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 August 27, 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 August 27, 2014).

Share This




More Health & Medicine News

Wednesday, August 27, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Predicting Heart Transplant Rejection With a Blood Test

Predicting Heart Transplant Rejection With a Blood Test

Ivanhoe (Aug. 27, 2014) Now a new approach to rejection of donor organs could change the way doctors predict transplant rejection…without expensive, invasive procedures. Video provided by Ivanhoe
Powered by NewsLook.com
Better Braces That Vibrate

Better Braces That Vibrate

Ivanhoe (Aug. 27, 2014) The length of time you have to keep your braces on could be cut in half thanks to a new device that speeds up the process. Video provided by Ivanhoe
Powered by NewsLook.com
Smartphone App Tracks Your Heart Rate

Smartphone App Tracks Your Heart Rate

Ivanhoe (Aug. 27, 2014) A new app that can track your heart rate 24/7 is available for download in your app store and its convenience could save your life. Video provided by Ivanhoe
Powered by NewsLook.com
Stroke in Young Adults

Stroke in Young Adults

Ivanhoe (Aug. 27, 2014) A stroke can happen at any time and affect anyone regardless of age. This mother chose to give her son independence and continue to live a normal life after he had a stroke at 18 years old. Video provided by Ivanhoe
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