March 24, 2019
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The hospital patient’s safety checklist, part 2

(This is the second in a two-part series about a patient-driven checklist for safe hospital care. The first article discussed the rationale for such a checklist.)

Many hospitals now routinely use checklists to force fastidious adherence to key safety steps that must be completed to ensure safe care of patients in the hospital. What most hospitals don’t do, however, is make the patient and patient family “co-pilots” in the patient’s safe care or give them their own safety checklist to use for that job.

So here is my Hospital Patient Co-Pilot Safety Checklist — your job as the co-pilot in your own safe care is to make sure each of these checklist items get done every time, no exceptions. It’s your surrogate’s job if you cannot do it. This checklist will not prevent every error in your care, but could prevent many if you just say, “Time out” when your checklist is not being followed.

1. No one comes in my room without cleaning their hands at the door. That includes family and friends, who are lovable but also germy.

2. If I am to have elective heart surgery or a new joint put in, I first get tested for the potentially deadly bacteria MRSA (Methicillin-Resistant Staph Aureus). I want to know up-front if I carry MRSA so measures designed to minimize my chance of an infection from it can be taken before surgery. Related, if I carry MRSA, no one touches me without gowning and gloving first to minimize the risk they pass my MRSA onto some other patient.

3. No one does anything to me without first asking my name, then checking my name band to confirm my identify, then telling me what they are doing and why. No exceptions to the “ID me, explain to me, then treat me” rule. Mis-identification of patients continues to be a major source of errors in patient care, but not in my care, with me as my safety co-pilot.

4. Related, I will not take any medicine without the nurse confirming who I am, then confirming to me they have done the Five Rights of Medication Administration. This is their check that this is the right medication as ordered, at the right dose, at the right time, by the right route (i.e., don’t put any pill where the sun does not shine that is not supposed to go there), for the right patient. Ideally, I want a list of my hospital medications to keep at my bedside so I can check every medicine the nurse wants to give me against that list. If it’s not on the list, or it appears unfamiliar, time out while you please confirm that I am supposed to get that pill or IV med bag in your hand; I am not taking it until you do because your co-pilot would not let you do something potentially unsafe.

5. During the admission process, check my risk for developing a blood clot while in the hospital. If I am at high or moderate risk, please confirm to me that I am getting appropriate preventive measures.

6. If I am conscious, no procedure gets done on me without the Joint Commission’s Universal Time Out (or equivalent) being done with my active participation. This time out confirms to me and the rest of the team that the right procedure is about to be performed on the right body part (which I must sign with the surgeon) of the right patient, etc.

7. Nothing inserted into me gets changed or manipulated by ungloved hands — catheters, IVs, whatever.

8. Nothing temporarily inserted into me stays in me without a compelling reason for each day it’s there.

9. Any time anything on my checklist is not being done, my job as the patient co-pilot in my safe care is to tell my physician, nurse, or other caregiver “Time out — please stop what you are doing to me while we check whether it is the right thing to do.” That’s what great patient care teammates do for each other — no exceptions.

Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems.

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