{"id":1013,"date":"2010-02-25T15:44:44","date_gmt":"2010-02-25T14:44:44","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=1013"},"modified":"2010-02-25T15:44:44","modified_gmt":"2010-02-25T14:44:44","slug":"douglas-noble-on-checklists","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2010\/02\/25\/douglas-noble-on-checklists\/","title":{"rendered":"Douglas Noble on checklists"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" style=\"float: left\" src=\"http:\/\/www.bmj.com\/columns\/icons\/douglas_noble.jpg\" alt=\"douglas noble\" width=\"160\" height=\"110\" \/>I remember as a medical student when the Rockall score for GI bleeding came into common practice.\u00a0 As with all checklists and tick box style scoring systems, well thumbed photocopies of ever decreasing quality slowly surfaced in emergency departments and acute medical units.\u00a0 The first time I \u2018scored\u2019 a patient I was surprised that their risk of complications was far higher than I had thought from clinical assessment.\u00a0 It seemed a great idea: standardise assessment, gauge risk, and manage accordingly.\u00a0<!--more--><\/p>\n<p>More recently the checklist approach has become increasingly advocated in many areas of medicine.\u00a0 Apparently aviation changed much of its unsafe practice through the simple introduction of checklists, standard operating procedures and the like.\u00a0 No doubt it has disadvantages, reducing clinical autonomy, or increasing the number of times nurses call doctors to the ward because a patient has \u2018scored\u2019 (not a football match breaking out on the ward, but a triage score of basic measures such as heart rate and blood pressure that indicate the need for escalation of care).\u00a0<\/p>\n<p>Specific checklists claim to have made a dramatic impact on patient safety.\u00a0 The WHO Surgical Safety Checklist contains a series of basic checks prior to surgery, including: antibiotics given on time, estimated blood loss and checking the correct site of surgery.\u00a0 Despite the latter seeming patently obvious, the National Patient Safety Agency recently reported 15 burr holes being drilled on the wrong side of the head \u2013 the mind literally boggles.\u00a0<\/p>\n<p>Is there not an inherent sensibleness about such an approach?\u00a0 How often in the operating theatre have you heard the inevitable question from surgeon to anaesthetist: \u2018have you given the antibiotics yet?\u2019 or the predictable panic when it\u2019s realised that there\u2019s not enough matched blood available.\u00a0<\/p>\n<p>As with all change in practice it\u2019s usually difficult and invariably messy.\u00a0 At some point I suspect someone will think of linking use of checklists to payments for quality of care.\u00a0 Payment could improve uptake and I suspect would see a reversal of some of the current apathy.\u00a0 Maybe even a step further is needed.\u00a0 What about tying such quality improvement interventions to clinical excellence awards?\u00a0 Now that would definitely send temperatures soaring!<\/p>\n<p><em><strong>Douglas Noble<\/strong><\/em> <em>has worked in surgery, emergency medicine, public health and for WHO Patient Safety. From 2006 to 2008 he was clinical adviser to chief medical officer for England, Sir Liam Donaldson.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>I remember as a medical student when the Rockall score for GI bleeding came into common practice.\u00a0 As with all checklists and tick box style scoring systems, well thumbed photocopies [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2010\/02\/25\/douglas-noble-on-checklists\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":66,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1576],"tags":[],"class_list":["post-1013","post","type-post","status-publish","format-standard","hentry","category-douglas-noble"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Douglas Noble on checklists - 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