Articles: checklist.
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The Helsinki Declaration was created and signed by the European Board of Anaesthesiology (EBA) and the European Society of Anaesthesiology (ESA). It was initiated in June 2010, and it implies a European consensus on those medical practices which improve patient safety and provide higher quality perioperative care. Authors focus on four elements of this initiative, which can be easily implemented, and provide almost instant benefit: use of preoperative checklist, prevention of perioperative infections, goal-directed fluid therapy and perioperative nutrition. The literature review emphasizes that well organized perioperative care plays the most important role in improving patient safety.
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Perioperative checklists are mandated by many hospitals as determined by the reduction in morbidity and mortality seen with the use of the World Health Organization's Surgical Safety Checklist. An adapted perioperative checklist was implemented within our hospital system, and compliance with the checklist was reported to be 100%. We hypothesized that compliance does not measure the fidelity of implementation. ⋯ These data show that despite the 100% documented completion of the preincision phase of the checklist; most of the individual checkpoints are either not executed as designed or not executed at all. These findings demonstrate lack of checklist implementation fidelity, which may be a reflection a poor implementation and dissemination strategy.
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The safety and consistency of the care given to hospital inpatients has recently become a particular political and public concern. The traditional 'ward round' presents an obvious opportunity for systematically and collectively ensuring that proper standards of care are being achieved for individual patients. ⋯ Although the 'multidisciplinary ward round' is widely accepted as good practice, the medical and nursing staff in many teams are failing to coordinate their workloads well enough to make multidisciplinary rounds a working reality. 'Nursing' and 'medical' care on the ward have become 'de-coupled' and the potential consequences for patient safety and good communication are largely self-evident. This problem is further complicated by a medical culture which values the primacy of clinical autonomy and as a result can be resistant to perceived attempts to 'systematize' medical care through instruments such as checklists.