Introduction Pleural interventions (PI) are generally safe, however adverse events occur due to human error or system failure. The World Health Organisation (WHO) safety checklists are widely used in surgery and reduce complications.¹ The Royal College of Physicians has recently advocated their use for invasive medical procedures.²

Aims

1. To develop and implement a modified WHO surgical checklist for use in PI; specifically thoracoscopy (TS) and chest drain (ICD) insertion.

Methods Adverse events for TS were identified using a locally developed TS database (previous 3 years data) and ICD events were identified using our unit’s BTS National audit data.

Following a MDT discussion we developed and implemented a modified WHO checklist for the specific risks of TS and ICD. The checklists follow the three-part structure recommended by the WHO; 1. Sign in (before arrival to procedural area), 2. Time out (before starting), 3. Sign out (before leaving).

Checklist effectiveness was reviewed 6 months following implementation.

Results Pre-implementation

For TS there were a small number of adverse events (mistaken identity of an abnormal ECG in patients with similar names, delay in pre-procedure blood results, ECG not performed, intravenous fluids not readily available, kinked ICD, thromboprophylaxis not prescribed); most events led to delayed procedure only.

For ICD insertion, several avoidable patient safety issues were identified: 5.6% no support nurse available; insufficient documentation of observations pre (13.7%) and post (5.6%) ICD insertion.

Post-implementation

No adverse events recorded in TS and an improvement in ICD patient safety issues (procedure not done without support present, observations documented in 42% of cases). Team-working and communication reported to have improved.

However, ICD checklist completion rate was poor (53%), with form retrieval rates in TS low compared to reported completion rates (66.7% v 100%). Forms were generally incomplete.

Conclusion Most adverse events identified were due to system errors despite previously available safeguards. Well-designed procedural checklists can improve patient safety. Paper versions were not fully completed therefore we have incorporated an electronic version of the checklist into the procedural database, which has to be completed before the procedure starts.

References 1 N Engl J Med. 2009;360:491

2 Clin Med. 2014;14:468–474