More Than a Tick Box: Medical Checklist Development, Design, and Use
More Than a Tick Box: Medical Checklist Development, Design, and Use
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DOI：
10.1213/ane.0000000000002286
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发表时间：
2018-01-01
影响因子：
5.7
通讯作者：
Ruskin, Keith J.
中科院分区：
文献类型：
--
作者：
Burian, Barbara K.;Clebone, Anna;Ruskin, Keith J.
尽管在一些围手术期环境中改善了患者安全性，但一些检查表没有发挥其潜力，并且对检查表疲劳和完全拒绝检查表的投诉正在增加。报告的问题往往涉及人为因素：设计不良，介绍和培训不足，与其他安全检查重复，与现有工作流程整合不良，以及文化障碍。每种医疗环境（如手术室或重症监护室）和不同的临床需求（如交接班或关键事件响应）都需要不同的检查表设计。一刀切是行不通的，必须围绕医疗队的结构及其在这些环境中的工作流程制定检查清单。在文献中可以找到有用的指导;然而，迄今为止，还没有一个综合全面的框架来指导检查表的开发和设计，使其与医疗和围手术期任务的流程保持有效和和谐。我们提出了这样一个框架，组织围绕检查表生命周期的5个阶段：（1）概念，（2）确定内容和设计，（3）测试和验证，（4）入门，培训和实施，（5）持续评估，修订，并可能退休。我们还举例说明了一种方法，在这种方法中，检查表的设计可以更好地匹配特定围手术期环境中的用户需求（在这种情况下，在关键事件期间的手术室）。只有改进医疗检查单的开发，并根据用户的具体需求和使用环境进行设计，医疗检查单才能发挥其提高病人护理质量的潜力。
Despite improving patient safety in some perioperative settings, some checklists are not living up to their potential and complaints of checklist fatigue and outright rejection of checklists are growing. Problems reported often concern human factors: poor design, inadequate introduction and training, duplication with other safety checks, poor integration with existing workflow, and cultural barriers. Each medical settingsuch as an operating room or a critical care unitand different clinical needssuch as a shift handover or critical event responserequire a different checklist design. One size will not fit all, and checklists must be built around the structure of medical teams and the flow of their work in those settings. Useful guidance can be found in the literature; however, to date, no integrated and comprehensive framework exists to guide development and design of checklists to be effective and harmonious with the flow of medical and perioperative tasks. We propose such a framework organized around the 5 stages of the checklist life cycle: (1) conception, (2) determination of content and design, (3) testing and validation, (4) induction, training, and implementation, and (5) ongoing evaluation, revision, and possible retirement. We also illustrate one way in which the design of checklists can better match user needs in specific perioperative settings (in this case, the operating room during critical events). Medical checklists will only live up to their potential to improve the quality of patient care if their development is improved and their designs are tailored to the specific needs of the users and the environments in which they are used.