Checklist Modification 101

Make Me Your Own

The Basics

• One size doesn’t fit all. Every hospital should modify the checklist.

• Checklist modification creates buy-in and ownership.

• The checklist is designed to promote teamwork and communication . . . don’t remove teamwork/communication items.

Things to Keep In Mind When Modifying the

Checklist

Brief• Each section (Before Induction of Anesthesia, Before Skin

Incision, and Before the Patient Leaves the Room) should take < 1 minute.

• The checklist should never take longer than the procedure.

• The checklist should fit on one page.

• Is this a critical safety step and in great danger of being missed?Examples: Known Allergies, Essential Imaging, Antibiotic Prophylaxis

• Is this adequately checked by other mechanisms?Examples: Anesthesia safety checklist has been completed, Sterility

including indicator results

• Is this actionable, with a specific response?Example: Monitoring blood pressure

• Is this item discussed at a time when all relevant team members are present and when something can be done to fix it?Examples: Essential equipment and expected blood loss

• Will this item help anybody here?

When Adding and/or Removing Items Ask Yourself . . . .

Alternative Wording for Particular Items

Are blood products required and available?

What is the EBL?

Blood (or cross-match) available if needed.

Is there a need for blood products?

Blood availability confirmed.

EBL/Blood Plan

Modifying Blood Loss

Modifying Team Introductions We will start by introducing ourselves

by name and role.

Team introductions to patient, including name and role.

Are there any unfamiliar staff in the room? Please introduce yourself by name and role.

What If We Already Know Each Other?

• We recommend that even if you know each other that everybody says something before the procedure starts.– Check-off with everybody in the room

Surgeon says, “Mary, are you ready to go?” etc.

Modifying the Safety StatementSurgeon says: “If anyone on the team sees something that the team should know about, please speak up”

Surgeon declares: “If anyone on the team sees something that the team should know about, please speak up anytime during the procedure.”

Surgeon states, “If you see, suspect, or feel that patient care is compromised, will you speak up?”

Surgeon states, “Remember that all are free to voice any concerns at any time throughout the procedure”

Surgeon states, “Does anyone have concerns? If you think there is a problem, please speak up”

Is the Checklist the Best Way to Take Care of This?

• Glycemic Control

• Fire Risk Assessment

• Hair Removal

• Checking Pressure Points

Examples of Modified Checklists