Standardisation and the use of checklists
Standardisation supports workers in undertaking often difficult tasks by
reducing the attentional demands normally required to achieve these,
freeing up cognitive resources for dealing with complex issues that can
evolve in dynamic work environments. There has, however, been noticeable
resistance to standardisation in healthcare, not least because efforts
at standardisation may be poorly thought through, and often irrelevant
to the complex, nuanced, sociotechnical systems in which healthcare
professionals undertake their duties . Checklists are a form of
cognitive aid which have gained widespread acceptance in safety critical
industries and are becoming more prevalent in healthcare both for
elective and emergency situations . There are design rules for effective
checklists including standardised language and layout, and a focus on
including only the key safety critical steps of a task. When used
properly, checklists reduce cognitive load, protect against
forgetfulness, and minimise omission of key steps.
Standardisation of key procedures in OxCRF and by the COV-CHIM study
team was evident during the study period, as was the use of checklists,
both those designed and approved in advance and those generated in
response to perceived deficiencies. Despite face validity these
processes were evidently suboptimal, with improvements in design being
required in advance of study delivery and to deal with arising issues
during study conduct. The Association of Anaesthetists in the UK has
designed a Quick Reference Handbook (QRH) to support improved safety in
anaesthetic practice which adheres to these design principles (see
Appendices 3 and 4). These principles will now be used to support the
development of a QRH for safety critical tasks and emergency situations
(such as anaphylaxis) in this trial and others conducted in the OxCRF,
an approach that may be mirrored in other units.