MbShea@PWP@English@UMCP

ABSTRACT: While hospitals should be a safe palace for patients, medical errors are the eighth leading cause of death in the U.S. (Debourgh and Prion, 2012). Medical errors also cost roughly $19 billion annually (Andel et al., 2012), so improving patient safely helps to lessen both economic and emotional hardships. The two main categories of medical errors are latent errors, caused by failures of hospital organization, and active errors, caused by failures of an individual (Collins et al., 2014). Nurses are particularly at risk to making medical errors due to fatigue and working shifts. Irregular shift work causes disruptions to the circadian rhythm, which are associated with increased medication errors (Saleh et al., 2013). In order to improve patient safety, the Patient Safety and Quality Improvement Act of 2005 was established to create Patient Safety Organizations that propose procedures to reduce patient safety hazards. The World Health Organization has also proposed checklists as a way to reduce medical errors. Checklists have been demonstrated to reduce medical errors in surgical settings (Arriaga et al., 2013). In order for nurses to feel comfortable using checklists, discussing the importance of patient safety and practicing using checklists can be incorporated into nursing education (Debourgh and Prion, 2012). Two examples of checklists used in the field of nursing are also provided in the appendix.

WC=217

READER’S PROFILE: I imagine a reader who is an experienced nurse educator who believes in the power of quality nurse training and “being prepared for anything.” Additionally, the reader is skeptical of implementing standardized protocols during a time when medicine is becoming personalized.

READER’S RESPONSE: Increasing patient safety is necessary in a hospital. However, checklists may not be the way to go. Particularly in critical care and emergency situations, I may not be enough time to grab a checklist to make sure everything is going as planned. With enough training and experience, checklists should not be necessary. If a patient’s family is present during the emergency situation and sees me pull out a checklist, the family may not feel confident in my abilities. This could lead to families not understanding the purpose of the checklist and requesting a different health care professional during the situation. The process could be slowed down further and I would not be able to respond to a crisis in a quick and efficient manner.

Additionally, medicine is becoming personalized for the patient, so a strict checklist may not be appropriate. Two individuals may be diagnosed with the same condition, but their treatment approaches may differ. I am required to know my patient’s needs and conditions in order to customize the care the patients receive. If a checklist is in place, I might feel unable to customize the treatment delivery for fear of “breaking a rule.” In order to accommodate all of the possible situations that may arise, checklists may become long, detailed, and difficult to follow. Ultimately, a simplified checklist may not be appropriate for all patients, but a detailed checklist may interfere with efficient treatment procedures.

E -- you really did capture the limits of checklists in that last profile. A profession relies on judgement, and this could be one of the difficulties with such programs. Still, checklists do seem important in combatting systemic error.

Very clear plan with good details.