Patient Monitoring, Patient Safety, Patient-Controlled Analgesics, PCA, Post-Operative Monitoring

Why You Should Let Patients Participate in PCA Safety Checklists, Too

by Sean Power

(This article first appeared in Healthcare News.)

Last month, in an Outpatient Surgery e-weekly newsletter, Jim Burger shared research by Tulane University Hospital and Clinic in New Orleans, suggesting that surgical teams are more likely to use the World Health Organization’s (WHO) Surgical Safety Checklist when patients know about the existence of such checklists. All of the informed patients said that knowing about the checklist made them feel more comfortable going into surgery.

In the study, which was presented at the American Society of Anesthesiologists’ conference, students secretly monitored 104 procedures. In 43 cases, patients were told about the checklist; in the other 61 procedures, patients were left in the dark.

According to the article, compliance on all of the items on the checklist was higher when patients were aware of its existence.

Below, I outline three reasons why, like the WHO Surgical Safety Checklist, you should share the Patient-Controlled Analgesia PCA Safety Checklist with your patients.

1. Evidence-based checklists improve patient safety. Sharing checklists with patients will increase patient confidence, comfort, and satisfaction.

Peter Pronovost, MD, PhD, FCCM (Professor, Departments of Anesthesiology/Critical Care Medicine and Surgery, The Johns Hopkins University School of Medicine and Medical Director, Center for Innovation in Quality Patient Care), describes the process of translating evidence into practice:

  • Summarize the evidence in a checklist.
  • Identify local barriers to implementation.
  • Measure performance.
  • Ensure all patients get the evidence.

Evidence should guide decisions. Since checklists summarize evidence it is crucial that physicians comply with the steps outlined by checklists.

Based on the Tulane research, patients will feel more confident, more comfortable, and more satisfied when they see the PCA Safety Checklist before they receive anesthesia.

2. Checklists help communicate with patients and families and clarify the patient’s role in safe care.

Since checklists are evidence-based, when you share them with patients you effectively give them a crash course on all of the evidence behind the care that they are about to receive.

Physician compliance to checklists, demonstrated by the Tulane study, is important to safe care. Patient compliance is equally important. When patients understand what is expected of them in light of the evidence at hand, they are more likely to comply.

For example, some patients receiving PCA complain of discomfort from the capnograph’s nasal cannula that measures carbon dioxide in exhalations. When nurses explain the importance of capnography, and that measuring end tidal CO2 can alert medical staff if the patient has stopped breathing, patients become more willing to comply.

Tammy Haslar, Oncology Clinical Nurse Specialist at the Franciscan Alliance at St. Francis Health, suggests nurses discuss the monitoring program “during pre-op appointments” and “while going over surgery instructions.” Doing so sets expectations for the patient and offers reasons for complying with safety measures.

Sharing the PCA Safety Checklist with patients before their operation helps to make sure that nothing is overlooked and that expectations are communicated clearly. This communication will increase the likelihood that patients fulfill their own expectations.

3. Sharing checklists with patients fosters a culture of transparency.

Dr. Pronovost explains that transparency prevents harm:

“To be accountable for patient harms, health care needs valid and transparent measures, knowledge of how often harms are preventable, and interventions and incentives to improve performance.”

Transparency with patients promotes accountability, which leads to safe care. Accountability both rewards good behavior and deters poor performance. Sharing checklists with patients enables them to participate in the accountability discussion.

The PCA Safety Checklist is a free resource offered by the Physician-Patient Alliance for Health & Safety that was developed by a multidisciplinary team of experts. It is designed to minimize adverse events associated with PCA. You can download Word version here or a “checkable” PDF here.

Have you shared the PCA Safety Checklist with your patients? What kind of reaction did you receive?

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