Transcript SCAI Pediatric Quality Improvement Toolkit: Procedural Checklist

Procedural Checklists for the
Pediatric Cath Lab
This tool kit includes the following:
 Background information on the utility of
procedural checklists
 Key elements of procedural checklists
 Sample procedural checklists (both basic
and comprehensive)
 Bibliography
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Human error can add to the risk inherent to
procedures used for diagnosis and treatment of
congenital heart disease.
Checklists utilized in aviation and construction
industries are thought to reduce risk and
improve efficiency.
Concepts of Crew Resource Management
(CRM) are being increasingly adapted to the
practice of medicine to improve efficiency and
safety.1
What can procedural checklists do in medicine?
1. Improve safety by reducing morbidity and mortality 1-3
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e.g. DVT prophylaxis, antibiotic dosing
2. Improve teamwork and communication 4
3. Facilitate handoffs between services 5
4. Reduce costs 6
5. Potentially reduce or eliminate litigation (up to 1/3 of
all malpractice claims) 7
The ideal procedural checklist should:
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Improve communication and staff awareness –
especially at transfers of care
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Reduce medical errors and improve patient
safety
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Improve efficiency
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Ultimately improve staff morale and patient
satisfaction
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Key components of procedural checklists, as
defined by the World Health Organization: 8
1.
Pre-anesthesia/sedation
1.
Pre-incision (vascular access)
1.
Post-procedure (pre-transport)
Pre-anesthesia/sedation examples:
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Pregnancy test
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Planning of type of sedation
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Special equipment needs (nitric oxide,
rotational angiography)
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Allergies/Contrast reaction
Pre-incision (vascular access) examples:
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Staff introduction
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Access plan/previous problems
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Medications (heparin, antibiotics)
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Planned admission and location
Post-procedure (pre-transport) examples:
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Complications
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Follow up studies
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Patient sign-out
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Lines/drains
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Family updated
We sought to:
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Produce a checklist that could be readily put to
use in pediatric cardiac catheterization labs
without an existing procedural checklist
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Produce a checklist that could easily be adapted
or modified for local use
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Examples of a basic and more comprehensive
checklist follow.
The following are examples of checklists utilized
at various institutions
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The KEY to this document is that it is designed
specifically for quality improvement and should
therefore NOT become part of the medical
record
It can and should be a tool to improve periprocedural patient care and safety
Each catheterization laboratory should verify
with their institution the implications of, and
regulations surrounding, this document, as
different states may have different codes.
1. Ricci MA, Brumstead JR. Crew resource management: using aviation techniques to improve operating
room safety. Aviat Space Environ Med. 2012; 83(4):441-4.
2. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala
PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA; Safe Surgery Saves Lives
Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J
Med. 2009. 360(5):491-9.
3. Berrisford RG, Wilson IH, Davidge M, Sanders D. Surgical time out checklist with debriefing and
multidisciplinary feedback improves venous thromboembolism prophylaxis in thoracic surgery: a
prospective audit. Eur J Cardiothorac Surg. 2011
4. Hayes C. Surgical Safety Checklist: Improved Patient Safety through Effective Teamwork. Nurs Leadersh
(Tor Ont). 2012;15:57-62.
5. Kim SW, Maturo S, Dwyer D, et al. Interdisciplinary development and implementation of communication
checklist for postoperative management of pediatric airway patients. Otolaryngol Head Neck Surg
2012;146:129-34.
6. Semel ME, Resch S, Haynes AB, Funk LM, Bader A, Berry WR, Weiser TG, Gawande AA. Adopting a
surgical safety checklist could save money and improve the quality of care in U.S. hospitals. Health Aff
(Millwood). 2010;29(9):1593-9.
7. de Vries EN, Eikens-Jansen MP, Hamersma AM, Smorenburg SM, Gouma DJ, Boermeester MA.
Prevention of surgical malpractice claims by use of a surgical safety checklist. Ann Surg.2011:253(3):6248.
8. http://www.who.int/patientsafety/safesurgery/en/index.html
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Many thanks to the individuals who contributed to
the SCAI Pediatric QIT Procedural Checklist
Module:
 Henri Justino, MD (P-QIT Chair)
 Brent Gordon, MD
 Bryan Goldstein, MD
 Paul Seib, MD
 Abhay Divekar, MD
 Troy Johnston, MD
 Joel Harder, MBA
 Drew Voytal, MPA