Use protocols and checklists wisely
Think of protocols and checklists as memory aids rather than as rigid models for unthinking behavior. Protocols convey information simultaneously to everyone involved about correct actions, thus decreasing the time needed for communication. They support standardization. Checklists serve as reminders of critical tasks, especially when an omission can have serious consequences. Both of those are helpful in reducing individual variation in practice, but they must be used with care since indiscriminate adherence can also be a source of error.
Changes for using protocols and checklists:
• Avoid statements that contain negatives. (For example, "Check to see that the light is off," is better than "Check to see that the light is not on.")
• Make instructions agree with the most likely state of the system, so that a "yes" is the usual response.
• Make sure that everyone has agreed on the protocol or checklist and is aware that it is in use.
• Revisit the protocol or checklist regularly to understand what exceptions were made and why. Such exceptions might require revision of the protocol or checklist.
Examples:
• Many hospitals use protocols for the administration of medications like heparin and insulin — drugs that can be lethal and have a range of doses.
• Some hospitals use checklists for high-hazard situations — preoperatively, when giving chemotherapy and administering blood products — to ensure that all information is available and all preparations have been made.
• Several organizations treat protocols as living documents. Continually evaluate and update them as needed.
Source: Institute for Healthcare Improvement, Boston.
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