Peter Pronovost, MD, PhD, whose eponymous checklist is credited with preventing thousands of central-line infections at Hopkins, throughout the state of Michigan and elsewhere, notes that checklists need to be accompanied by a “change in the culture of arrogance still widespread in medical care,” according to the release. For example, such a change would need to ensure that nurses are empowered to question physicians who don’t follow steps properly.
In the review, Dr. Pronovost and his colleagues applied a rigorous scientific analysis of checklists, looking especially for which ones have the potential to work best in varying situations, according to the release. For example, some checklists are 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, for instance, the anesthesiologist has a checklist that assists him or her in making sure that every step is followed to ensure the anesthesia machine is working properly before a patient is put under.
However, the researchers noted that that type of checklist may not be the best for all instances, such as the case in preventing central-line infections. However, Dr. Pronovost warns that checklist overload can occur, causing staff members to become distracted or depend too much on the checklist.
“Each step in the diagnosis, treatment and monitoring process poses risks for error that we need to defend against. 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,” Dr. Pronovost said in the release.
Researchers noted, however, that underuse of effective checklists is due in part to a paucity of scholarly research on how best to use, build and measure the effectiveness of checklists. More study also needs be conducted on sustaining their use in a slow-changing culture, according to the release. Dr. Pronovost also noted that checklists need to be regularly assessed to ensure they are accomplishing their goals and to ensure patient safety.
Read the Johns Hopkins release on patient safety checklists.
