Streamline procedures to lower odds of big errors

The Institute for Healthcare Improvement, a Boston nonprofit offering advice on reducing medical errors, suggests that streamlining procedures can help prevent wrong-site surgery. This is some of the advice offered by the institute:

Reduce reliance on memory by designing processes with automatic prompts and less reliance on fallible processes. Checklists, marking the operative limb, and double-checking by team members can prevent many wrong-site mistakes.

Simplify the system by reducing the number of steps and hand-offs in work processes. Have the same personnel move the patient whenever possible. Always repeat the patient’s name and surgical site aloud to the receiving person in front of the patient.

Standardize by limiting unneeded variety in drugs, equipment, supplies, rules, and processes of work. Prescribing conventions and protocols for complex procedures can eliminate the opportunity for mistakes.

Use constraints and "forcing functions." These tools prevent actions from occurring until certain conditions are met, helping to reduce reliance on memory and checklists.

If there is any deviation from procedure or doubt for any reason, build in a "stop process" so that the patient’s proper identification is ensured before proceeding. Train the team so that each member feels confident enough to raise concerns and other members understand they should never belittle or dismiss another team member’s inquiry.

Use repetition, standard vocabularies, and insist on clear communication. But allow judgment and critical thinking, rather than strictly adhering to rigid models.

Make sure any checklist or protocol can accommodate atypical scenarios such as emergency surgery and trauma.

Design processes so that the safe channel is the one requiring the lowest energy. Make doing the right things the easiest thing to do. When designing tasks and work systems, keep in mind issues of stress, workload, circadian rhythm, time pressure, limits to memory, and properties of human vigilance.

Decrease multiple entries of data because duplication increases the risk for errors.