1. Checklist Modification 101 Make Me Your Own

2. The Basics One size doesn’t fit all. Every hospital should modify the checklist. Checklist modification creates buy-in and ownership. The checklist is designed to promote teamwork and communication... don’t remove teamwork/communication items.

4. Things to Keep In Mind When Modifying the Checklist

5. Brief Each section (Before Induction of Anesthesia, Before Skin Incision, and Before the Patient Leaves the Room) should take < 1 minute. The checklist should never take longer than the procedure. The checklist should fit on one page.

6. Is this a critical safety step and in great danger of being missed? Examples: Known Allergies, Essential Imaging, Antibiotic Prophylaxis Is this adequately checked by other mechanisms? Examples: Anesthesia safety checklist has been completed, Sterility including indicator results Is this actionable, with a specific response? Example: Monitoring blood pressure Is this item discussed at a time when all relevant team members are present and when something can be done to fix it? Examples: Essential equipment and expected blood loss Will this item help anybody here? When Adding and/or Removing Items Ask Yourself....

7. Alternative Wording for Particular Items

8.  Are blood products required and available?  What is the EBL?  Blood (or cross-match) available if needed.  Is there a need for blood products?  Blood availability confirmed.  EBL/Blood Plan Modifying Blood Loss

9. Modifying Team Introductions  We will start by introducing ourselves by name and role.  Team introductions to patient, including name and role.  Are there any unfamiliar staff in the room? Please introduce yourself by name and role.

10. What If We Already Know Each Other? We recommend that even if you know each other that everybody says something before the procedure starts. –Check-off with everybody in the room Surgeon says, “Mary, are you ready to go?” etc.

11. Modifying the Safety Statement  Surgeon says: “If anyone on the team sees something that the team should know about, please speak up”  Surgeon declares: “If anyone on the team sees something that the team should know about, please speak up anytime during the procedure.”  Surgeon states, “If you see, suspect, or feel that patient care is compromised, will you speak up?”  Surgeon states, “Remember that all are free to voice any concerns at any time throughout the procedure”  Surgeon states, “Does anyone have concerns? If you think there is a problem, please speak up”

12. Is the Checklist the Best Way to Take Care of This? Glycemic Control Fire Risk Assessment Hair Removal Checking Pressure Points

13. Examples of Modified Checklists