Quality improvement, checklists and systems of work: why do we need them?
Missing out one small step in a complex procedure can lead to an error. A checklist is a list of actions that can identify the small but crucial steps which may be missed out. Checklists are just one of the tools used to form a culture of continuous quality improvement (QI) in veterinary practice. QI is about understanding the level of care practices provide and implementing interventions to try to improve it. Checklists have been used in aviation and in human healthcare to reduce errors. The use of a surgical safety checklist can be very effective both in human healthcare and in veterinary practice. Checklists can be used in many other areas of practice too. They are a patient safety system, not just a piece of paper, they encourage teamwork, communication and situational awareness and can help to reduce errors.
Many procedures we carry out in veterinary practice are complicated and depend on a series of steps being carried out correctly to be effective. We are all human and it is very easy to miss out one small step, which can lead to an error.
These errors are more likely to occur if we are stressed, distracted by other things going on, rushing, tired or hungry. Other factors that contribute to errors identified by Oxtoby et al (2015) are lack of communication, teams that are understaffed or do not work well together, a poor practice culture or lack of systems of work.
One system of work that may help to reduce errors is a checklist. Checklists are lists of vital actions which need to be completed before, during, or after a procedure by compensating for the limits of our memory, they can act as a trigger to remind us of crucial steps that are easily overlooked. They improve team communication, and consistency and quality of care. They have been proven to reduce complications and errors in many safety critical industries such as in aviation and human medicine (Thomassen et al, 2014).