By Peggy McDaniel, BSN, RN
Ok, I will admit right off that I am a huge fan of Atul Gawande’s writing. I have read his books Better and Complications, and I think much of his work should be required reading for all health care students. I haven’t read his newest book, The Checklist Manifesto: How to Get Things Right. I plan to soon, but it’s the 3rd book down in the pile on my bedside stand.
That confession aside, there has been some recent news around the use of checklists that bears some attention. Dr. Gawande helped develop a two-minute checklist that is to be done prior to surgery.
Dr. Peter Pronovost was involved in the development of a similar checklist related to the insertion of central lines.
Airlines and airplane manufacturers, such as Boeing, use checklists constantly to ensure consistent, high quality outcomes.
I did a quick Google search for “checklists and nursing” and found various references to skills and competency checklists. As a nurse, my skills have been observed and validated with checklists over the years. I have also been party to filling out checklists on myself and my peers. Come to think of it, much of our charting has been done by filling out checklists.
I guess I am a bit surprised that the use of checklists to validate competencies and keep track of specific processes and actions by doctors and multidisciplinary teams has been so long in coming. Much of the current work done in health care around the use of checklists appears to be spearheaded by doctors, but it also supports nurses by promoting open communication between all parties.
Why is it that a simple checklist can make such a difference? When Gawande speaks of the positive outcomes that he has seen from the implementation of his checklist, he admits that he “didn’t think he needed the reminders.” But he also admits that he has not had a week where the checklist did not prevent a problem.
The Pronovost checklist that monitors the insertion of central lines can empower a person, such as a nurse, when they are monitoring the actions of a doctor. The checklist becomes a leveler—it takes finger-pointing out of the equation, and ensures quality by stopping the process if it is not being done properly. The success of such checklists and high quality outcomes can only be ensured when the highest level of the organization is supportive of the person holding the checklist.
Both Pronovost and Gawande admit that checklists are not a “magic wand,” but they do agree that when used consistently, they have been consistently proven to improve outcomes. Are you using checklists in your place of employment? How long have you been doing so and what do you see as the benefits and the challenges? Has their use made a difference to the patients you serve?