Medical Physics Practice Guideline 4.a: Development, implementation, use and maintenance of safety checklists

Abstract

The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States.The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner.Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized.The following terms are used in the AAPM practice guidelines:Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

Figure 1

Diagram of end‐to‐end checklist development, implementation, and maintenance process.

Figure 2

Visual comparison between a poor and an improved checklist (with permission from Dr. McLaughlin and AHRQ WebM&M: http://www.webmm.ahrq.gov/perspective.aspx?perspectiveID=92)

Figure B.1

The Checklist for Checklists was created by Dr. Atul Gawande, the Brigham and Women's Hospital Center for Surgery and Public Health Dissemination Team, and Dan Boorman of Boeing. The goal of this checklist is to aid the checklist creation process. A pdf copy of this checklist can be found on: http://www.projectcheck.org/checklist‐for‐checklists.html_ (with permission from Dr. Atul Gawande and the Safe Surgery 2015 group at Harvard School of Public Health).

Figure B.2

This is an example of a smart checklist tool for the treatment planning process. This tool was developed by James G. Mechalakos, PhD., Sean Berry, PhD, and the group at Memorial Sloan‐Kettering Cancer Center. Based on the plan demographic information and specific treatment procedure, the smart checklist tool automatically generates a custom‐built checklist. This has the benefit of avoiding items that are unrelated to the current plan, so the checklist is shorter. The tool incorporates certain forcing functions such as entering “Covering Planner”, which is a required field for the checklist to be printed. (Courtesy of James G. Mechalakos, PhD.)

Figure B.3

Example of checklist for High‐Dose‐Rate (HDR) Breast Brachytherapy Record proposed by the American Brachytherapy Society (Courtesy of Bruce Thomadsen and Zoubir Ouhib).

Figure B.4

(a) Example of a checklist used as part of the physics weekly chart check process from the University of Washington (Courtesy of Eric C. Ford, PhD). (b) Example of a checklist used as part of the physics weekly chart check process from Yale University Cancer Center (Courtesy of Suzanne Evans, MD). Conceptually Figs. B.4(a) and (b) are achieving the same goal; nevertheless the specific elements and organization of the checklist items will depend on the clinical setting, workflow, and needs of each practice. These examples emphasize the fact that each practice needs to go through its own implementation and validation process to make sure that a checklist would meet its needs.

Figure B.5

Developed by the WHO and collaborators at Ariadne Labs (http://www.ariadnelabs.org), this checklist identifies key safety steps during perioperative care that should be accomplished during every single operation no matter the setting or type of surgery. More information and details of this checklist can be found on: http://www.safesurg.org.

Figure B.6

This checklist is one of the 12 checklists developed by the team at Ariadne Labs (http://www.ariadnelabs.org) with the goal of improving care during the most common operating room crises. This checklist shows the differences in layout and approach when developing and using checklists for emergency or crisis situations. For more information on this project follow this link: http://www.projectcheck.org/crisis.html. (With permission from Dr. Atul Gawande and the Safe Surgery 2015 group at Harvard School of Public Health).

Figure B.7

Pre‐MRI procedure medical physicist checklist. This is an example of a checklist used in diagnostic imaging. This checklist was developed by Anshuman Panda, PhD and Judy R. James, PhD from the Diagnostic Radiology group at Mayo Clinic Arizona. The goal of the checklist is to manage patients with pacemaker devices that will have an MRI procedure. (Courtesy of Anshuman Panda, PhD)