Development and pilot of a Cardiac Catheterisation Laboratory (CCL) specific pre-procedural checklist. (A multiple methods study).

Abstract

Background Interventional cardiology has seen increasing procedural complexity and patient acuity. CCL nurses help protect patient safety. The aims of this project were to: (1) implement a CCL-specific pre-procedural checklist in a regional private hospital; (2) evaluate the checklist usability and feasibility in practice; and, (3) evaluate change in adherence to best practice guidelines post-checklist implementation when conducting the team ‘time-out’. Methods A multiple-methods study design was conducted. Phase 1: baseline pre-implementation staff surveys and silent observation audits; Phase 2: focus group interview, development and implementation of a CCL-specific checklist; Phase 3: post-implementation staff survey and observational audits to compare adherence to pre-procedural ‘sign-in’ and ‘time-out’ processes. CCL nurses (n=5, 56%) and radiographers (n=2 66%) participated. Results Focus groups supported the need for a CCL-specific checklist; key emerging themes included: a generic checklist is not ideal; information about medical history and having effective time-out briefing processes are essential; and CCL nurses have additional responsibilities for patient safety. Baseline audits revealed critical gaps in the ‘sign-in’ phase: patient identification (57%), alert card (29%), and allergy (71%) checking and staff participation during ‘time-out’ processes (28%). Post-implementation results showed improvement during the ‘sign-in’ phase: checking patient identification and procedure matching, alert cards, and patient allergies improved by 43%, 55% and 29%, respectively. All staff participated in the ‘time-out’ phase: checking alert cards (85%) and confirming allergies (100%). Conclusions Introducing a CCL-specific checklist to guide peri-procedure checks resulted in better adherence to practice standards for patient identity confirmation, procedure matching and conducting ‘time-out’ procedures.