Could checklists reduce harm?

January 01, 2015

Recently, I analyzed a series of 60 cases (2009-2012) from 22 states that I have been asked to review. Thirty-eight of these resulted in death and 14 resulted in serious disability. Only eight had no discernable serious harm. Here are some remarkable findings. In 49 of the 60 cases, the patient’s history or behavior was either ignored or disbelieved. Some of these cases demonstrated ineptitude and others demonstrated outright cynicism. Five patients were punished for their mental illness by custody staff, with either prolonged restraint or Taser. About half the cases had nurses practicing well beyond the scope of their licenses. As to diagnoses, the most common were alcohol or benzodiazepine withdrawal (9), MRSA sepsis (6), GI bleed (5), and hunger strike/dehydration (4). Poor training and subsequent poor judgment by correctional health professionals can cause harm, leading to death or substantial disability for our patients. Upon reflection, I wonder if the industry could move toward developing a simple tool to reduce iatrogenic harm to prisoners. The secondary gain will be less litigation cost. Can we work together on this? I suggest we develop a checklist for training and clinical use that addresses errors of omission and commission, similar to those used increasingly in medical care.[1], [2] There is ample evidence that checklists can save lives. The content of the checklist should be a synthesis of evidence-based best practices and expert panel recommendations, consistent with institutional policies and procedures. The elements should be logical and simple to use.