Checklist Modification 101

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Checklist Modification 101
Make Me Your Own
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The Basics

• One size doesnt fit all. Every hospital should
  modify the checklist.
• Checklist modification creates buy-in and
  ownership.
• The checklist is designed to promote teamwork and
  communication . . . dont remove
  teamwork/communication items.

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Things to Keep In Mind When Modifying the
Checklist
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Brief

• Each section (Before Induction of Anesthesia,
  Before Skin Incision, and Before the Patient
  Leaves the Room) should take lt 1 minute.
• The checklist should never take longer than the
  procedure.
• The checklist should fit on one page.

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When Adding and/or Removing Items Ask Yourself .
. . .

• Is this a critical safety step and in great
  danger of being missed?
• Examples Known Allergies, Essential Imaging,
  Antibiotic Prophylaxis
• Is this adequately checked by other mechanisms?
• Examples Anesthesia safety checklist has been
  completed, Sterility including indicator results
• Is this actionable, with a specific response?
• Example Monitoring blood pressure
• Is this item discussed at a time when all
  relevant team members are present and when
  something can be done to fix it?
• Examples Essential equipment and expected blood
  loss
• Will this item help anybody here?

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Alternative Wording for Particular Items
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Modifying Blood Loss

• Are blood products required and available?

• What is the EBL?

• Blood (or cross-match) available if needed.

• Is there a need for blood products?

• Blood availability confirmed.

• EBL/Blood Plan

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Modifying Team Introductions

• We will start by introducing ourselves by name
  and role.

• Team introductions to patient, including name and
  role.

• Are there any unfamiliar staff in the room?
  Please introduce yourself by name and role.

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What If We Already Know Each Other?

• We recommend that even if you know each other
  that everybody says something before the
  procedure starts.
• Check-off with everybody in the room
• Surgeon says, Mary, are you ready to go? etc.

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Modifying the Safety Statement

• 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, 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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Is the Checklist the Best Way to Take Care of
This?

• Glycemic Control
• Fire Risk Assessment
• Hair Removal
• Checking Pressure Points

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Examples of Modified Checklists
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