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There is a difference between “one hour before” and “within an hour of surgery.”

Having a checklist right before the surgery is like an inspection. If they hadn’t given the antibiotic 60 minutes before surgery, it’s too late when the checklist is being used. The checklist should guide the process to PREVENT mistakes/omissions rather than catching them at the last minute. So I think we’re saying the same thing, that a checklist at the very last minute might not be the right timing?

I do share your concerns about the checklist being driven “top down.” That’s not normally the best way to implement lasting change.

I hope we can have some more interaction about this and other topics.

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This is what I am saying:

1.) The initial comment indicates that the author’s wife did not receive the standard of care. With regards to timely administration of an antibiotic, she did.

2.) A checklist was not used to make this happen.

If one is trying to make the case for the use of checklists, this anecdote gives little support. This patient received appropriate care without the use of a checklist.

Let us imagine that the WHO Surgical Safety Checklist (First Edition) had been used in this patient’s care. The check item “has antibiotic prophylaxis been given within the last 60 minutes?” is number 13 of 22 on this particular checklist. This check would be done moments prior to the skin incision. This check would not have averted a similar conversation between the nurse and the anesthesiologist. Nor would it have caused an improved timing for administration of the antibiotic.

I have not made up my mind about the use of surgical checklists. There are pros and cons. Current medical literature does not support or disprove that the use of a checklist can improve patient safety in a United States hospital.

I appreciate your initial blogging about the implementation of checklists. I am the surgery section chief (practicing general surgeon) at a hospital that is planning to implement a surgical safety checklist. The initial stages of the planning indicate this is going to come from a “top down” approach under nursing direction. I would like to see a more grassroots approach to this implementation and your comments support this view.

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I’m not sure what you’re trying to say.

1) Checklists aren’t necessary

2) You’re thankful the right things were done without a checklist being used

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“While a front-page feature on “A Surgical Revolution” (“A checklist that could prevent thousands of deaths”, 25 June) is to be welcomed, our research over the past five years into teamwork in surgery shows that the checklist in itself is not really the point. What is important is the quality of its implementation.”

That’s spot on, for any type of standardized work. Having a document is worthless if people don’t follow it… leaders have to manage the process and follow up properly to make sure the checklist or standardized work is being used, that it’s helping, and that it’s being improved upon.

LINK (scroll down)

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