Electronic Rounding

8 Must-Haves for Any Hospital Checklist

A hospital checklist assists staff in staying on task & completing their rounds while being efficient and timely. Find out what's needed on a list.

8 Must Haves for any Hospital Checklist blog header

Building Effective Checklists for Hospitals

As one of the cornerstones of high reliability, much is made of utilizing checklists in hospitals as a means to build, support and sustain high reliability efforts by proactively checking the reliability of systems and processes. For all hospital staff designing, conducting and analyzing checklists, it’s important to keep in mind some key elements that make an effective checklist with sustainable outcomes.

Here are the 8 must-haves for any hospital checklist:

1. The Design Must Streamline the Process

The design of the checklist and deployment by process needs to be carefully thought through. Avoid layering on “another” thing to check. Gather all existing rounding tools from all parts of your hospital (you will be stunned by the number). The design must eliminate all current tools to avoid duplicative effort and maximize internal support for the approach.

2. A Single Platform – Checklists Must Not Sub-optimize

Data collection tools, rounding formats and tracers abound in every hospital environment. For example, nursing alone currently has or responds to anywhere from 15 -25 different formats all built in isolation. This contributes significantly to nursing documentation time burden and frustration. Instead, make sure all checking conducted outside of the Electronic Health Record is consolidated to a single platform. This will significantly reduce hospital-wide time spent on production, conducting and analyzing data along with improving the overall integrity of the process.

3. They Must be Electronic

The vast majority of checklists used in hospitals today are manual - often Word documents aggregated in Excel. The sheer volume of data overwhelms this approach very quickly, creating a format that will not be sustainable. The effective deployment of real time service recovery is another key driver of ensuring a reliable electronic system is in place.

4. They Must Be Deployable in Any Work Environment

Do not find the “ideal” hand hygiene tool and charge ahead. Do not find the “ideal” patient rounding tool and charge ahead. Solving for one or two functions is simple and a very basic software function. Adopting this approach will lead to moving 20 different paper-based rounds to 20 different software rounds and replicates the current data silos. Ensure your solution is intuitive to a nurse conducting a CAUTI checklist and also a pharmacy technician conducting medication safety checks.
doctor with tablet

5. They Must Be Sustainable

With the pressure on IT resources and the extreme complexity of this data-gathering (often well in excess of 300,000 annual quality observations) and management effort, it is likely that you will want to use “off the shelf” programs. Shift your operational focus to conducting the checklists, correcting items failing and launching performance improvement efforts, not developing a platform to conduct the checklist.

Ensure your package is not reliant on the hospital to update system, standards, etc. Find a supplier who specializes in hospitals and who has dedicated service support to not only provide special design and set up, but to maintain the system over time. This approach is likely to come with a higher price tag but it will avoid the almost certain failure with any other approach.

6. They Must Be Flexible

When buying “off the shelf”, ensure that there are well-developed templates to support every checklist. Ensure that the checklists are easily customizable to your local conditions. A word of caution about customization: if you have selected the right checklist system, the pre-built templates will meet the vast majority of your needs.
Invest your initial time in working on teamwork and safety culture components of high reliability:
· Leadership commitment
· Patient safety culture
· Teamwork
Customize based on widespread use and deployment. There is a huge culture shift to manage to make checklists a part of daily workload in hospitals. Focus on this effort and tweak checklists on the fly from user feedback.

7. They Must Manage Follow-up Automatically

Effective closed-loop follow-up is worth a 1 to 2 point improvement in patient safety, quality of care and experience. The checklist must be properly designed to manage, notify and escalate items that need correction. Frequency must be customizable. A patient request needs immediate action; a Human Resources file audit doesn’t have the same urgency. Ensure your operational management is not overloaded by the system. This is also a key issue in ensuring you have a single system for managers to correct items from a variety of sources.

8. They Must Link to Regulatory Standards

While regulatory compliance will be a simple by-product of high reliability, insist that all template questions are linked to The Joint Commission  /  CMS  /  HFAP  /  DNV standards. Ensure this linking is available for any custom questions.

In the Joint Commission environment, as an example, annual submission data is generated in real-time at the time of scoring, providing immediate verifiable data point for any measure of success items as an example.

CAUTION: A Tracer is Not a Checklist

Tracers are appropriate if you want a specialist team to conduct a limited number periodic assessments in patient treatment areas. Tracers by design do not support a comprehensive approach to high reliability. Tracers by design are extraordinarily time intensive and disruptive to staff and daily operations. Tracers by design do not place accountability for high reliability with frontline staff.

Choosing the appropriate checklist software will directly affect the success of adoption, implementation and results the hospital will see. Take the time to truly investigate the features, flexibility and customization of any software you are considering.
What are YOUR must-have features for a patient safety checklist? Comment below. We’d like to know!

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