencedaily.com/releases/2010/02/100216101206.htm (accessed July 23, 2014).

Share This




More Health & Medicine News

Wednesday, July 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Courts Conflicted Over Healthcare Law

Courts Conflicted Over Healthcare Law

AP (July 22, 2014) Two federal appeals courts issued conflicting rulings Tuesday on the legality of the federally-run healthcare exchange that operates in 36 states. (July 22) Video provided by AP
Powered by NewsLook.com
Why Do People Believe We Only Use 10 Percent Of Our Brains?

Why Do People Believe We Only Use 10 Percent Of Our Brains?

Newsy (July 22, 2014) The new sci-fi thriller "Lucy" is making people question whether we really use all our brainpower. But, as scientists have insisted for years, we do. Video provided by Newsy
Powered by NewsLook.com
Scientists Find New Way To Make Human Platelets

Scientists Find New Way To Make Human Platelets

Newsy (July 22, 2014) Boston scientists have discovered a new way to create fully functioning human platelets using a bioreactor and human stem cells. Video provided by Newsy
Powered by NewsLook.com
Gilead's $1000-a-Pill Drug Could Cure Hep C in HIV-Positive People

Gilead's $1000-a-Pill Drug Could Cure Hep C in HIV-Positive People

TheStreet (July 21, 2014) New research shows Gilead Science's drug Sovaldi helps in curing hepatitis C in those who suffer from HIV. In a medical study, the combination of Gilead's Hep C drug with anti-viral drug Ribavirin cured 76% of HIV-positive patients suffering from the most common hepatitis C strain. Hepatitis C and related complications have been a top cause of death in HIV-positive patients. Typical medication used to treat the disease, including interferon proteins, tended to react badly with HIV drugs. However, Sovaldi's %1,000-a-pill price tag could limit the number of patients able to access the treatment. TheStreet's Keris Lahiff reports from New York. Video provided by TheStreet
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins