Using checklists to improve patient safety

Nurse Leader Insider, December 4, 2019

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In nursing, we often see checklists in the form of order sets, flow sheets, protocols, cognitive aids, care plans, and algorithms. Although designed with good intent, these tools often have limited usability and differ significantly from airline style checklists. In the cockpit, checklists are developed to fit specific operations. How checklists are presented and what they look like are predicated on how the flight crew will actually use them in each situation.

When developing and using checklists in nursing practice, the same considerations should apply. Checklists can be divided into two types: read and verify, and read and do. Let's look at each.

Read and verify checklists are used for normal procedures. Normal procedure means anything that is done consistently and repeatedly on a routine basis, most often from memory.

One thing to keep in mind with read and verify checklists is that if they are to be used in the manner described, particular attention must be paid to how information is presented to the user. The checklists must not be loaded with narrative or expanded verbiage. They should be presented in a manner that is simple, uncluttered, and easy to read. The checklists' items should be clear and concise, allowing ease of use.

Read and do checklists are used in situations that are more critical, such as rapidly changing scenarios, critical events, abnormalities, and emergencies. Unlike routine scenarios, in emergent situations, individuals can experience strong physiologic reactions such as fear or anxiety that must be managed while still performing required tasks. The stress of an emergency can make it extremely difficult to recall items from memory; the ability to assess and critically think can be negatively affected which reduces situational awareness as the scenario unfolds. Critical situations and emergencies often present a complex set of variables and the appropriate response may depend on the presence or absence of specific circumstances. Accurate analysis is required to select the most appropriate course of action.

Read and do checklists allow humans to move through this process by providing guidance and direction so that assessments and analysis are focused on the right things, and the actions taken are suitable for the conditions experienced. With read and do checklists, beyond a few initial procedural items that "may" be carried out from memory, all items are read directly from the checklist, then carried out, one by one. All that is required is to follow the checklist until completion. This is an important distinction from the read and verify checklist in terms of both use and construction.

Editor's note: This is an excerpt from Soaring to Success: Taking Crew Resource Management from the Cockpit to the Nursing Unit. Check out our latest nursing resources here.

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