![]() ![]() More focused on pre-surgical issues, the WHO’s recommendation to “modify and revise” is advantageous when constructing a LETO checklist. With 19 items, it is both thorough and efficient. The WHO’s original surgical safety checklist is an excellent template. Hand washing was at the top of our list because it is the standard way to begin a sterile procedure-and we knew we needed a reminder if we were to achieve our goal of 100% compliance in this regard. For example, we make note of the platelet count and pre-procedure blood pressure as well as asking about the use of anticoagulants and concerns regarding fetal heart tones. Items unique to laboring patients and placement of an epidural were then added. Our LETO checklist was created by including items that are universal to pre-procedure checklists, such as identification of the patient, verification of their allergies, confirmation of a completed consent, and availability of emergency equipment (including resuscitation drugs). Soon after we started using the LETO checklist, its usefulness was demonstrated when a latex allergy was noted as a team member was donning latex gloves. Their obvious importance and high “hit-ratios” do not indicate that other items are less valuable. In our review of the use of the LETO checklist, hand washing was the most common item to be prompted by the checklist followed closely by completion of the consent for epidural. This is shown to occur as often as 48% of the time, 3 which is consistent with our observations in the use of the LETO checklist. One measure of the utility of a checklist is determined by the frequency with which a patient’s care plan is modified as the checklist is completed. 2 Conducting a randomized controlled study to unequivocally prove this point would not be pragmatic since omission of the safety checklist for half of all subjects would be required. checklists appear to be associated with” a reduction in the risk of major complications. A recent meta-analysis of cohort studies utilizing safety checklists for surgery noted that, “. 1 Various communications tools that require minimal monetary resources to implement and little time to perform on a daily basis include the “Huddle,” “Time Out,” or “Pause for Cause.” These tools enhance communication among all team members and have been shown in various settings to improve patient outcomes. Year after year, the Joint Commission reports errors in team communication as a significant cause of sentinel events. Example of the labor epidural time out checklist. ![]()
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