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such as patients' medication allergies. This redundancy, intended
as a mechanism to identify potential errors at multiple points
before they occur, looks like extra work to staff members, who
might resort to workarounds and shortcuts.
• Social structure. The OR has historically been a hierarchical
environment in which the surgeon is perceived to be the captain
of the ship. Surgeon resistance to checklists therefore results in
staff members also dismissing the process.
— Vanessa Lyons, PhD, RN, CNOR
checklist use due to inflated reported completion rates, so use
observational audits to measure true compliance (a "secret shop-
per" approach is one effective method to complete the observa-
tions). Update staff on the results of the observational audits and
current patient safety statistics, so they're aware of the checklist's
real impact on case outcomes. Share specific examples of how
the checklist rundown averted potential problems to show its
value in your specific clinical setting.
Institute consequences for noncompliance.
Once you've identified the barriers to the checklist process
(see "Reasons for Checklist Pushback"), provide non-punitive remedi-
ation the first time a staff member fails to follow proper checklist
protocols. If compliance continues to be an issue, your facility's
policy should guide the disciplinary process. Regardless of your
policy, consequences for noncompliance must be planned and
clearly communicated to staff before checklist implementation.
OSM
Dr. Lyons (vanessa.lyons@kctcs.edu), a nursing instructor at West
Kentucky Community and Technical College in Paducah, Ky., is the former
perioperative staff development and technology coordinator at Murray-
Calloway County Hospital in Murray, Ky.
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