2. Procedural Checklists for the Pediatric Cath Lab

3. This tool kit includes the following:  Background information on the utility of procedural checklists  Key elements of procedural checklists  Sample procedural checklists (both basic and comprehensive)  Bibliography

4.  Human error can add to the risk inherent to procedures used for diagnosis and treatment of congenital heart disease.  Checklists utilized in aviation and construction industries are thought to reduce risk and improve efficiency.  Concepts of Crew Resource Management (CRM) are being increasingly adapted to the practice of medicine to improve efficiency and safety. 1

5. What can procedural checklists do in medicine? 1.Improve safety by reducing morbidity and mortality 1-3  e.g. DVT prophylaxis, antibiotic dosing 2.Improve teamwork and communication 4 3.Facilitate handoffs between services 5 4.Reduce costs 6 5.Potentially reduce or eliminate litigation (up to 1/3 of all malpractice claims) 7

6. The ideal procedural checklist should:  Improve communication and staff awareness – especially at transfers of care  Reduce medical errors and improve patient safety  Improve efficiency  Ultimately improve staff morale and patient satisfaction

7.  Key components of procedural checklists, as defined by the World Health Organization: 8 1. Pre-anesthesia/sedation 1. Pre-incision (vascular access) 1. Post-procedure (pre-transport)

8. Pre-anesthesia/sedation examples:  Pregnancy test  Planning of type of sedation  Special equipment needs (nitric oxide, rotational angiography)  Allergies/Contrast reaction

9. Pre-incision (vascular access) examples:  Staff introduction  Access plan/previous problems  Medications (heparin, antibiotics)  Planned admission and location

10. Post-procedure (pre-transport) examples:  Complications  Follow up studies  Patient sign-out  Lines/drains  Family updated

12. We sought to:  Produce a checklist that could be readily put to use in pediatric cardiac catheterization labs without an existing procedural checklist  Produce a checklist that could easily be adapted or modified for local use  Examples of a basic and more comprehensive checklist follow.

15. The following are examples of checklists utilized at various institutions

18.  The KEY to this document is that it is designed specifically for quality improvement and should therefore NOT become part of the medical record  It can and should be a tool to improve peri- procedural patient care and safety  Each catheterization laboratory should verify with their institution the implications of, and regulations surrounding, this document, as different states may have different codes.

19. 1. Ricci MA, Brumstead JR. Crew resource management: using aviation techniques to improve operating room safety. Aviat Space Environ Med. 2012; 83(4):441-4. 2. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Herbosa T, Joseph S, Kibatala PL, Lapitan MC, Merry AF, Moorthy K, Reznick RK, Taylor B, Gawande AA; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009. 360(5):491-9. 3. Berrisford RG, Wilson IH, Davidge M, Sanders D. Surgical time out checklist with debriefing and multidisciplinary feedback improves venous thromboembolism prophylaxis in thoracic surgery: a prospective audit. Eur J Cardiothorac Surg. 2011 4. Hayes C. Surgical Safety Checklist: Improved Patient Safety through Effective Teamwork. Nurs Leadersh (Tor Ont). 2012;15:57-62. 5. Kim SW, Maturo S, Dwyer D, et al. Interdisciplinary development and implementation of communication checklist for postoperative management of pediatric airway patients. Otolaryngol Head Neck Surg 2012;146:129-34. 6. Semel ME, Resch S, Haynes AB, Funk LM, Bader A, Berry WR, Weiser TG, Gawande AA. Adopting a surgical safety checklist could save money and improve the quality of care in U.S. hospitals. Health Aff (Millwood). 2010;29(9):1593-9. 7. de Vries EN, Eikens-Jansen MP, Hamersma AM, Smorenburg SM, Gouma DJ, Boermeester MA. Prevention of surgical malpractice claims by use of a surgical safety checklist. Ann Surg.2011:253(3):624- 8. 8. http://www.who.int/patientsafety/safesurgery/en/index.html

20.  Many thanks to the individuals who contributed to the SCAI Pediatric QIT Procedural Checklist Module:  Henri Justino, MD (P-QIT Chair)  Brent Gordon, MD  Bryan Goldstein, MD  Paul Seib, MD  Abhay Divekar, MD  Troy Johnston, MD  Joel Harder, MBA  Drew Voytal, MPA