Patient Safety Checklists Now Law in NV

Checklists have been touted as a method of elevating quality of care in hospitals for years. Yet, the medical community does not fully embrace them. Even Atul Gawande, MD, who literally wrote a manifesto on the subject has said, "There's a set of values in the idea of a checklist, and they're in distinct conflict with some of the values we have in medicine."

Nevertheless, the Patient Protection Checklist bill, which requires Nevada hospitals and other medical facilities to develop state-mandated patient safety checklists, was signed into law on Wednesday.

AB 280, sponsored by Assembly Speaker John Oceguera, faced little opposition in either the Senate or Assembly and was signed into law by Gov. Brian Sandoval.

Existing law requires hospital and medical facilities to adopt safety plans and establish patient safety committees to oversee anything related to the health and safety of patients. The new law takes safety a step further by requiring the patient safety committee create and adopt patient safety checklists to improve patient health outcomes.

The Patient Protection Checklist law also requires the patient safety committee to review the checklists each year, revise them if necessary, and to provide an annual report to the legislative committee on healthcare detailing how the checklists were developed and used. Administrative sanctions may be imposed if the bill is not followed.

The law does provide medical facilities with some leeway in creating the safety lists. It requires only that patient safety checklists "be appropriate for the type of treatment provided at the medical facility," and "be designed to ensure that the providers of health care follow a recognized protocol to improve the health outcomes of patients."

• Establish a protocol for identifying a patient and to making sure the patient is receiving the correct treatment, including requiring healthcare providers to positively identify a patient each time they interact with the patient.
• Ensure that each healthcare provider adheres to the universal precautions protocol, including personal hygiene.

Despite making more work for hospital and medical facilities, AB 280 had the support of the Nevada Hospital Association. In an e-mail to HealthLeaders, an NHA representative said that the support reflected NHA's commitment to the "highest standards of care to our patients."

A representative for the SEIU, which represents healthcare and public service employees in the state, was unfamiliar with the bill.

Checklists have gained stature in the medical community not only through the work of Gawande, but also through the efforts of Peter Pronovost, MD, who developed a five-step checklist that nearly eliminated intensive care unit bloodstream infections at Johns Hopkins. Provonost has since warned of checklist overload.

Gawande on Checklists: Why Don't Hospitals Use Them?
Peter Pronovost: Slashing Infection Rates