Checklists In The Outpatient Department Setting Moorfields Eye

Checklists In The Outpatient Department Setting Moorfields Eye Hospital Dubai Ophthalmology Ambulatory Centre Emma Smyth Orthoptist and Quality Officer

Patient Safety Challenge. Identification Issue Identified – • Repeat occurrence of patients’ pupils dilated before all required tests completed. Patient Safety Issue – • Risk of lack of detection of some eye conditions and increased IOP • Inconvenience to patient. How was this detected – • Incident reports submitted to Quality Department through electronic Safeguard system. Severity • In all cases there was no actual patient harm.

Patient Safety Challenge. Analysis • Pattern of 3 reported incidents of incorrect process followed for General Civil Aviation Authority (GCAA) patients within 3 month period from 213 patient encounters • This was deemed to be a pattern and thus highlighted as an area for Quality Improvement to reduce inconvenience to such patients and prevent possible future patient safety issue

Patient Safety Challenge. Approach • A multidisciplinary team was gathered • Discussion raised the need to update the Standard Operating Procedure (SOP) for GCAA assessments. • Several drafts of the SOP were produced to incorporate all aspects of the GCAA regulations and create an appropriate and agreed upon internal process • Research conducted on best methods to reduce such errors in healthcare

Patient Safety Challenge. Solution Customizing an already existing and proven best practice followed for overcoming such challenge Discussion and research suggested the best method to adopt was a check list

Patient Safety Solution. Best Practice Implementation methodology – • Review and update of SOP • Development of check list with counter sign • 3 teaching sessions Challenges faced – • “The end user must not get the feeling that he/she is deprived of the opportunity to apply common sense” (Thomassen et al. 2011) • Difficulties in balancing usefulness in addressing the predefined problem, but was user friendly and allowed for clinical judgment • Compliance Implementation period – • 6 months

Patient Safety Solution. Best Practice Results & Sustainability Outcome Measurement – • Number of similar incidents reported following implementation • Staff opinion of checklist ease of use Results • To date, 6 months following implementation and 573 patient encounters there have be zero similar incidents • Positive staff reports Sustainability – • Regular review of SOP • Incident report trends • Adherence to checklist audits

Patient Safety & Best Practice Lessons Learned Lessons and Advice to DGCC Colleagues • Incident reports are a useful way to detect trends clinical practice and in identifying potential patient safety challenges • Checklists are prevalent in high reliability organisations (HROs) • Checklists have relevance in the outpatient department setting • Encouraging culture of incident reporting is necessary

References Clay-Williams R. , Colligan L. (2015) Back to basics: checklists in aviation and healthcare BMJ Qual Saf 2015; 24: 428 -431. Hales B. M. , Pronovost P. J. (2006) The checklist–a tool for error management and performance improvement. J Crit Care 2006, 21: 231 -235. Thomassen et al. (2011) Implementation of checklists in health care; learning from high-reliability organisations. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011, 19: 53 Weick K. , Kathleen M. (2001) Managing the Unexpected-Assuring High Performance in an Age of Complexity. Sna Francisco, CA, USA: Jossey. Bass; 2001.