Checklist culture: how simple solutions can revolutionise patient safety and tackle AMR

  • Posted on 18.11.2019

Checklist culture: how simple solutions can revolutionise patient safety and tackle AMR


Goran Ribaric

Director, Regional Safety Officer EMEA J&J Medical Devices


As we mark World Antibiotic Awareness Week and European Antibiotic Awareness Day, it is vital that we do all we can to address antimicrobial resistance. The medtech sector supports a wide range of tools that reduce infection risk and support antimicrobial stewardship – some are technologically sophisticated; others are startlingly simple.

Checklists are just one way that we can make surgery safer, reduce healthcare-associated infections, and support antibiotic stewardship.

In 2006, Peter Pronovost, a critical care specialist at Johns Hopkins University, designed a checklist to tackle central line infections in intensive care units (ICU). On a sheet of plain paper, he plotted out the steps to take in order to avoid infections when putting in a central line. Doctors are supposed to: wash their hands with soap; clean the patient’s skin with chlorhexidine antiseptic; place sterilised drapes over the entire patient; wear a mask, hat, sterile gown and gloves; and put a sterile dressing over the site once the line is in.  

These steps are no brainers; they have been known and taught for years. So, it seemed silly to make checklist for something so obvious. Pronovost asked the nurses on his ICU to observe the doctors for a month as they put lines into patients and record how often they carried out each step. In more than one third of patients, doctors skipped at least one step. He and his team later persuaded the Johns Hopkins Hospital administration to authorise nurses to stop doctors if they saw them skipping a step on the checklist.

A year afterwards, Pronovost and his colleagues monitored what happened. The results were so dramatic that they weren’t sure whether to believe them: the ten-day line infection rate went from 11% to zero. So, they monitored patients for 15 more months. Only two line infections occurred during the entire period. They calculated that, in this particular hospital, the checklist had prevented forty-three infections, eight deaths and saved $2 million in costs.

in 2008, the WHO published guidelines as part of its Safer Surgery Saves Lives initiative, identifying multiple recommended practices to ensure the safety of surgical patients worldwide. On the basis of these guidelines, Atul Gawande, a US surgeon and writer, and his team at Ariadne Labs, from Harvard Medical School, designed a 19-item checklist intended to be globally applicable and to reduce the rate of major surgical complications.

A paper by the group published in the NEJM showed that following implementation of the checklist, the rate of any surgical complications at all sites significantly dropped from 11% at baseline to 7%. The rate of in-hospital death dropped from 1.5% to 0.8%, and overall rates of surgical site infection declined significantly. Moreover, Atul Gawande, helped the idea to go mainstream in his widely-read book, The Checklist Manifesto. At the beginning of his book he explained how checklists have improved safety in the aviation sector over several decades. By comparison, healthcare is playing catch-up with aviation, where checklists have reduced the negative impact of human factors and ensure public trust in commercial flying. Aviation professionals recognise the simplicity and power of using a checklist. And so can we. We have no choice.

The medtech industry has developed a wide range of products that help to tackle AMR across the patient pathway, from diagnosis to cure. These range from prevention and detection of infection to monitoring and outbreak management. Many are innovation and complex – some are innovative yet simple, including checklists. 

Together, we will play our part in tackling the global challenge of AMR.

Find out more about medtech and AMR here


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