Checklist

How many people does it take to perform a gastroscopy?

As an on-call endoscopist, I often settle with the assistance of one student nurse. With luck, I may have a house officer too. So the answer is – two or three.

“How wrong you are,” sneered AJ.

That was a trick question. We cannot perform endoscopy without a patient. The answer should be four.

Seeing I was hopeless, LL enlightened me on this subject.

As part of the hospital accreditation exercise (I didn’t know this term either but was too ashamed to ask), every team had to prepare checklists for different procedures to improve safety. Since I was too dumb to be involved, I had never seen this kind of things. Anyway, according to LL, before a staff took blood from a patient, he or she was expected to fill in a form like this:

Blood taking checklist (Version 27.3, last updated at 16:17, 17 Nov 2010)
This checklist is the latest version. (Y/N)
I have completed training in blood taking. (Y/N)
I have brought a tourniquet. (Y/N)
The name and ID on the request form match those of the patient. (Y/N)
The scanner is in good function. (Y/N)
The label printer is in good function. (Y/N)
Scan the barcode on the request form. (Y/N)
Scan the barcode on the wrist band of the patient. (Y/N)
Print the labels. (Y/N)
The name and ID on the labels match those of the patient. (Y/N)
Check the expiry date of the needle. (Y/N)
Check the expiry dates of the specimen tubes. (Y/N)
Check the name and ID on the labels again. (Y/N)
Stick the labels on the specimen tubes. (Y/N)
Put on the tourniquet. (Y/N)
Draw blood. (Y/N)
Release the tourniquet. (Y/N)
Pull the needle out. (Y/N)
Cover the puncture site with a piece of gauze. (Y/N)
Discard the needle in the sharp box. (Y/N)
Put the request form in a designated box for proper disposal. (Y/N)
Put the specimen tubes in a designated specimen box. (Y/N)
Check for leftover needles and tourniquets at the bedside. (Y/N)
Put this checklist in the patient’s folder. (Y/N)
Fax a copy of this checklist to Room XXX. (Y/N)

“Very well,” said LL, “this is just a simple form for a simple procedure. Our job, however, is to develop a checklist for endoscopic procedures. We have to prepare for all expected and unexpected circumstances that may happen to an endoscopist and the team.”

I was wondering how they might foresee unexpected circumstances, but was interrupted by AJ.

“After the first meeting, we have not even gone beyond step three. The trouble was one of the committee members immediately smelled danger in the item ‘The endoscope is in good function’”.

“I don’t get it,” I was puzzled. “We always check our instruments. The item is quite reasonable.”

“The colleague said none of us were engineers. We were not qualified to certify that the endoscope was in good order. If we signed the checklist and complications occurred because of mechanical failure, we would be held responsible.”

“Hearing this, the nursing officer immediately declared the nurses would not sign the checklist either,” added LL. “And so the meeting went on and on for three hours.”

KL always says the only way to avoid trouble is by not doing anything.

But if we do not do anything, what are we doing here?

“We will hold another meeting,” concluded AJ and LL.