Checking in healthcare safety: theoretical basis and practical application

Healthcare includes important processes such as checking to reduce errors. Checking is a prescribed part of many patient care activities with many checks being performed during one hospital admission. Some may be standard but unwritten practices, whereas others are laid down in official guidance. Errors in the bedside checking procedure are the commonest cause of mis-transfusion, so more thorough checking could prevent adverse events. This paper aims to explore and enhance understanding regarding healthcare checking procedures. In doing so it seeks to identify a further research agenda.

The computerised databases CINAHL, PsycLIT, EMBASE, PubMed, PsycINFO and MEDLINE were searched using specific indexing terms and free text including "bedside, peri-operative safety, theatre checking and checklists". Only English publications were included.

Like any human activity, checking is part of personality and behaviour. There are several psychological factors relevant to patient safety, including: memory, prospective memory, automaticity and responsibility. All are relevant to healthcare.

Bandolier criteria have not explicitly been used within this review but have been met. It would be beneficial for future reviews to explicitly state how Bandolier criteria are met. This would possibly enhance the publications' scientific quality.

There is much to learn regarding interacting factors that influence healthcare checking procedures and ultimately checking performance. The authors recommend that relationships between checking and personality should be explored. Furthermore, exploring how healthcare "mindfulness" might be promoted and what reminder/checking strategies healthcare staff already use in their day-to-day work routines should be examined.

Several psychological factors involved in checking and its relevance to healthcare and patient safety are identified. Additionally, recommendations for further research are indicated.