Development and Implementation of a Perianesthetic Safety Checklist in a Veterinary University Small Animal Teaching Hospital

Abstract

IntroductionThe use of a surgical safety checklist is recommended by the World Health Organization and is associated with advantages: improved communication and reduced complications and mortality. Adapting checklists to the environment in which they are used improves their efficiency, but their implementation can be challenging. The aim of this study was to develop and implement a perianesthetic safety checklist for a small animal hospital.Materials and methodsA panel of eight anesthesia diplomates and seven residents and doctoral students were gathered. The Delphi method was used to generate a checklist. The checklist was presented individually to each user by the primary investigator and introduced into the clinical routine over a 5-week period. An interdisciplinary meeting was then held, and the checklist was modified further. Six months after introduction, the use of the checklist was directly observed during 69 anesthetic cases and a survey was sent to the users. A second implementation was organized after formally presenting the checklist to the staff, designating the anesthesia clinical lead as the person responsible for printing and controlling use of the checklist. A second evaluation was performed 3 months later (64 anesthetic cases).ResultsUsing the Delphi process led to the creation of a checklist consisting of three parts: “sign in” (before induction of anesthesia), “time out” (before the beginning of the procedure), “sign out” (at the end of the procedure). At the first assessment, the checklist was printed and used in 32% of cases and not printed in 41% of cases. Response rate of the survey was fair (19/32 surveys): 14/19 users thought the checklist contributed to improving communication; 15/19 reported improved safety and better management of the animals; 9/19 users avoided mistakes (77% would have omitted the administration of antimicrobial prophylaxis); 10/19 thought it was time consuming. At the second assessment, the checklist was used in 45% of cases (printed but not used in 55%). The use of the sign-out section of the checklist was significantly improved.Conclusion and clinical relevanceThis study illustrates an innovative use of the Delphi method to create a safety checklist. Challenges associated with implementation are reported.

Use of a surgical safety checklist after implementation in an academic veterinary hospital

“…However, the inconsistent uptake of SSC documented in the human literature justifies exploration of implementation strategies in veterinary medicine 19 . Barriers identified in the human research may prove a useful benchmark for effective implementation of SSC, but it is hypothesized that veterinary organizational and cultural differences may nuance the experience 20,21 . The impact of SSC could remain varied in veterinary medicine until appropriate veterinary implementation programs are widespread.…”

Development and implementation of veterinary anesthesia medical quality standards for primary care

“…Patient safety has been a focus in the human health field for years (Berwick 1989;Institute of Medicine 2000, 2001; Institute for Healthcare Improvement 2021) and information derived from that research was incorporated into the study design described in this manuscript. Improvements in the provision of care in the veterinary field, especially around the provision of anesthesia, have been demonstrated by others related to safety (Hofmeister et al 2014) and the use of surgical checklists (Bergstrom et al 2016;Menoud et al 2018).…”

Using checklists to improve patient safety during anaesthesia

“…Menoud and others (2018) devised a veterinary anaesthetic safety checklist which was adapted from the WHO SSC. The authors then attempted multiple interventions in order to optimise implementation in a veterinary university small animal teaching hospital environment.…”