Error Found in Employee File Review Checklist in Hospital

• Journal List
• Crit Care
• v.19(ane); 2015
• PMC4438434

Crit Intendance. 2015; 19(i): 214.

A comprehensive method to develop a checklist to increase safety of intra-hospital transport of critically sick patients

Anja H Brunsveld-Reinders

Section of Intensive Care, Leiden Academy Medical Center, Albinusdreef ii, PO Box 9600, 2300 RC Leiden, the Netherlands

G Sesmu Arbous

Department of Intensive Care, Leiden University Medical Centre, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, kingdom of the netherlands

Sander K Kuiper

Department of Intensive Care, Leiden Academy Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, the netherlands

Evert de Jonge

Department of Intensive Care, Leiden University Medical Heart, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, kingdom of the netherlands

Received 2014 Dec 19; Accepted 2015 Apr 22.

Abstract

Introduction

Transport of critically sick patients from the Intensive Care Unit (ICU) to other departments for diagnostic or therapeutic procedures is ofttimes a necessary part of the critical care procedure. Ship of critically ill patients is potentially dangerous with up to seventy% agin events occurring. The aim of this study was to develop a checklist to increase safe of intra-infirmary transport (IHT) in critically ill patients.

Method

A three-pace approach was used to develop an IHT checklist. First, various databases were searched for published IHT guidelines and checklists. Secondly, prospectively collected IHT incidents in the LUMC ICU were analyzed. Thirdly, interviews were held with physicians and nurses over their experiences of IHT incidents. Following this arroyo a checklist was developed and discussed with experts in the field. Finally, feasibility and usability of the checklist was tested.

Results

11 existing guidelines and five checklists were constitute. Just 1 checklist covered all iii phases: pre-, during- and mail service-ship. Recommendations and checklist items mostly focused on the pre-transport phase. Documented incidents most frequently related to patient physiology and equipment malfunction and occurred most ofttimes during ship. Discussing the incidents with ICU physicians and ICU nurses resulted in important recommendations such as the introduction of a standard checklist and improved advice with the other departments. This approach resulted in a by and large applicable checklist, adaptable for local circumstances. Feedback from nurses using the checklist were positive, the fill in time was 4.5 minutes per phase.

Conclusion

A comprehensive fashion to develop an intra-hospital checklist for safety ship of ICU patients to another department is described. This resulted in a checklist which is a framework to guide physicians and nurses through intra-hospital transports and provides a continuity of care to heighten patient safety. Other hospitals can customize this checklist to their own state of affairs using the methods proposed in this paper.

Electronic supplementary cloth

The online version of this article (doi:10.1186/s13054-015-0938-1) contains supplementary material, which is available to authorized users.

Introduction

Critically ill patients are oftentimes transported between the ICU and other sections of the hospital for diagnostic and/or therapeutic interventions [1-three]. Unfortunately at that place is an increased risk of an agin outcome during intra-hospital send (IHT) [4]. The outset documentation that IHT is potentially dangerous was published in 1970: during transport, arrhythmia occurred in 84% of patients at high risk of cardiovascular events [5]. Subsequent studies reported incidents in iv.2 to 70.0% of critically ill patients during IHT [1-three,6-eight]. Incidents were by and large related to equipment failure (39 to 45%) [half dozen-8], physiological deterioration of the patient including hypotension in up to 47% and hypoxia (20 to 29%) [3]. Specific knowledge on the risk of particular incidents during IHT can contribute to improved safety merely so far little is known about what kind of incidents occur during intra-hospital transport of critically sick patients.

Measures to reduce incidents include better pre-send planning, the introduction of standardised procedures related to personnel, organization and equipment during send and the employ of checklists during the preparation phase [iii,6-10]. Indeed, some guidelines on optimal IHT [11,12] are available just they are not easily translated into practical measures to reduce incidents. Every bit an alternative, checklists are practical and tin can provide tools to improve condom [13]. The aim of our study was to develop a checklist covering the pre-transport training phase, the actual transport phase and the ICU reinstallation (mail-ship) stage, to ameliorate safety during intra-hospital ship of developed critically ill patients.

Methods

This report was conducted in a 29-bed, adult patient mixed tertiary ICU at the Leiden University Medical Center (LUMC), the Netherlands. Iii complementary methods were sequentially applied to develop the checklist. These consisted of (1) a review of the available literature on IHT guidelines and checklists, (2) an assay of incidents related to IHT at the LUMC and (3) an inventory of what could get incorrect during IHT and how to preclude its aggregating through structured interviews with ICU doctors and ICU nurses. Based upon the study results, a checklist was developed and the feasibility and usability of the checklist were tested during a one-month period.

Definitions

For the purpose of this report we explicitly divided intra-hospital transport into three phases, and for the literature search we determined whether these iii phases were addressed in the guidelines and checklists. Furthermore, nosotros specifically focussed on the split up phases when analysing the reported incidents and in the interviews with doctors and nurses [fourteen].

The pre-transport phase is the phase in which the patient is prepared for transport. The focus is on the patient's severity of illness and stability, on the kind of monitoring and therapy the patient currently requires and also on what the patient is likely to need during the transport process. The ship stage comprises the transport from the ICU to another section and vice versa as well as the period during the diagnostic or therapeutic procedure. The post-send stage is the stage when the patient has returned to the ICU, in which ICU monitoring and earlier ICU therapies have to exist reinstalled, and the patient has to be stabilised. This phase requires 0.5 to 1 h after transport and must be considered as office of the transport process. An incident is defined as 'any event or event which could have reduced, or did reduce the safety margin for the patient. It may or may non have been preventable and may or may non accept involved an fault on the part of the health intendance team' [fifteen].

Review of the literature

Our review of the literature focused on guidelines and checklists on intra-infirmary send of critically ill patients. We searched in PubMed, Embase, Web of Science, COCHRANE, CINAHL, Bookish Search Premier and ScienceDirect; from inception until 12 January 2014. The databases were searched for medical literature with the post-obit terms: 'intensive care', 'disquisitional care', 'critically sick', 'intra-hospital transport', 'in-hospital ship', 'radiology department', 'guideline' and 'checklist'. Reference lists of review manufactures and eligible primary studies were checked to identify cited articles not captured by electronic searches.

Study pick

Two authors (AB and SK) scrutinised titles and abstracts of all references for possible inclusion. Inclusion criteria were: transport of adult ICU patients in the hospital, checklist and/or recommendations for IHT. Excluded were manufactures related to paediatric critical care, inter-hospital transport, reviews and editorials. Full text manufactures were examined and any disagreement was resolved by a third author (SA).

Data abstraction

The following information were bathetic from the studies with guidelines or checklists: author/research group, year of publication, country and recommendations and checklist items related to the pre-transport-, transport- and mail service-transport phase.

Analysis of incidents related to transport

We nerveless and analysed IHT incidents in our hospital to learn about the types and contributing factors of IHT incidents. In our ICU all incidents are submitted to an electronic incident reporting system. All routinely registered transport-related incidents were analysed and categorised with respect to type, phase of occurrence and contributing factors in the period from 2006 to 2009. Afterwards, over a 12-month period in 2012 we specifically asked ICU physicians and ICU nurses to report all incidents occurring during intra-hospital transport. A questionnaire was developed to collect these incidents. Incidents were predefined and categorised equally airway, breathing, circulation, disability, exposure and other. Also, a free-text field allowed the reporter to give a description of the situation during transport, perceived causes and actions that were taken. Incidents were analysed with respect to type, circumstances and contributing factors.

Interviews with experts in the field of intensive care

Structured interviews based on findings from the literature and collected incidents were undertaken with ten ICU physicians and fifteen ICU nurses. The interviews followed a questionnaire containing 53 questions on what could become incorrect during the iii phases of IHT and how to prevent it. Questions were related to equipment, patient physiology, monitoring, medication and fluid management; and covered all three transport phases. Additionally, for the transport phase questions focused on logistics and advice with the other department, and registration of vital signs. For the mail-ship phase the focus was on the reinstallation of ICU therapies and monitoring and on the stabilization of the patient. A detailed overview of the questions used for the structured interview tin can be found in Additional file 1.

Development of the checklist

The information gathered from the review of the literature, the analysis of transport-related incidents and the interviews with experts in the field were combined to develop the checklist. Checklist items were structured according to the different phases of transport. The checklist was introduced to ICU physicians and ICU nurses and was implemented in the Patient Information Management Organization of our ICU to be used in daily practice.

Feasibility and usability

The checklist was used by the ICU for 1 month, whereupon nosotros nerveless information to investigate the feasibility and usability of the checklist. Nurses were asked to fill in a questionnaire after each transport documenting their experiences using this checklist. The following information were collected: overall rating of the checklist, the time information technology took to fill in the checklist, relevance of the questions, logistics of the filling in of the checklist, and questions that were felt to be lacking. The questionnaire is listed in Additional file 2.

Ethical approval

The Medical Ideals Committee of the LUMC waived the demand for upstanding evaluation of the written report due to the observational nature of the study. Consequently, the need for informed consent was not applicative.

Results

Review of the literature

In total eleven guidelines [11,12,xvi-24] and v checklists on IHT [25-29] were identified in the literature. The guidelines were developed in United states of america, Europe, India, Australia and New Zealand and described recommendations for intra-hospital transport too equally for inter-hospital transport. In the guidelines some basic principles regarding transport were divers for example, that a infirmary transport protocol should be present [eleven,sixteen-18,21,22,24] and that the patient should receive the aforementioned level of basis physiologic monitoring during IHT as they received in the ICU [12,17-nineteen,23]. Three phases of transport were recognized. For each phase recommendations could be subdivided into categories namely (i) use of (monitoring) equipment, (ii) patient physiology, (three) medication and fluids, (iv) arrangement and planning. The pre-send phase was most extensively described. In this phase, recommendations were related to the use of a transport trolley, equipment to secure an airway, and preparation of monitoring, medication and fluids. With respect to patient physiology, a careful evaluation of the risk-benefit ratio should exist fabricated by the physician [11,16-24] and special attention should exist paid to the indication for transport [eleven,12,17,eighteen,23,24]. Other recommendations included planning of personnel with the suggestion that a minimum of ii qualified staff members, an ICU nurse and ICU physician, should accompany the patient [11,12,16-24] and the demand for clear communication to ensure that the patient is expected at the destination section [16,twenty,22-24] and to ostend that the receiving party is gear up [xi,12,20,23,24].

In the transport phase an important goal should exist to proceed monitoring during the ship as well as during the diagnostic or therapeutic procedure [11,17,18] and to check and record the patient's vital signs on a regular ground, at to the lowest degree every xv minutes [sixteen,24]. Furthermore, medication and fluid direction and maintenance of physiologic stability should be of key importance.

Back in the ICU, after installation and stabilization of the patient, information technology is essential to check monitoring and medication and to document the grade of the transport in the medical chart. With respect to the latter, attention should be paid to the condition of the patient during and after transport [11,12,16-18,23,24] and also to the events and interventions that occurred during transport [12,sixteen-18,20,24]. All the transport equipment should be cleaned and plugged back in the main ability supply to ensure that the equipment is bachelor for another transport to the receiving department for a diagnostic or therapeutic intervention.

In the literature, 5 checklists for intra-infirmary send of critically ill patients were found [25-29], of which one was specifically developed for obese patients [29]. The main focus of the checklists was on the pre-send phase. Only the checklist developed by Jarden [27] likewise described items for the ship and post-transport phase. Checklist items in the pre-transport phase related to the patient, monitoring equipment, advice and quality of the squad. Before send, the clinical stability of the patient [26-28] and the necessity of the ship should be assessed [28]. Medication, fluids and the equipment should be checked including send trolley, monitoring devices, and boosted equipment [25-29]. Items related to planning and arrangement should also receive attention [26,28,29]. For example, in order to guarantee a safety send, items were formulated with respect to the composition of the transport team, namely the presence of a physician [27] and a minimum number of ICU nurses [26].

During send, when the patient has arrived at the destination section, various items should be checked and ensured. Commencement, the continuity of the oxygen supply and the electronic supply for transport trolley and medication pumps should exist checked [27]. Furthermore, vital signs and administration of medication should exist registered frequently.

Upon return in the ICU, it is essential to reinstall respiratory back up devices, medication and monitoring, and to describe in the medical chart the complications that have occurred during transport and to recheck the used equipment [27]. An overview of the content of the published checklists is shown in Tabular array1.

Tabular array 1

An overview of the content of published intra-hospital (IHT) checklists

Writer	Pope [ 28 ]	Fanara [ 26 ]	Jarden [ 27 ]	Roland [ 29 ]	Choi [ 25 ]	Current checklist a
Yr of publication	2003	2010	2010	2010	2011	LUMC
Pre-transport
Necessity of transport is confirmed	+
Patient cess pre-send		+	+
Wrist band patient or consent course		+	+	+	+
Transport team is notified	+	+	+
Equipment and materials are gathered	+	+	+	+	+	+
Check sufficient oxygen level		+		+		+
Extra intravenous fluid and medication	+	+	+	+		+
Check sufficient intravenous medication	+	+	+	+		+
End enteral feeding and enteral insulin						+
Check tubes and lines		+	+	+	+	+
Check and set monitor alarms		+	+			+
Check and set ship ventilator alarms		+				+
Insert intravenous cannula in case of computed tomography with contrast						+
Preparation and equipment adapted to procedure (magnetic resonance imaging)		+				+
Fill in magnetic resonance imaging safe questionnaire						+
Register baseline vital signs		+/−	+			+
Receiving department is notified	+					+
Transport route is articulate		+
During transport
Check and plug in equipment at destination			+			+
Registration of administered fluids/medication			+			+
Registration vital signs every 20 minutes			+			+
Post-transport
Start enteral feeding and enteral insulin						+
Turn on humidifier						+
Change HME filter						+
Change suction bag if used			+			+
Complement transport bag						+
Written report occurred incidents/events			+			+
Re-check equipment and materials			+			+

^aCurrent checklist Leiden University Medical Center (LUMC) refers to the final checklist that was based on reviewing the available literature on IHT checklists and guidelines, an analysis of transport related incidents and a structured interview with ICU physicians and ICU nurses. HME, estrus and moisture exchanger.

Analysis of incidents related to IHT

Over a 36-month period, a total of 5,937 incidents were reported in our incident registration system, of which 118 incidents (2.0%) were IHT related. Of the 118 IHT incidents 38% occurred in the pre-send phase, 47% in the transport phase and xv% in the post-send stage. In the pre-send stage most reported incidents were related to equipment and organizational issues. Examples of equipment-related incidents were: low battery of the ventilator and/or medication pumps, employ of a mechanical ventilator not suitable for the MRI and an empty oxygen tank. Examples of system-related incidents were inappropriate preparation of the patient leading to delay of transport or inadequate communication with the receiving department.

Also in the ship phase well-nigh reported incidents were related to equipment and organisation. Examples of equipment incidents during this stage included failure of the transport trolley and its monitor. Examples of the organisational incidents were in availability of CT or MRI equipment. Postal service-transport, about reported incidents were related to airway and respiratory management, such equally failure to install adequate oxygen level or to reconnect the humidifier of the ventilator. An overview of the most common incidents is shown in Table2.

Table 2

Top ten most ordinarily reported intra-hospital transport (IHT)-related incidents

Top ten routinely registered IHT related incidents a	Pre-transport	During transport	Post-transport	Total
Equipment malfunction	ix	24	1	34
Preparation before transport	thirty	0	0	30
Lack of advice with radiology department	1	5	0	half dozen
Dislocation of intravenous lines and tubing	0	12	one	thirteen
Oxygen tank empty	4	four	0	8
Increase need vasopressor or inotropics	0	three	0	3
Equipment not available at radiology department	0	5	0	five
Lack of documentation in medical nautical chart	0	0	ii	2
Failure reconnect humidifier on ventilator	0	0	11	11
Hypoglycemia	0	0	one	1
Top ten prospectively collected IHT-related incidents b
Equipment malfunction	vii	24	2	33
Preparation before transport	vi	5	0	11
Lack of advice with radiology section	five	5	0	10
Dislocation intravenous line	0	7	2	9
Oxygen tank empty	four	2	0	6
Increase need vasopressor or inotropics	v	xv	6	26
Depression blood pressure§	21	44	18	83
Hypoxia§/increased oxygen demand	5	eighteen	12	35
Increased need sedatives or opiods due to agitation	two	17	ii	21
Hypertension§	2	nine	3	14

^aAnalysis of send-related incidents that were identified from routinely collected incidents in an elecronic incident reporting system in Leiden Academy Medical Middle. ^bFor 12 months all incidents occurring during intra-hospital transport were prospectively collected. ^§No definitions were used to define hypotension, hypertension and hypoxia. Physicians and nurses were able to estimate whether it deviated.

In 2012, nosotros prospectively collected send-related incidents. In this period, 503 transports to the radiology section were undertaken. In 334/503 (66%) of IHTs an ICU physician and ICU nurse accompanied the patients to the radiology department. In 133/503 (27%) of IHTs iii ICU staff members, an ICU doctor and ii ICU nurses and in xvi/503 (3%) four ICU staff members, two ICU physicians and two ICU nurses accompanied the patient. When the patient was not intubated the nurses sometimes accomplished the ship without a physician 20/503 (4%). The median duration of the send was 55 minutes (range 10 to 305 minutes). In 77% the reason for the IHT was to perform computed tomography (CT) and in ten% angiography.

In 133 of the 503 transports (26%), one or more incidents occurred, and in total, 358 incidents were reported. Incidents occurred in the transport phase (215/358, threescore%), in the pre-transport phase (fourscore/358, 22%) and in the post-send phase (63/358, 18%). The ten nigh frequently reported incidents during transport are shown in Tableii. In the transport stage the incidents were related to hemodynamic instability, respiratory instability, equipment dysfunction and increased need of medication. In the pre-transport and post-transport phase incidents were related to hemodynamic instability. The lack of communication with the radiology section before and during ship also occurred regularly.

Interviews with experts in the field of intensive care

Ten physicians and fifteen nurses were interviewed to discuss the findings from the literature and the collected incidents. A transport protocol existed in our hospital simply 90% of the physicians and 73% of the nurses were not familiar with the protocol. The protocol described the composition of the accompanying team, the monitoring and respiratory equipment to exist used, and the medication and boosted equipment that should exist bachelor during transport.

Incidents considered most of import past physicians and nurses in the pre-ship phase were an empty oxygen tank, lack of sufficient intravenous access, missing equipment, trolley failure, inadequate length of intravenous tubing and miscommunication with the radiology department. In the send phase, nurses and physicians mentioned potential incidents such as dislocation of an intravenous cannula or endotracheal tube, low battery in the pumps, impaired view of the patient in the radiology department and patient instability. In the post-send phase patient instability and incorrect reinstallation of respiratory support and medication were commonly reported.

To enhance a safer transport, several improvement measures were suggested past physicians and nurses, such every bit introduction of a checklist for the iii phases of send and standardisation of the transport procedure and improved communication with the radiology department. A listing of recommendations can be found in Table3. Furthermore, the physicians and nurses indicated that they would experience more than confident if they received more instruction and applied training.

Table 3

Recommendations from ICU physicians and ICU nurses

	Recommendations
Team	Ventilated patient at to the lowest degree one ICU md and 1 ICU nurse
	Not ventilated patient and:
	o ≤ 1 inotropic, one ICU nurse
	o ≤ 1 inotropic, respiratory insufficient and arrhythmia, one ICU physician and 1 ICU nurse
Education	Focus on how to operate equipment of ship trolley
	More than didactics for ICU physicians and ICU nurses to execute transport of ICU patients
Equipment and materials	Equipment on trolley is equal to equipment in the ICU
	Check equipment and materials prior to transport
	Check extra length of intravenous lines for magnetic resonance imaging prior to transport
	Cheque and summate oxygen level in oxygen tank
	Defibrillator is standard equipment on ship trolley
	Check all equipment on transport trolley
	Batteries are fully charged prior to transport
Organization and procedure	Introduction of an intra-infirmary checklist
	Formal training in send procedure to MRI
	Standard Operating Procedure
	Standardization of IHT procedure
Communication	Confirm date with the other department prior to transport
	Improve communication with the other section to forestall incidents during transport
	Debriefing with ICU physician and ICU nurse after transport
Medication	Check and prepare intravenous medication prior to transport
	Actress intravenous medication and intravenous fluids

Recommendations suggested by ICU physicians and ICU nurses when they were interviewed to hash out safety and hazards of IHT and the findings from the literature and the collected incidents.

Development of the checklist

Based on the literature, we chose the checklist of Jarden [27] as a base of operations to develop our own checklist. The other iv checklists were used to complement our new checklist. All the checklists had several items in common such as check equipment/materials [25-29], medication [26-28] and intravenous access [25-29]. We included these items in our checklist. I detail, just establish in the checklist by Pope was 'whether the receiving department is notified' and we included this item also in our checklist [28]. An overview of the items of the published checklists is shown in Tableone.

The last checklist developed every bit described higher up is presented in Figures1 and ​ two. The basic principle of this checklist was to guide the physician and nurses through the different phases. In the pre-transport stage the focus is on required equipment, training of extra medication and intravenous fluids and checking of procedures such equally the use of contrast fluid and kidney protection. In the transport phase the focus is on the destination section with attention for the following items: plugging in the oxygen, monitoring equipment and keeping sight of the monitor during the process and registration of vital signs, and medication and intravenous fluids. In the post-transport phase it is important to connect the patient to the equipment in the ICU with specific attention to switching on the humidifier, nutrition, insulin and checking the correct dose of medication via the perfusor. Also, to assure that required equipment is fix for use on the next trip, the transport trolley and transport bag should be checked and connected to the power supply. Finally, documentation in medical charts including registration of incidents should be checked.

Newly developed Leiden University Medical Eye (LUMC), checklist side one. i.v., intravenous; MRI, magnetic resonance imaging; EtCO₂, end tidal CO₂; HME, heat and moisture exchanger; ET/TT, endotracheal tube/tracheal tube; PDMS, Patient Data Management System.

Newly developed Leiden University Medical Center (LUMC) checklist, side two. i.v., intravenous; 60 minutes, heartrate; BP, bloodpressure; MAP, mean aterial pressure level; CVP, primal venous force per unit area; PAP, pulmonary artery pressure; Vent style, ventilation way; FIO_two, fraction of inspired oxygen; PEEP/PS, postive stop-expiratory pressure/pressure support; RR, respiratory rate; SpO₂, peripheral capillary oxygen saturation; EtCO_two, stop tidal CO₂; GCS, Glasgow blackout scale; PDMS, Patient Data Direction System; HME, heat and moisture exchanger.

Feasibility and usability

In order to investigate the feasibility and usability of the checklist, data were nerveless over a one-calendar month period using the checklist. During this month, 41 transports were made to the radiology department. In 29 of these transports, the checklist was used and a questionnaire was later filled in by the nurses about their experiences using the checklist. Reasons for non using the checklist during ship were either due to forgetfulness of the squad to utilise it (5/29) or to the urgency of the transport (7/29). The time it took to fill in the checklist was on average 4.v minutes per phase (range 3 to x). Nurses stated that the user friendliness of the checklist was good, it was comprehensive and complete, it reduced the hazard of forgetting things, and it was like shooting fish in a barrel to use because it was implemented in the Patient Data Management Organization. A point of criticism was the documentation of vital signs every xx minutes on the paper-based checklist that was used in the ship stage. This was considered time consuming. Digitally input documentation was preferred. Items that were missed in the checklist were information on the completeness of the transport handbag and patient assessment in the pre- and post-transport phase. Information on the transport phase and post-transport phase was filled in after the transport.

Discussion

We adult a checklist to ameliorate safety of intra-hospital transport by using three complementary methods: a review of the available guidelines and checklists in the literature, an analysis of transport-related incidents and an inventory of what could go wrong during IHT and how to prevent it by interviews with ICU doctors and nurses. Importantly our checklist includes three phases of intra-infirmary send. Furthermore, we propose that our methods of local modification of an existing checklist on IHT may exist a useful procedure for whatsoever infirmary aiming at improving safety of intra-hospital transport.

The bones principles for intra-infirmary and inter-hospital transport are the same, namely to ensure safety during this potentially unsafe ship [18]. We were specifically interested in intra-hospital transports because they occur frequently on the ICU and because the number of incidents during these transports is even so very high. Our checklist is based on an earlier checklist by Jarden [27]. This is the only checklist that discerns iii different transport phases. In other checklists the focus was only on the pre-ship phase namely to check the patient and equipment before ship. If the patient is checked before transport it lowers the risks of incidents during transport. Nevertheless, patient transport is not limited to the pre-transport phase. It is essential that the entire transport process of critically ill patients is covered from start to cease.

Nosotros wanted to arrange the checklist of Jarden [27] to our own situation. It is oftentimes necessary to customise a checklist because aspects of the checklist may not be suitable to a specific local situation. Also in our example, some of our hospital policies and procedures differed from the described checklist items. Therefore, ICUs need to customize the available checklists to their own situation taking into account the hospital procedures and circumstances in which a send will be conducted.

A comprehensive method was used to develop the checklist. This included a review of the literature for available guidelines and checklists, an assay of incidents related to transport in our hospital and an inventory of ICU physicians' and nurses' skilful opinion over IHT. Due to this approach, we obtained dissimilar types of knowledge bachelor on the subject and we were improve able to build a comprehensive and applied checklist. This arroyo is supported by Hales et al. [30] who stated that peer-reviewed guidelines and show-based best practice should exist considered to form the torso of a checklist and that checklists should also reflect the local hospital and institution policies and procedures.

There are some differences betwixt the Jarden checklist [27] and ours. Nosotros added some items that are specifically related to our local situation and some that are a more generic addition for checklists on IHT. For instance, in the pre-ship phase checking the availability of sufficient intravenous medication was added. While Jarden's checklist included a patient assessment and documentation section in the pre-transport phase, we eliminated many of these items considering this information tin can be institute in our Patient Data Direction System. We added a few items to the checklist that were specific for our IHT policy. Examples of these are extending the length of intravenous tubing, hyper hydration for kidney protection and an MRI safety questionnaire for transport to MRI. In the postal service-transport phase the focus was on connecting the patient to the available equipment in the ICU and on checking the rate of assistants of intravenous pumps with the Patient Information Management System. These items were important for our ICU due to frequently reported incidents that decreased patient safety.

General guidelines and checklists provide guidance in developing a local checklist. The concept of local accommodation of the transport checklist adult by Jarden [27] was not previously described. In our opinion, customising a checklist according to local policies and procedures improves the commitment of nurses and physicians to utilize this checklist.

A checklist can exist seen as an of import instrument to avert incidents. It is of added value if information technology is introduced accompanied with education and training. Barriers to using checklists in healthcare are related to operational and cultural aspects [13]. Filling in a checklist adds to the nurse's workload. However, in our minor feasibility study, it simply took 4.five minutes (range three to 10) per phase and it appeared that nurses were on the whole positive well-nigh using a send checklist.

Our study has a few limitations. First, we have not nonetheless investigated whether our checklist indeed decreases the number of IHT-related incidents and improves safety. This will be the subject of hereafter research. Furthermore, the checklist is by definition most useful in our specific hospital because it is customized to the local hospital and ICU procedures and protocols. Third, while nosotros implemented the pre- and post-send phase checklist into the Patient Data Direction Organization, the checklist items in the ship phase are still registered on newspaper (vital signs, medication and fluids). This may result in a potentially lower adherence during this phase.

A strong bespeak of our report was the comprehensive fashion we adult the checklist. Particularly our inventory of what could go wrong during IHT and how to prevent it, which we achieved through interviews with ICU doctors and nurses, will have contributed to a clinically relevant checklist and to the applicability and acceptance of the checklist in daily practice by ICU doctors and nurses. We think that this checklist can contribute to the safety of ICU patients that need to be transported during their ICU stay. However, to ostend this, the next pace to be taken is testing and evaluating the efficacy of the checklist: is patient safety increased with the checklist and are ICU nurses and ICU physicians satisfied using information technology in daily practice? Our checklist, though specifically adapted for one hospital, tin be used in other hospitals besides. Each hospital should assess whether the items from the checklist are applicable to their specific situation. If necessary, local modifications tin can be made.

Decision

In conclusion, we applied a comprehensive approach to develop an intra-infirmary checklist for safe transport of ICU patients to another section and dorsum to the ICU. This checklist is not only based on available guidelines and checklists in the literature but also on reported incidents and expert opinions of ICU physicians and nurses. This resulted in a checklist that is a framework to guide ICU physicians and nurses through intra-infirmary transport and provides continuity of intendance to heighten patient prophylactic.

Key messages

• A comprehensive method was applied to develop a checklist which can exist used to increase the rubber of intra-infirmary ship of critically ill patients.

• The checklist covers the transport of critically ill patients from the start until the end of the process, including all three send phases.

• Customizing the checklist according to local policies and procedures - using the comprehensive method suggested in this written report - is important to better the commitment of nurses and physicians.

Abbreviations

CT	computed tomography
IHT	intra-hospital transport
LUMC	Leiden University Medical Center
MRI	magnetic resonance imaging

Additional files

Additional file 1:^{(31K, docx)}

Questionnaire used for structured interview of ICU physicians and ICU nurses.

Boosted file 2:^{(20K, docx)}

Questionnaire used to assess feasibility and usability of current checklist Leiden University Medical Center (LUMC).

Footnotes

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

AB contributed to the development of the manuscript concept and blueprint, carried out the report and performed main writing and editing of all drafts of the manuscript. SA contributed to the development of the manuscript concept and design and performed editing of all drafts of the manuscript. SG contributed to the development of the manuscript concepts and design, performed the literature search, analysed incidents and interviewed ICU physicians and ICU nurses and performed editing of the manuscript. EdJ contributed to the development of the manuscript concept and blueprint and performed editing of all drafts of the manuscript. All authors read and canonical the final version of the manuscript.

Contributor Information

Anja H Brunsveld-Reinders, E-mail: ln.cmul@srednieR-dlevsnurB.H.A.

1000 Sesmu Arbous, Email: ln.cmul@suobram.

Sander One thousand Kuiper, Email: moc.liamg@98repiukgs.

Evert de Jonge, E-mail: ln.cmul@egnoJ_ed.Due east.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4438434/

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