Patient Pre-Procedure Checklist

Patient Pre-Procedure Checklist

Christie Ellison

Southern New Hampshire University

Table of Contents

Introduction……………………………………………………………………………….. 3

Justification for Change…………………………………………………………………… 3

Change Theory……………………………………………………………………………. 4

Pre-Implementation Plan………………………………………………………………….. 5

Patient and Nurse Safety………………………………………………………………….. 5

Technology………………………………………………………………………………... 6

Health Literacy……………………………………………………………………………. 6

Administrative Policies…………………………………………………………………… 7

Equity……………………………………………………………………………………... 8

Implementation Plan……………………………………………………………………… 8

Technological Considerations…………………………………………………………….. 8

Institutional Structures…………………………………………………………………….. 9

Financial Trends…………………………………………………………………………… 9

Hospital Policy Constraints……………………………………………………………….. 10

Regulatory Requirements…………………………………………………………………. 10

Patient Diversity……………………………………………………………………………11

Stakeholder Buy-In………………………………………………………………………... 11

Evaluation Plan……………………………………………………………………………. 12

Nurse Satisfaction…………………………………………………………………………. 13

Patient Satisfaction and Feedback………………………………………………………… 13

Checklist Documentation Auditing……………………………………………………….. 14

Time Line and Resource Allocation………………………………………………………  15

Conclusion………………………………………………………………………………… 16

Table 1-Project Time Line………………………………………………………………… 17

My Philosophy of Nursing…………………………………………………………………18-22

References………………………………………………………………………………… 23-24

Patient Pre-Procedure Checklist

        The purpose of this Capstone Project is to propose a change with the surgical screening of

patients set to undergo endoscopic procedures.  This change proposal is for the use of a

checklist tool in order to eliminate postponement and cancellation of procedures due to patients

who show up for their procedures un-prepped, without having discontinued the use of

anticoagulants, or having had something to eat or drink in a lesser amount of time then deemed

safe by anesthesia.  Currently, there is not a plan in place to screen patients prior to their

procedure as to their understanding of the directions for procedures.  With no plan for screening

patients in place, one out of seven patients experiences a delay or cancellation due to controllable

information that had not been communicated prior to procedures costing patients time, money,

and satisfaction levels to decrease.  By implementing a pre-procedure checklist to communicate

information to patients once they are scheduled, a few simple questions on the pre-surgical

phone call could eliminate these issues altogether. This would be clinically significant to the

nursing practice in the respect that education is a huge component of patient care, and by

implementing a pre-procedure checklist it would be pro-active in ensuring our patients are safely

prepped according to the American Society of Gastrointestinal Endoscopy (ASGE) guidelines,

hospital anesthesia guidelines, and current anti-coagulant policies for endoscopic procedures.

This implementation will eliminate cancellations and delays, increase patient satisfaction, as well

as the satisfaction of staff and providers.  

Justification of the Need for Change

        One in seven endoscopy patients that show up for procedures unprepared or in need of

further medical clearance also have a high reluctancy to come back after experiencing a less than

satisfying attempt.  The need for clarified preparation instructions, anti-coagulation therapy

instructions, and that the patient is not to have anything by mouth (NPO) for a minimum of eight

hours prior to procedure, should be reviewed with the patient in a checklist format to reduce the

chances of procedure complications and/or cancellation and is key in ensuring an effective

procedure and why there is a need for a change theory.      

        Delays in having diagnostic procedures with symptoms that are indicative of

colon or esophageal cancer, such as bleeding, lead to higher mortality rates.  In instances where

these symptoms are caught earlier, they could’ve easily been treated or even prevented

altogether.  “An inadequate bowel prep dooms even the most skilled endoscopist and the best

equipment” (Mishra, 2014).  Bowel prep challenges account for nearly 85% of procedure

cancellations.

Change Theory

        An organizational change is something instituted system wide for the betterment of patient

care.  The change plan proposal is that of a pre-procedure checklist to ensure during

the pre-operative phone call the patient is screened for any health issues that would interfere with

their test, time they are set to come in, and any clarification of the preparation that is needed.  To

institute this change, a checklist would be created showcasing questions pertaining to

preparation, a list of medications that would alter coagulation times and the bloodwork they

would need to have prior to procedure if the patient is on one of them, and also a check-off in

verifying time of arrival and last time solids/drinks are consumable prior to coming in.  The

motivating forces behind this is the need to clarify ahead of procedure if patients are on

something they need clearance to stop or be on substitute medicines for.  Unfortunately

restraining forces, such as corporate opposition to implement any changes without documented

proof, mean time periods of trial before system-wide initiation can begin.  The leveraging forces

allow for the proof of the need for the checklist to be presented to administration once enough

data about cancellations and delays associated with the lack of one in place and to support the

use of one, justifying the need and moving for change.  

        Theorist Kurt Lewin, known as “one of the most distinguished psychologists of his day”

(Burnes, 2017), often worked towards organizational change while resolving social conflict with

a focus on participative management.  Lewin highlights three stages which employees must

embrace in order to implement a change plan successfully.  The first stage, unfreezing, discusses