1. Call 5: Checklist Modification 101 Continued, Small Scale Testing, and the Checklist as a Documentation Tool

2. Last Week’s Call The importance of modifying the checklist for your hospital. Modification 101. Lynn Wythe from Palmetto Baptist shared her experiences implementing the checklist.

3. How Did the Homework Go?

4. Homework to Date Build an implementation team. Schedule a time and venue for a meeting to take place after January. Send us an email at: safesurgery2015@hsph.harvard.edu letting us know how you would like to administer the survey at your hospital. Please also include your mailing address in this email. Download the OR Personnel Spreadsheet from our website and begin completing the information with the names, roles, and email addresses if relevant. Review the checklist modification guide and South Carolina Checklist Template. Start to modify the checklist your implementation team.

5. Poll 1: Did You Review the Checklist Modification Guide? Yes No

6. Poll 2: Have You Started to Modify the Checklist For Your Hospital? Yes No

7. Meeting the Team Jim Sachetta Staff Assistant

8. Today’s Topics Modification 101 Continued. Small-Scale Testing: “Table-Top Simulation”. The Checklist as a Documentation Tool.

9. Checklist Modification 101 Continued The Next Step in Your Journey: Make Me Your Own

10. Alternative Arrangements of the Checklist

13. Alternative Wording for Particular Items

14.  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

15. 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.

16. What If We Already Know Each Other?

17. Modifying the Safety Statement  Surgeon 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”

18. When You Modify the Checklist with Your Implementation Team: –Discuss each item on the checklist using the guidelines that we previously discussed. –Ensure that the checklist follows your current flow in the OR. –Add your hospital logo to the checklist. –Say the words on the checklist aloud. Many times it looks good on paper and does not reflect what you would actually say during a case.

19. Examples of Modified Checklists

23. Small Scale Testing: “Table-Top Simulation”

24. Table-Top Simulation It is easy to test the checklist outside of the OR. It doesn’t take a lot of time. You can learn a ton. Testing the checklist on a small scale can prevent you from making BIG mistakes.

25. “Table-Top” Simulation Anes. Machine A CN SN S Conference Room or an Empty OR

26. “Table-Top” Simulation

27. Our Patient Age - 68 yr old male Condition – Healthy patient with a right inguinal hernia Procedure – Right inguinal hernia repair

29. The Checklist as a Document Tool

30. Poll 3: The Checklist as a Documentation Tool How many of you want to use the checklist as an auditing tool? When you discussed the checklist with your colleagues, did they have concerns about including the checklist in the medical record? If you are already using the checklist, do you keep it as part of the medical record?

31. Using the Checklist As a Documentation Tool SCIP Measures Electronic Medical Record Patient Chart Signatures Malpractice issues

32. SCIP Measures It can be used to document SCIP Measures. Be careful to make certain that your documentation is consistent.

33. Electronic Medical Record The checklist is compatible with the EMR. You want to avoid the checklist becoming a “tick the box” exercise.

34. Signatures at the Bottom Depends on the culture of your hospital. Can be looked at as punitive. It is best to have the entire team to sign it if you are going to use signatures so that responsibility is shared.

35. Patient Chart Many hospitals do not include it in the patient record. If you are going to put it in the chart to document make sure that the nurse isn’t the only one using the checklist.

36. Malpractice Concerns

37. We will never know which patient the checklist helps because of information that was shared and problems that were prevented.

38. This Week’s Homework Continue to modify your hospital’s checklist. Test your checklist using “table-top simulation”. Email our team and let us know if you will be administering the culture survey. Email: safesurgery2015@hsph.harvard.edu

39. ? ? Questions

40. Ask Us a Question By Using the Raise Hand Button

41. Next Call: Testing the Checklist in the OR

42. Office Hours: Cancelled Tomorrow

43. Resources Website: www.safesurgery2015.org Email: safesurgery2015@hsph.harvard.edu