Electronic Checklists Help Develop Safety Culture in Healthcare

Electronic checklists are a useful tool for medical and nursing staff to go over and check off routine tasks. The use of checklists has become increasingly common, especially in operating theatres. Electronic checklists used on mobile devices have many advantages over checklists on paper.

Most adverse events in healthcare are associated with human error, such as lack of communication or poor teamwork — and not with lack of skill or technical competence. [See 1; 2.] The use of checklists supports communication among professional groups, increasing a multidisciplinary team’s sense of unity. Information flows better, for example, between doctors and nurses. Checklists harmonise clinical practices and the number of errors declines. This shows as improvements in care quality and patient safety. [See 3.] In other words, checklists comprehensively improve the safety culture in healthcare.

Surgical Safety Checklist Harmonises Practices Worldwide

The use of checklists in operating theatres has become increasingly common over the last thirteen years, ever since the World Health Organization (WHO) published the guidelines “Safe Surgery Saves Lives” along with the WHO Surgical Safety Checklist in 2007. [1; 2; 3.] This checklist has been found to improve surgery patients’ risk management and prevent adverse events [1]. With the help of checklists, the number of postoperative complications and the postoperative mortality rate have been observed to decline in both the developed and the developing countries [4, 1].

Evidence-Based Advantages

Several Finnish and international studies have demonstrated the benefits of checklists [for a summary, see 5].

The use of checklists can also save some real money: as the number of patient injuries decreases, so does the amount of money spent on compensations for them [2]. Compensable patient injuries are usually related to surgical procedures and anaesthesia. For example, the Finnish Patient Insurance Centre paid a total of EUR 40.1 million in compensations in 2019. [6.]

Using the checklist is easy and has no known negative impact on outcomes [1]. For example, filling out the surgical safety checklist takes no more than 2–3 minutes [2].

Electronic Checklists on Mobile Devices

Conventionally, the checklists used in healthcare have been made out on paper. The benefits of electronic checklists include ease of data collection, safe data storage, and effortless updatability [Veerdaasdonk et al. 2008, according to reference 5]. When the checklists can be accessed through the same mobile device as other data and tools needed in patient care, the lists cannot get forgotten or lost. Medical and nursing staff can go over and check off the items at the patient’s bedside, using a mobile point-of-care application.

It is important that the checklists are customised to meet the needs of each hospital and unit. The list users’ wishes should be heard in the process — this is also recommended by the WHO [cf. 2; 7].

A surgical safety checklist may include the following items, among others [cf. 8]:

  • Has the patient’s identity been confirmed?
  • Has the patient been without food?
  • Has the patient taken or stopped taking their medication as instructed?
  • Has the patient received all the information regarding the surgery?
  • Have all necessary measurements been completed?
  • Have all necessary laboratory tests been taken?
  • Has the anaesthesia form been filled out?
  • Has the surgeon examined the patient?
  • Is the patient ready for surgery (i.e. are all the items on the checklist completed and checked off)?

Naturally, checklists are a useful tool in many fields of healthcare delivery, not just preoperative care. At Medanets, we always customise the checklists according to the needs and wishes of the customer.

REFERENCES:

[1] https://www.thl.fi/attachments/halo/SLL_2009_49-4249_LeikkaustiiminTarkistuslista.pdf

[2] https://www.duodecimlehti.fi/duo98616

[3] http://www.finnanest.fi/files/pesonen_tarkistus.pdf

[4] https://www.nejm.org/doi/full/10.1056/NEJMsa0810119#t=article

[5] https://www.theseus.fi/bitstream/handle/10024/68040/Mirja.Mertanen.Piia.Pitkanen.pdf?sequence=1&isAllowed=y

[6] https://www.pvk.fi//templates/vinha/services/download.aspx?fid=419824&hash=0affa4c2723b13323e3d6336e59ce10adacc66512de02d4fa453702f8424cc12

[7] https://www.duodecimlehti.fi/duo10740

[8] https://www.theseus.fi/bitstream/handle/10024/77633/Ahtinen_Oili.pdf?sequence=1&isAllowed=y