ICUs begin to adopt patient safety checklists

Following the lead of pilots who follow a point-by-point checklist before they take off, hospitals are developing ICU checklists to reduce the number of mistakes they make when treating critically ill patients.

Since the 1930s, pilots have used a step-by-step checklist in the cockpit to ensure they don't miss anything critical on takeoff.

"You don't have that nagging feeling in the back of your mind, did I forget to do something in a certain sequence?" Joe Riczu, a Skyservice captain, told CBC News.

Baltimore critical care specialist, Dr. Peter Pronovost, has taken the airline industry's checklist and adapted it for the ICU. He began by tackling IV infections, which are frequently caused by improper hygiene by health-care workers.

"They are busy, they are sleep deprived, their work environment is chaotic so we need some simple practical tools," said Provonost.

He said items as the line insertion checklist, washing hands with soap or cleaning a patient's skin with antiseptic are simple measures that can be checked off by medical personnel.

It's one of three ICU checklists Dr. Damon Scales has adopted in his Toronto hospital.

"When I tell people about these things they sort of have the reaction of saying, 'How could you ever forget that?' said the clinical associate in the department of critical care medicine at Sunnybrook Health Sciences Centre. "But this is a busy place with complicated patients and these are the kinds of things that can get lost in the shuffle."

Every year, 300,000 Canadians are admitted to an intensive care unit.

Data shows that such lists can be effective at reducing medical mistakes. According to a recent study in the New England Journal of Medicine, IV infections in the ICU were virtually eliminated in the state of Michigan after hospitals adopted checklists. As well, and estimated 2,000 lives and $200 million US were saved in the first year.

But Provonost admits there was initial resistance to the initiative.

"The nurses said: 'It's not my job to police the physicians and if I do I'm going to get my head bit off.' And the physicians said: 'There is no way a nurse can second-guess me in public, it hurts my credibility.' But eventually people get onboard."

"We all know that we should be doing it," said Scales.