The Medical Checklist

I'm a Nurse - What's your Superpower?

Nurses have long been advocates for their patients. Research suggests that vets and nurses can have different perspectives on veterinary care which can sometimes lead to difficulties in communication and clashes over care and treatment plans. Vets tend to be ‘fixers’ - they like to problem solve, diagnose, treat and ‘cure’ the patient. Nurses place a high value on care – pain relief, comfort, stress reduction and both the technical and rehabilitation aspects of the ongoing plan.

One such example of how nurses can directly influence patient outcomes and contribute to culture change in organisations is demonstrated by the story of the original medical checklist. While most attention when we think of these tools focusses on the WHO Safe Surgical checklist so well promoted by Atul Gawande in his book ‘The Checklist Manifesto’, less well known are the details of the original checklist project.

In 2006, 108 ICUs in Michigan ran a collaborative study to try and mitigate the harm caused by central venous line catheter infections, which were claiming 28,000 lives every year across the USA and costing the health service an annual $2.3 billion (Pronovost 06). Amongst other simple interventions, the research group produced a short checklist based on best evidence: Clinicians should wash their hands, use full barrier precautions, surgically prep the site, remove all other catheters, and avoid the femoral site if possible. Most importantly, the hospitals empowered their nurses to enforce it.

If a clinician did not comply with all five steps, the attending nurse was authorised to stop the procedure and call the hospital CEO, who would come down to the shop floor and enquire as to what was going on. Infection rates fell to zero and stayed down after the study period finished.

The 2015 RCVS Royal Charter regulating veterinary nurses was a long overdue recognition of their expertise, value and unique set of skills. Recent discussions in the RCVS working group have focussed on the role of nurses in the future. This is a welcome acknowledgement of the potential veterinary nurses, like their human nurse counterparts, possess for driving veterinary practice forwards - particularly in the areas of patient safety and quality of care.

Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S., Sexton, B., Hyzy, R., Welsh, R., Roth, G. and Bander, J., 2006. An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine, 355(26), pp.2725-2732.