Checklists for everything do we really need them

Checklists for everything: do we really need them? Paul Malcolm, Consultant Radiologist Norfolk & Norwich University hospital

The history of the checklist Where are we now? How can apply this advice?

‘The best radiologist I ever met was also the one with the saddest career-ending story. Experienced in hundreds of biopsies, he got the wrong side one day. He was busy and distracted. The radiographers and nurses watching the routine case didn’t interfere because that wasn’t their role. He knew what he was doing. One avoidably dead patient in a whole working lifetime and all that goes with it for so many people …’ Tony Nicholson Dean of the Faculty of Clinical Radiology December 2010

History

RCR/NPSA WHO modified checklist Issued 9 April 2010

‘Local adaptation of this Checklist is encouraged to ensure it is effectively integrated into clinical practice. ‘

February 2013

• Included all diagnostic and therapeutic image guided interventions • ‘Fellows expressed concerns………. . ’ – based on theatre checklist • Relevant and proportionate • Shouldn’t replace current good practice • Adaptation to local needs to be encouraged

• Didn’t define an intervention • Suggested the RCR/NPSA template be considered as a minimum checklist • Annual audit

What is an image guided intervention?

December 2010

Conundrum • Checklists suitable for intervention suite • Should be applied to all diagnostic and therapeutic image guided interventions • Many of these are minor interventions not taking place in the intervention suite • No clear standard or process for these • Many ‘unpleasant’ procedures are not ‘invasive’

7 Sep 2015 48 pages

3. 1 Nat. SSIPs and Loc. SSIPs National Safety Standards for Invasive Procedures Organisations should develop Local Safety Standards for Invasive Procedures

3. 2 The development of the Nat. SSIPs • Surgical Never Events and patient safety • Never Events and the Duty of Candour

‘Invasive procedure’ p. 15 • Surgery , endoscopic & cardiology interventions • Interventional radiological procedures. • Thoracic interventions such as bronchoscopy and the insertion of chest drains. • Biopsies and other invasive tissue sampling.

p. 15 It is not intended that Nat. SSIPs and Loc. SSIPs address procedures that involve the simple penetration of the skin or entry of a body cavity, such as the insertion of an intravenous line or a urinary catheter, or the use of ionising radiation Neither is it intended that every detail of the Nat. SSIPs be transposed into Loc. SSIPs for single-operator, ward-based procedures such as bone marrow aspiration, pleural biopsy and tapping of ascites

p. 15 it is recommended that providers of NHS-funded care, when creating policies for the safe performance of all procedures that come under NICE’s definition of “interventional procedure”, but are not included in our definition of “invasive procedure”, take Nat. SSIPs guidance into consideration when developing local policies for safe patient care. (NICE definition of ‘interventional procedures’ includes a wider range of procedures including x-rays)

Where are we? • Process in intervention suite relatively clear • No ‘invasive’ procedure however small is excluded from the Nat. SSIPs process. • Not every procedure requires every aspect of Nat. SSIPS • What procedures and aspects of Nat. SSIPS should be included is not clearly defined

What should we do? • We need to develop Loc. SSIPS for ‘invasive’ procedures to improve patient safety • Checklists are one aspect of this • Proportionate and appropriate • Agreed at Trust governance • Documented and audited

Example: Invasive procedures USS • I was forgetting to label samples and slides • Consent forms appeared behind cabinets - litigation • We realised meaningful consent required providing information prior to the procedure and documentation

• Needed samples checked and consent documented • Provided information sheets about procedures • Paper checklist to be scanned in

Invasive procedures in USS

Evolution • A paper version annoyed everyone – more work • They got lost and someone had to scan them in • First audit of electronic version showed good compliance (audit is easy) • It pops up for all relevant exams but isn’t yet mandatory to complete before completing exam

RCR Audit • To re-audit following a national audit in 2012 – Eg FNA, breast and MSK interventions? • To document current practice • To obtain your ideas for what is appropriate for minor invasive procedures

Thank you