How to implement OR emergency checklists?

黄建宏

Howto implement OR emergency checklists?

Implementation OR emergency checklists required institutional support and inclusion of all of the staff (surgeons,nurses, and anesthesia providers).

Step I: Get the tools

TheStanford Anesthesia Cognitive Aid Group hasmade publicly available a no-cost downloadable document, which is hosted athttp://emergencymanual.stanford.edu. The Stanfordemergency checklists included a set of 23 anesthesia cognitive aids. The events areorganized alphabetically.

StepII: Get training

Emergency manuals willnot be used if the providers are unaware of them and untrained. Awareness aloneis also not enough—practice is critical. An important goal of thetraining and familiarization is to enable clinicians to use  emergency checklists  without interfering  immediate patient care.

Practitionersshould be trained during simulations to use the same emergency manuals thatthey will use clinically.

StepIII: Actual use

Thereare 3 distinct types of the use of OR emergency checklists.

Precrisis “what if” exercises:The OR emergency checklists can be used to the current patient’s history andsurgery, highlight potential complications, and practice appropriate responses.

Postcrisisdebriefing: Once the patient is stabilized, the OR emergencychecklists can be used to guide immediate debriefing, reinforce learning forfuture events, and help the current patient if some further actions are indicated.

During-crisis:use of emergency manuals can have the most direct impacton crisis management, but is also the most challenging to implement effectively.

StepIV: Change culture

Accordingto Goldhaber-Fiebert and Howard'sreports, their anesthesia department and hospital leaders now want all teammembers to be trained in the use of OR emergency checklists. Sinceimplementation, practitioners have supported that the emergency manuals were particularlyhelpful during specific critical events.

References:

Goldhaber-FiebertS, Howard S: Implementing Emergency Manuals: Can Cognitive

AidsHelp Translate Best Practices for Patient Care During Acute Events? AnesthAnalg 2013;117:1149–61