Bowie Paul, Ferguson Julie, MacLeod Marion, Kennedy Susan, de Wet Carl, McNab Duncan, Kelly Moya, McKay John, Atkinson Sarah
Department of Postgraduate GP Education, NHS Education for Scotland, Glasgow, and honorary senior lecturer, Department of General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow.
Department of Postgraduate GP Education, NHS Education for Scotland, Glasgow.
Br J Gen Pract. 2015 May;65(634):e330-43. doi: 10.3399/bjgp15X684865.
The use of checklists to minimise errors is well established in high reliability, safety-critical industries. In health care there is growing interest in checklists to standardise checking processes and ensure task completion, and so provide further systemic defences against error and patient harm. However, in UK general practice there is limited experience of safety checklist use.
To identify workplace hazards that impact on safety, health and wellbeing, and performance, and codesign a standardised checklist process.
Application of mixed methods to identify system hazards in Scottish general practices and develop a safety checklist based on human factors design principles.
A multiprofessional 'expert' group (n = 7) and experienced front-line GPs, nurses, and practice managers (n = 18) identified system hazards and developed and validated a preliminary checklist using a combination of literature review, documentation review, consensus building workshops using a mini-Delphi process, and completion of content validity index exercise.
A prototype safety checklist was developed and validated consisting of six safety domains (for example, medicines management), 22 sub-categories (for example, emergency drug supplies) and 78 related items (for example, stock balancing, secure drug storage, and cold chain temperature recording).
Hazards in the general practice work system were prioritised that can potentially impact on the safety, health and wellbeing of patients, GP team members, and practice performance, and a necessary safety checklist prototype was designed. However, checklist efficacy in improving safety processes and outcomes is dependent on user commitment, and support from leaders and promotional champions. Although further usability development and testing is necessary, the concept should be of interest in the UK and internationally.
在高可靠性、安全关键型行业中，使用检查表以尽量减少错误已得到充分确立。在医疗保健领域，人们对检查表的兴趣与日俱增，希望通过检查表使检查流程标准化并确保任务完成，从而进一步提供系统性的防错和防患者伤害措施。然而，在英国的全科医疗中，使用安全检查表的经验有限。
识别影响安全、健康、福祉及绩效的工作场所危害，并共同设计一个标准化的检查表流程。
应用混合方法识别苏格兰全科医疗中的系统危害，并基于人因设计原则制定安全检查表。
一个多专业的“专家”小组（n = 7）以及经验丰富的一线全科医生、护士和诊所管理人员（n = 18）识别系统危害，并通过文献综述、文档审查、使用小型德尔菲法的共识构建研讨会以及内容效度指数练习的完成情况，开发并验证了一份初步检查表。
开发并验证了一个安全检查表原型，它由六个安全领域（例如药品管理）、22个子类别（例如急救药品供应）和78个相关项目（例如库存平衡、药品安全储存和冷链温度记录）组成。
确定了全科医疗工作系统中可能对患者、全科医生团队成员的安全、健康和福祉以及诊所绩效产生潜在影响的危害，并设计了一个必要的安全检查表原型。然而，检查表在改善安全流程和结果方面的效果取决于用户的承诺以及领导者和推广倡导者的支持。尽管还需要进一步进行可用性开发和测试，但该概念在英国及国际上应该会受到关注。
