Standardisation and the use of checklists
We observed an appreciation of the importance of standardisation of
tasks and a clear focus on using SOPs for key procedures during the
trial. However, the SOPs were frequently lengthy (ranging between seven
and 79 pages for amalgamated documents with multiple elements), and
simplified checklists to accompany tasks such as inoculation were not
available leading to the development of unapproved ‘workarounds’.
We observed that the study team had designed checklists for use both
pre-procedure and during inoculation (see Appendix 1). However, these
checklists were not designed according to human factors principles and
were cumbersome to use. For instance, the in-room checklist for
inoculation was an adapted SOP containing over 50 steps rather than an
optimised, task-focused list of safety critical steps, and was being
used in paper form in the room with live virus
A standardised approach to the management of potentially life
threatening emergencies such as anaphylaxis is important when teams are
interacting on an ad hoc basis. Despite the OxCRF having the full
complement of emergency equipment and appropriate signposting, the
anaphylaxis box was noted to be different from the one used routinely in
the OUHT. This may present unnecessary confusion for staff arriving from
the hospital to assist in an emergency. Issues with lack of a
standardised approach to PPE have already been described above.