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Abstract
Background In the complex medical environment, clinicians commonly face varying challenges especially when undertaking invasive procedure with the risk of potential to harm patients. Checklists have a role in not only helping overcome human fallibility, but also ensuring that key steps are adhered to in order to ensure patient safety.
Intercostal chest drains are amongst the most invasive procedure undertaken in Internal Medicine, often out of hours and in emergent clinical situations, and possibly in less than ideal environments and with limited or no supervision. All of these factors have been highlighted in the 2008 UK National Patient Safety Agency (NPSA) report highlighting 780 events of harm including 12 deaths from intercostal chest drain insertions1. The NPSA Never Events2 list includes wrong site surgery, and in the respiratory discipline this encompasses the inserting of a chest drain on the wrong side. Never Events are preventable because: there is guidance that explains what the care or treatment should be; there is guidance to explain how risks and harm can be prevented; and there has been adequate notice and support to put systems in place to prevent them from happening.
Methodology A systematic review of available literature around chest drain insertion, proformas and checklists was conducted. Other relevant checklists e.g. WHO surgical safety checklist were also reviewed. After an iterative design process involving chest physicians, general physicians, trainees and nurses, a checklist was devised, piloted and introduced into practice.
Conclusion The Chest drain safety checklist was introduced in August 2011, and has since been adopted by the A&E Department and also neighbouring hospitals. Since its introduction, there have not been any adverse incidents in the Medical Department involving intercostal chest drain insertions. There is more confidence amongst nursing staff as they feel more involved and engaged. Trainees find the structured approach particularly helpful in ensuring key steps are not missed and patient safety ensured, and seek supervision and assistance more readily.
References
NPSA Rapid Response Report 2008 NPSA/2008/RRR003
The NPSA ‘never events’ 2011/2012, Department of Health
Abstract P213 Figure 1.