The effect of a simple checklist on frequent pre‐induction deficiencies

Abstract

BACKGROUND: A substantial proportion of anaesthesia-related adverse events are preventable by identification and correction of errors in planning, communication, fatigue, stress, and equipment. The aim of this study was to develop and implement a pre-induction checklist in order to identify and solve problems before induction of anaesthesia. METHODS: The checklist was developed in a stepwise manner using a modified Delphi technique, literature search, expert's opinion, and a pilot version, and then implemented in a clinical environment during a 13-week study period. Each list was registered and analysed using statistical process control. The checklist was mandatory, but emergency cases were excluded. RESULTS: The checklist, containing 26 items, was used in 502 (61%) of a total of 829 inductions. Eighty-five checklists (17%) identified one or more missing items. The number of missing items decreased significantly throughout the study period. The most important missing items were lack of a second laryngoscope available, introducer not having been fitted to the endotracheal tube, the endotracheal tube cuff not having been tested, and no separate ventilation bag being available. It took a median of 88.5 s (range 52-118) to perform the checklist when no items were missing. The pre-induction time was the same before and after the checklist was introduced (25.1 vs. 24.3 min, P50.25). CONCLUSIONS: It is possible to develop, introduce, and use a pre-induction checklist even in a hectic and stressful clinical environment. The checklist identified and reduced a surprisingly large number of missing items required in a standard induction protocol.