Patient Safety – The Role of Guidelines, Protocols and Checklists

Presenter – Pam Mosedale BVetMed MRCVS, RCVS Practice Standards Scheme Veterinary Adviser / Acting Lead Assessor

In truth, this was a webinar whose title didn’t fill me with enthusiasm, but after being glued to my tablet for an entire hour and immediately afterwards googling a recommended book called ‘ The Checklist Manifesto’ I realised my lack of enthusiasm was very much misplaced.

This was most definitely a webinar which should be watched by every practice owner, vet and vet nurse who want to reduce the number of mistakes made in practice and ensure the best care for their patients.

Pam Mosedale led this webinar and delivered a relevant, compelling and fascinating discussion on why vet practices should be using checklists, guidelines and protocols. The main aim of utilising these tools is to reduce the number of errors we make in practice. These errors could be as a result of human error where tiredness and time pressures can play a role. System errors can also cause mistakes to be made and this usually occurs when teams aren’t working well together or in many cases where systems just aren’t put in place. Finally poor communication is a common reason for errors and may be associated with the presence of continually changing teams or associated with a closed practice culture where staff don’t talk about their mistakes for fear of being blamed.

Human error is inevitable, but the number of these errors can be reduced by having checklists in place in order to prevent essential steps within a process being omitted. Pam advised it is important for the veterinary profession to learn from other industries where safety is paramount and the airline industry has been instrumental in demonstrating the efficacy and importance of checklists. Before every flight the co-pilot will read out a comprehensive checklist for the pilot to perform ensuring every precaution is taken to keep passengers safe.  These checklists have since been utilised in the medical profession with the WHO performing a pilot study on the use of surgical checklists in 2009. This study was performed because of appalling statistics stating that seven million people became disabled and one million died as a result of post-surgery complications. A surgical checklist was compiled which comprising a set of questions and instructions which staff needed to perform prior to a surgical procedure and included tasks such as counting in swabs and instruments. The checklist also asked for all staff present to introduce themselves and state their purpose which helped cement the team, some of whom may have never worked together before and in so doing aid with communication.

The results of this study were compelling showing a reduction in deaths by 47%, a reduction in surgical complications by 36% and a reduction in infections by 48%. 93% of the team members enrolled into this study also said they would want a checklist system to be used if they were a patient undergoing a procedure.

Checklists have the potential to be equally as useful within the veterinary sector and could be utilised in a variety of situations. For example they could be invaluable for use prior to anaesthesia or at handover in large practices where emergency out of hours is performed. The key however, when introducing checklists into practice, is to ensure each checklist is short, simple and evidence based and not to go into checklist overload by utilising them for every known procedure. Pam also advises it is essential to audit complications so these can be measured to ensure improvement in figures post implementation. In order to encourage the whole practice team to use checklists, it is also imperative to involve all members of the team when compiling checklists and it is crucial that the team leader is seen to be fully on board and is consistently using these checklists as appropriate. For those of you who are still not convinced, Pam cited a 2016 paper published in Veterinary surgery which demonstrated a drop from 17% to 7% in surgical complications following the implementation of a surgical checklist within a veterinary hospital.

Pam went on to discuss the use of protocols and guidelines in practice which can offer consistency in standards of treatment between all members of staff. Compiling guidelines can be an excellent team building exercise offering team members an opportunity to have input into how they are constructed. Also if a team has input into guidelines and protocols they are much more likely to use them compared to having them forced upon them when they have had no input. These guidelines should only be decided upon by looking at the evidence base and for those of you (including myself) who balk at the amount of work and time this is likely to involve, Pam suggested a number of resources including ‘RCVS knowledge’ and ‘BestBETs for Vets’ which summarise the evidence base for a number of conditions making the formation of guidelines and protocols based on evidence much simpler and less time consuming.

This webinar has opened my eyes to a whole new approach to veterinary practice and explains why checklists, guidelines and protocols are so important.  By adopting this approach errors within practice should be kept to a minimum and the process of compiling these documents should help to create a more united team and create a more positive no blame culture, which is key to delivering the best care to our patients.

Click here to view a preview of the webinar.

The Stethoscope (MRCVS)


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