A Paediatric Safety Checklist Based on the Principles of the WHO Surgical Safety Checklist

Background: A 3-year old child presented with apparent respiratory problems. The underlying problem of diabetic ketoacidosis was missed and diagnosis was delayed. This was an isolated incident comparable to a surgical ‘Never Event’. We hypothesised that a Paediatric Safety Checklist based on the principles of the WHO Surgical Safety Checklist¹ can address this.

Objective: To determine whether a Paediatric Safety Checklist can be integrated successfully.

Methods: Potential barriers were addressed, including clinical engagement, active and passive resistance from staff and practicalities in relation to the current system. Five PDSA cycles were completed from September 2014 to June 2015, with intermittent interventions. A further PDSA cycle was undertaken in January 2017. A staff questionnaire was performed in September 2014 during initial introduction and repeated in February 2017.

Results: The first PDSA cycle in 2014 showed 55% compliance rate. A fall to 17% was seen on the second data collection. After interventions compliance increased to 67% and remained at 62% and 67% respectively. In January 2017 none of the checklists in a sample of 40 were filled appropriately.

In 2014 73% of doctors felt that the Paediatric Safety Checklist improved patient safety, compared with 83% in 2017. One hundred percent of nurses agreed with this in 2014, compared to 53% in 2017. In 2017 52% of staff lacked awareness of the trigger case and 67% stated this knowledge increased their opinion of checklist importance.

Discussion: We were able to introduce the Paediatric Safety Checklist in 2014; three years later however the checklist has stopped working. There is a lack of compliance despite previous and current positive feedback. Reasons appear to be the absence of champions and a lack of clarity by staff in regards to what is expected. The questionnaires showed that staff perceptions and attitudes are key to the project’s success.

References: 1. Haynes AB et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 360:491–499.