6303 Do pre-procedure checklists reduce risk and error during emergency procedures in a tertiary NICU?

Objectives We use a pre-procedure checklist in our local Neonatal intensive care unit as a pre-procedure checklist, similar to a theatre WHO checklist. In the 2010 report by Patient Safety First, the majority of hospitals reported improved safety and teamwork as a result of the WHO theatre checklist.¹ However, there is still some challenge faced in terms of negative attitudes towards these safety tools, and lack of engagement.² Our checklists are known locally as 'STEPP cards'. Other trusts may have similar tools. STEPP stands for Situation checks, Think – problems, Equipment checks, Prepare, Proceed. Their purpose is to standardise high risk processes, ensure equipment is prepared, improve situational awareness and to focus the team. I was interested to find whether we could quantify the impact of this human factors tool in our NICU environment. Methods We carried out an audit about Human Factors on the neonatal unit and using STEPP cards prior to intubation to minimise errors. I first surveyed staff attitudes towards STEPP cards to identify who uses them and why they might be useful. I then audited the use of STEPP cards prior to all intubations on the neonatal unit through January and February 2023. I audited whether STEPP cards were used, and whether they identified any missing equipment or preparatory steps. In the cases where they weren't used, I interviewed the people involved to determine if they could have prevented any misses. Results There were 11 intubations over a 2 month period. STEPP cards stopped us missing on average 3 elements of preparation in non-emergency intubations, and 5 in emergencies. They were less likely to be used in an emergency. People found STEPP cards useful as a tool to aid teamwork and also as a training tool. Conclusion Although this was a small QI project, it showed STEPP cards do quantifiably prevent us missing important parts of preparing for procedures; most commonly checking equipment and ensuring other emergencies are covered. This is more significant in an emergency where STEPP cards are used less often. Based on these findings, I have created an emergency STEPP card so when we intubate in theatre or in an emergency, we still ensure it is safe without delaying patient care. This project could have far wider implications, and supports the use of STEPP cards before procedures. We could expand their use across the trust, and also use them for other complex or invasive procedures. References Walker, et al. British Journal of Anaesthesia 2012. National Patient Safety Agency. The Campaign Review 2011.