About the
ChELO Project

The Checklist for Ethical and Legal Obligations (ChELO) is an initiative to ensure decision-making is patient-centred, and supports healthcare professionals to meet ethical and legal obligations to patients at end-of-life.

About the
ChELO Project

The Checklist for Ethical and Legal Obligations (ChELO) is an initiative to ensure decision-making is patient-centred, and supports healthcare professionals to meet ethical and legal obligations to patients at end-of-life.

The collaboration of patients, substitute decision makers and frontline healthcare professionals is essential to achieving positive ChELO outcomes.

For families, ChELO shifts attention away from technology and back to the person they care so much about.

 

For nurses and physicians, it protects against errors in consent and helps you to be a patient advocate.

 

For William Osler Health System, across Ontario, and around the world, we believe it is the easiest way to ensure ‘the right care for the right patient.’

Why Use A Checklist?

Despite improvements in communication, errors in consent and end-of-life care continue to be made.

For example, healthcare professionals may:

  • take direction from the wrong substitute decision maker, or from family members when the patient is capable;
  • permit families to propose treatment plans;
  • conflate values and beliefs with prior expressed wishes; or
  • fail to inquire about prior expressed wishes.

Sometimes healthcare professionals know what prior expressed wishes are but do not respect them; others do not believe they have enough time to have an end-of-life discussion or lack the confidence, willingness and skills to manage one.

As has been show in initiatives to improve surgical safety, the use of a checklist presents opportunities to potentially minimize common mistakes and errors.

When engaging in end-of-life care, a checklist can help focus on what needs to be communicated, rather than how it needs to be communicated.

Using a checklist in clinical care:
  • Minimizes common errors during end of life care
  • Ensures patient-centred decision-making by respecting their values, wishes and beliefs
  • Strengthens professional integrity and clinical judgment
  • Ensures that the treatment team meets ethical and legal obligations to patients
  • Reduces stress/conflict related to moral and ethical decision-making

ChELO Materials

The checklist documents:

  • the patient’s incapacity;
  • the legally correct substitute decision maker;
  • the patient’s prior wishes regarding end-of-life care; and
  • the patient’s values and beliefs, including religious commitments.

Additionally, the supporting Values Information Sheet is a short questionnaire completed by patients and/or their families to help the patient’s healthcare team learn about the patient as a person.

The Values Information Sheet captures information such as the patient’s preferred name, home language, happiest moments, coping strategies, dreams, goals, fears, activities, and more.

ChELO Project Development

The Idea

  • “Checklist to meet ethical and legal obligations to critically ill patients at the end of life” published in Healthcare Quarterly. (Sibbald RW, Chidwick P, Handelman M, Cooper AB, 2011;14(4):60-6).
  • “Creating and Measuring change in ICU Consent Process: ChELO (Checklist to Meet Ethical and Legal Oblications)” presented at the Critical Care Canada Forum in Toronto, ON

Testing the Idea

  • In October 2012, a poster –  “ChELO iPhone APP to meet Ethical & Legal Obligations in Critical Care at End-of-life” – was presented at the Canadian Critical Care Forum in Toronto, ON.

Sustaining the Idea

  • Recipient of the Best Quality Improvement Initiative Innovation and 3rd place Winner ChELO iPhone APP to meet Ethical & Legal Obligations in Critical Care at End-of-life at the Patient Safety and Quality Improvement Poster Challenge/Expo.

Spreading the Idea

  • Invited to present ChELO Checklist to The Osgoode Certificate in Clinical Risk, Negligence, & Claims Management in Health Care.
  • ChELO published in Critical Care Access and Consent Toolkit for Critical Care Services Ontario.

Testing the Idea

  • Recipient of CMPA Grant for Reducing Ethical and Legal Errors to Improve Patient Safety in Critically Ill Patients Who Lack Decision Making Capacity

Publishing the Idea (Again)

Spread & Scale

  • Launch of ChELO Project standardized tools, Playbook and website

ChELO Project Team

Dr. Paula Chidwick

Dr. Paula Chidwick is the Director, Clinical & Corporate Ethics at William Osler Health System. She was the first full-time Ethicist to be hired at a community hospital. She has a Ph.D. in Philosophy specializing in Bioethics from the University of Guelph and a Fellowship in Clinical Ethics from the University of Toronto Joint Centre for Bioethics.

Paula provides ethics services to health care organizations throughout Ontario. She publishes and lectures widely on a variety of topics including end-of-life, advanced care planning, and diversity considerations in health care and ethical decision-making.

She has served on the Canadian Bioethics Society Executive, Health Canada’s Scientific and Expert Advisory Panels, and for MOHLTC Critical Care Coaching Teams. She is currently a Subject Matter Expert for Critical Care Services Ontario and a founding member of the Clinical Ethics Summer Institute (CESI).

Dr. Andrew Cooper

Dr. Andrew Cooper practices Critical Care Medicine, Anesthesiology and Bioethics at William Osler Health System where he has an active staff appointment. He has the academic rank of Assistant Professor in the University of Toronto Faculty of Medicine, Department of Anesthesiology.

Dr. Cooper’s recent publications address resource allocation in critical care medicine and quality improvement strategies for the reliable determination of best interest in seriously ill patients.

Dr. Cooper is a clinician with 25 years of experience in general practice, anesthesiology and critical care medicine.