Barriers to a safety checklist and methods to improve usage of the WHO safety checklist in interventional radiology

Abstract

Our aims were to first assess uptake of the modified safety checklist (SC) for interventional radiology (IR), identify obstacles to using the SC, and then apply changes to local policy to reach maximum compliance. Retrospective data collection was performed of all patients who underwent an interventional procedure in the interventional suite at the Royal Berkshire Hospital in February, March and May 2014. Barriers to a SC: a lack of awareness about the SC; lack of training in how to complete the SC; lack of leadership—no team member had been given the role of promoting the SC and collecting and collating the SC; attitude of staff—some team members felt that the SCs were time consuming and further bureaucracy; out-of-hours procedures involved staff from outside departments who were not familiar with the SC; paper copies of the completed SCs were being misplaced. Results: February 2014 = 79%; staff education of the importance of the modified World Health Organization (WHO) checklist disseminated in the interventional suite and at clinical governance; each day a designated ‘SC champion’ in the interventional suite has the responsibility for overseeing the WHO checklist is completed for each patient; the use of a clipboard for storing checklists, amalgamated and scored at the end of each day. Any checklists not completed are highlighted and discussed with the consultant. March 2014 = 95%; junior nurse involvement in auditing to improve awareness and engagement; out-of-hours interventional radiologist ensuring that the checklist is completed for each patient. May 2014 = 100%.

Validation of a patient safety checklist for radiological procedures in hemodynamics

“…Barriers can contribute to the poor effectiveness of the instrument, such as lack of knowledge about the checklist and its accomplishment; lack of leadership (no member of the team is responsible for promoting and auditing the checklist); staff considers time-consuming and additional bureaucracy; after-hours procedures involving employees from other sectors not familiar with the tool; and loss of instruments. To that end, the nurse can be the principal professional in awareness, training, engagement, and auditing for the implementation of the tool ( 27 ) .…”

“…In safety checklist models in interventional radiology services proposed in the literature, there is a frequent concern to verify team presentation, history, informed consent, review of previous images, sedation and analgesia, renal function, anticoagulation status, allergies, prior heparin therapy, concerns about equipment, post-procedure instructions and notes performed ( 20 , 22 - 24 , 27 ) .…”

“…In interventional radiology, more extensive and multicenter studies are necessary to verify the effectiveness of the use of a checklist and its correlation with the decrease in complications and mortality ( 21 , 27 , 30 ) .…”

The introduction of a safety checklist in two UK hospital emergency departments: A qualitative study of implementation and staff use

“…In contrast, in ED1 it was attached as a separate piece of paper and was vulnerable to being disassociated from the core clinical documentation. The differences between the EDs were also evident around training, a significant factor in checklist implementation (Puttick, Speirs, Gibson, Tadjkarimi, & Ahmad, ), in that ED2 were able to draw on training resources supported by the hospital infrastructure that were not available in ED1. More than this, in ED2 the implementation was mobilised around a team that included senior nursing staff and consultants whereas in ED1 it was led by a senior nurse.…”

Avoiding and Managing Error in Interventional Radiology Practice: Tips and Tools

“…However, what has been demonstrated so far is that there are specific barriers to checklist uptake in IR, including lack of awareness, training, and leadership along with staff attitude (''checklists are time consuming and bureaucratic''). 19 Also, educating radiologists about checklists along with e-mail reminders has been shown to increase adoption. 20 Some data suggest an IR checklist can reduce procedure ''process deviations'' and delays/cancellations.…”