As veterinary professionals, we are constantly taking on more work and knowledge, as well as learning techniques that support our practices, colleagues and patients.

But sometimes, our memory fails us. Whether a missed step, forgotten swab, mislabelled tube or result that was never delivered – all of us have made an error, be it in our professional or personal lives, and that’s normal.

But what if we could do something to reduce the chances of it happening again?

It’s natural

How many times have you gone to the supermarket, only to realise you forgot to take your shopping list? We are all intelligent people, but not infallible. A list – be it a to-do list, shopping list or procedural checklist – works to assist and facilitate tasks we can’t always fully commit to memory.

Ideally, a checklist will not be a duplication of a task, outlining every step of a procedure, but rather, a summary highlighting the critical stages. Checklists work by triggering your memory – your clinical expertise – to ensure the most important stages are not overlooked.

For some of us, checklists can be a part of everyday life – this does not mean said people are any less intelligent or capable. A checklist – or any kind of list – is an assurance; a safeguard that tasks won’t be overlooked.

Preventing harm

Unlike forgetting to buy milk at the supermarket, when you miss a step in a surgical procedure, or even the preparation for a procedure, it can result in serious harm.

We have heard the stories: a patient waking up mid-procedure, a surgical tool retained in a cavity – these situations can, and do, happen in practice. But we can do something to lessen their frequency.

In veterinary care, we often look to the medical profession to seek out commonalities in failure and success. One great success has been the introduction of the surgical safety checklist (SSC).

Launched in 2008 by the World Health Organization (WHO), the one-page checklist is designed to be read aloud in an operating theatre at three key stages:

• prior to induction of anaesthesia
• prior to skin incision
• prior to leaving the operating room

These three stages are considered to have the most critical points in a surgical procedure, where missing a step or a lack of preparation could have significant consequences.

Early in the implementation of the SSC, pilot studies were undertaken to determine its efficacy. The results speak for themselves:

• deaths fell by 47%¹
• postoperative complications fell by 36%²

Most convincingly, of the teams using the checklist, 93% said they would want this checklist used if they were undergoing surgery³.

Efficacy

As with many aspects of quality improvement, examples of the effectiveness of some of its initiatives within veterinary practice are limited; however, some studies are available.

Bergström et al⁴ were able to show surgeries where the SSC was not used encountered a significantly higher proportion of complications. Complications were noted in 52 out of 300 cases (17.3%) for procedures without the checklist, and 15 out of 220 (6.8%) for procedures with the checklist.

As with any new initiative, product or method, it requires a champion – someone who will take the lead in his or her workplace to ensure everyone is on board, and understands and is committed to applying a new technique for the greater success of the practice and the care of its patients.

More often, we are seeing the nurse’s role in veterinary practice increasing in responsibility, skill and esteem. VNs are capable and prepared to go the extra mile to give the very best care for their patients.

As in human medicine, these nurses should be empowered to take ownership of initiatives such as these, and lead on improving the quality of veterinary care and outcomes.

Consistency

Much like your grocery shopping list, a checklist only works when you use it. Keep printed copies of the SSC in your theatre to ensure you have it for every procedure and every patient, every time.

To find out more about checklists, including examples of SSCs from the WHO and leading veterinary clinics, visit the RCVS Knowledge Quality Improvement Project website.