|The Power of Checklists: An Interview with Bob Moser, R.Ph.||| Print ||
A recent conversation with Bob Moser, R.Ph., supervisor of pharmacy clinical systems for Winston Salem Healthcare Pharmacy, brought up the topic of checklists and their potential to improve pharmacy operations. The topic came to Moser's attention from several sources, including reading airline captain Chesley Sullenberger's book "Highest Duty: My Search for What Really Matters." In this interview, ComputerTalk senior editor Will Lockwood talks with Moser to find out more about how he sees checklists applying to pharmacy.
CT: Bob, tell us exactly what do you mean when you talk about a checklist?
Moser: Pharmacy workflow is a sort of checklist in its self. I am specifically referring to the quality assurance or pharmacist verification check in the workflow. I have seen a system in a major retailer that has check boxes off to the side of the verification screen. The information confirmed using these check boxes includes:
In the verification process at this major retailer, the system does not allow the pharmacist to pass the prescription unless the pharmacist acknowledges that he or she had checked all of these boxes.
The Symphony workflow from Innovation, which we use at Winston Salem Healthcare Pharmacy, does allow something similar to this. It allows the pharmacist to place check marks on the prescription image to indicate that these have been checked. It is not a requirement in Symphony. This is not a standard of practice at this time, but we are giving it consideration. We are using other systems that do not have this functionality and therefore, cannot apply this method of checking prescriptions to those systems.
CT: What got you interested in this concept?
Moser: A couple of different things. First, the med safety committee at Forsyth Medical Center, of which our pharmacy is a department, has talked about how checklists may apply across our health system. Then, I also came across the concept in "Highest Priority," in which captain Sullenberger talks about how the healthcare industry can take lessons from the airline industry with safety checklists. And finally, a colleague forwarded the link to an article that appeared on the Web site medpagetoday.com called "Cockpit Safety Checklists Take Off in Hospital" (www.medpagetoday.com/HospitalBasedMedicine/WorkForce/17628 ).
CT: Where are the places that pharmacists can use checklists to best effect now and what are some of the tools that let them do it?
Moser: One important place to
use checklists is at quality assurance or verification as I described
earlier. If pharmacists don't have this feature in their software, then
they can simply pick up a pen and put checks on the hard copy as they
check a prescription. In a sense, they are following a list of details
to be checked and acknowledging that these have been checked with their
pen marks. This is a checklist.
CT: Thanks, Bob. This sounds like a simple technique to help pharmacy staff focus on getting critical details right and a way to create accountability that necessary steps have been taken.
Editor's Note: Another resource describing the impact checklists can have in a clinical setting can be found in the December 10, 2007 New Yorker article "The Checklist: If something so simple can transform intensive care, what else can it do?" by Atul Gawande (www.newyorker.com/reporting/2007/12/10/071210fa_fact_gawande ).