I read an article this week that talked about a program which was successful in reducing central line associated blood stream infections and one of the researchers compared steps related to their findings to flossing your teeth.
The analogy seems odd but after I thought about it, it made perfect sense. Here’s how the study worked. Clinicians leading the study provided home care nurses and families additional training in hand hygiene, tube changing and the use of needles, gloves, masks and dressings. Teams held regular meetings, webinars, and learning sessions to discuss quality improvement practices and to identify lessons learned from every infection.
Families also received education on central line safety, were asked to monitor provider compliance and regularly were asked to demonstrate their own abilities to care for their child’s central line.
The information provided to families and care givers were common sense and easy to implement but maintaining those practices seemed to be the hard part. It’s the same thing when people floss when they’re about to go to the dentist. If flossing is important the week before your visit to the dentist isn’t it important the other 5 months and 2 weeks in between?
The conclusion of the study was systems need to be created to help people remember to do the right thing every time in every setting. One way to achieve consistent practices is with a checklist. I’m a pilot and one of the first things you learn as a pilot is to use a check list to verify the flight worthiness of your aircraft prior to take off. The check list reminds you to check things as basic as the amount of fuel in the tank. A pilot with 25 years of experience is more likely to run out of fuel mid-flight than a pilot with less than 5 years of experience and that’s because “seasoned” pilots grow more trusting of their skills and they are less likely to use their checklist prior to take off.
Have you ever returned home and realized you forgot to close your garage door? Would that happen if you used a check list that said “Close garage door prior to leaving driveway”? I doubt it, and wouldn’t a checklist be even more useful when it could result in saving the life of a patient?