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Checking in on medical checklists, part 1: infection prevention

Anytime a document bears the word "manifesto" in its title, you know its author or authors had or have ambitious aims.

Karl Marx and Friedrich Engels famously issued their "Communist Manifesto" in 1848. Their aims were practically apocalyptic: the overthrow of capitalism and the introduction of a radically reoriented collectivist society.

In this two-part post, we will - pun fully intended - check in on the implementation of a very different type of manifesto: "The Checklist Manifesto" for preventing medical errors, issued by prominent doctor / writer Atul Gawande.

The subtitle of Gawande's book is "How to Get Things Right." It first appeared in December 2009.

Gawande certainly had help from forerunners in advocating for the use of checklists to cut down on human errors in the delivery of medical care. Another key figure, Peter Pronovost of Johns Hopkins medical center, had been pushing for them for several years.

Pronovost, in particular, was influential in asking how applying the concept of a safety checklist from the aviation context could apply to medical care. To test the idea out, he designed a checklist of steps that should be taken in one very specific setting.

The setting was intensive care units with patients hooked up to intravenous lines to deliver medications or fluids. The checklist was intended to prevent these patients from getting infections.

The steps, when written down, seemed utterly basic. For example, the first step was hand hygiene - i.e., washing hands with soap -- before handling the intravenous lines or interacting with patients.

And yet, under the pressure of high-volume medical care delivery, doctors and nurses have far too often missed steps like this. Getting a protocol in place in the form of a checklist, however, has now been proven to be an important safety protection.

In part two of this post, we will discuss how the commitment to using checklists has now been extended beyond surgery and the ICU to another health-care setting: emergency medical services.

Source: JEMS, "EMS Checklists: Highlighting critical areas of the protocols not be missed," Cynthia Kincaid Additional Source: The New York Times, "A Hospital How-To Guide That Mother would Love," Robin Mararanz Henig, Dec. 23, 2009

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