Standardisation and the use of checklists
Standardisation supports workers in undertaking often difficult tasks by reducing the attentional demands normally required to achieve these, freeing up cognitive resources for dealing with complex issues that can evolve in dynamic work environments. There has, however, been noticeable resistance to standardisation in healthcare, not least because efforts at standardisation may be poorly thought through, and often irrelevant to the complex, nuanced, sociotechnical systems in which healthcare professionals undertake their duties . Checklists are a form of cognitive aid which have gained widespread acceptance in safety critical industries and are becoming more prevalent in healthcare both for elective and emergency situations . There are design rules for effective checklists including standardised language and layout, and a focus on including only the key safety critical steps of a task. When used properly, checklists reduce cognitive load, protect against forgetfulness, and minimise omission of key steps.
Standardisation of key procedures in OxCRF and by the COV-CHIM study team was evident during the study period, as was the use of checklists, both those designed and approved in advance and those generated in response to perceived deficiencies. Despite face validity these processes were evidently suboptimal, with improvements in design being required in advance of study delivery and to deal with arising issues during study conduct. The Association of Anaesthetists in the UK has designed a Quick Reference Handbook (QRH) to support improved safety in anaesthetic practice which adheres to these design principles (see Appendices 3 and 4). These principles will now be used to support the development of a QRH for safety critical tasks and emergency situations (such as anaphylaxis) in this trial and others conducted in the OxCRF, an approach that may be mirrored in other units.