Aims The WHO surgical safety checklist has been shown to significantly reduce complication and death rates in surgical patients. Along similar lines, we designed a novel NICU (neonatal intensive care unit) bedside pre-procedural safety checklist to improve teamwork, communication and act as a learning tool for junior doctors performing these procedures (Figure 1).
Methods The NICU safety checklist, including both general and procedure-specific points, was refined by doctors and nurses involved at multidisciplinary risk meetings prior to use. A laminated checklist was attached on all equipment trolleys in NICU and SCBU. Nurse and doctor champions were recruited to encourage use of the checklist and medical students helped raise awareness. NICU was updated on progress at weekly risk meetings and we published an article in the NICU newsletter to encourage nurses to fill out audit forms during each procedure.
After every procedure, nurse observers were asked to fill in a form at the bedside, about the type of procedure, whether the NICU checklist was used and if so, whether it was convenient, useful and worthwhile (5-point Likert scale).
After 3 months, a questionnaire was sent to all NICU doctors asking how often they use the checklist and whether it is convenient, detects errors at a time when they can be prevented, improves teamwork/communication, and whether it is worthwhile (5-point Likert scale).
Results Nurse observers filled out 24 forms over 3 months, showing that the checklist was convenient (median 4, IQR 1) and worthwhile (median 4, IQR 1). The 3-month point questionnaire showed that doctors (n = 10) were using the checklist for 50% of procedures and that the checklist was convenient, improves teamwork, is useful reminder and learning tool. Reasons for not using the checklist were that doctors didn’t know where it was and that during emergencies the checklist was not practical due to urgency and insufficient staff.
Conclusion The WHO surgical safety checklist can be adapted to any complex procedure, including bedside procedures in NICU. Safety checklists have been shown to improve teamwork, communication and adherence to process measures. The NICU bedside safety checklist also acts as a useful learning tool helping junior doctors performing invasive procedures in NICU.
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