Mec Tech

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Mec Tech

MEC Tech AMAT 8330 Flame Spray Tray and Top Part Kit MEC Tech AMAT 8330 Flame Spray Tray and Top Part Kit Paypal US $851.10 29d 21h 6m
MEC Tech AMAT Replacement Parts Kit MEC Tech AMAT Replacement Parts Kit Paypal US $1,537.26 29d 21h 5m
MEC TECH INC MEC300008-1043R LOAD ASSEMBLY AMAT APPLIED MEC TECH INC MEC300008-1043R LOAD ASSEMBLY AMAT APPLIED Paypal US $449.99 29d 17h 26m
Production Tech MEC-082605-1-10 Cable NEW-NO BOX Production Tech MEC-082605-1-10 Cable NEW-NO BOX Paypal US $39.00 26d 4h 51m
Lot of 21 MEC Tech Clip Support Spacer MEC81105-208A New Lot of 21 MEC Tech Clip Support Spacer MEC81105-208A New Paypal US $812.11 21d 21h 12m
MEC Tech Process Ring 30512-1001R new MEC Tech Process Ring 30512-1001R new Paypal US $1,007.11 17d 21h 48m
Lot of 3 M.E.C. Tech MEC83305-1088L Focus Ring Rev.A New Lot of 3 M.E.C. Tech MEC83305-1088L Focus Ring Rev.A New Paypal US $56.05 14d 23h 58m
Lot of 6 M.E.C. Tech Extended Inner Overlay Rev.A MEC81155-201A new 0020-01044 Lot of 6 M.E.C. Tech Extended Inner Overlay Rev.A MEC81155-201A new 0020-01044 Paypal US $312.11 14d 22h 41m
NEW MEC TECH MEC86008-1051 FOCUS RING, SI, 200MM, 3.8MM NEW MEC TECH MEC86008-1051 FOCUS RING, SI, 200MM, 3.8MM Paypal US $99.99 13d 21h 28m
Lot of 4 M.E.C. Tech MEC83305-1088L Focus Ring Rev.A new Lot of 4 M.E.C. Tech MEC83305-1088L Focus Ring Rev.A new Paypal US $56.05 12d 45m
Lot of 47 MEC Tech MEC81155-204A Cap Strap EXTD New Lot of 47 MEC Tech MEC81155-204A Cap Strap EXTD New Paypal US $1,012.11 11d 19h 39m
M.E.C. TECH MEC50008-554-5 RING  LOPEC M.E.C. TECH MEC50008-554-5 RING LOPEC Paypal US $33.75 10d 23h 51m
M.E.C. Tech MEC81156-200A Extended Lower Overlay Rev.A 0020-01060 new M.E.C. Tech MEC81156-200A Extended Lower Overlay Rev.A 0020-01060 new Paypal US $31.06 10d 17h 7m
M.E.C. Tech MEC81155-202A Extended Lower Overlay Rev.A 0020-01043 new M.E.C. Tech MEC81155-202A Extended Lower Overlay Rev.A 0020-01043 new Paypal US $31.06 10d 16h 48m
Lot of 84 M.E.C. Tech Focus Ring MEC83305-1010A Rev.A new Lot of 84 M.E.C. Tech Focus Ring MEC83305-1010A Rev.A new Paypal US $812.11 9d 23m
LOT, 6 NEW MEC TECH MEC81105-209L OVERLAY, TRAY SUPPORT LOT, 6 NEW MEC TECH MEC81105-209L OVERLAY, TRAY SUPPORT Paypal US $49.99 8d 21h 55m
LOT OF 3 NEW MEC TECH MEC81105-205L SPACER .26 LEXAN LOT OF 3 NEW MEC TECH MEC81105-205L SPACER .26 LEXAN Paypal US $24.99 8d 21h 54m
M.E.C. Tech Tapered Finger Oxide Clamp Ring MEC50005-534-1 Rev.A new 0020-33739 M.E.C. Tech Tapered Finger Oxide Clamp Ring MEC50005-534-1 Rev.A new 0020-33739 Paypal US $812.11 5d 26m
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Transformers: Dark of the Moon - MechTech Leader - Bumblebee Transformers: Dark of the Moon - MechTech Leader - Bumblebee
List Price: $49.99
Sale Price: $30.00

Get ready for action with this exciting vehicle-to-robot hero. Convert this mighty Bumblebee figure from Camaro Concept vehicle mode to battle-ready robot mode and back again so he's ready for anything. His light-up pop-out weapons and blaster sounds are sure to scare off his opponents. As the battle rages on, keep switching him back and forth and prepare to face whatever his enemies throw at him. The weapons work with any MechTech Transformers figure. It includes 2 AA batteries.Product Dimensions (inches): 2.8 (L) x 7.5 (W) x 12 (H)Age: 5 years and up

Transformers: Dark of the Moon - MechTech Voyager - Shockwave Transformers: Dark of the Moon - MechTech Voyager - Shockwave
List Price: $22.99
Sale Price: $16.75

Few have ever seen Shockwave and lived. His is the hand that ensures Decepticon plans remain secret from the Autobots. He eliminates evidence and witnesses with brutal, emotionless efficiency. The only hints he ever leaves of his presence are smoking craters and the collapsed tunnels through which he travels. Fasten your seatbelts for some fast-paced battles with this vehicle-to-robot villain. This sneaky Shockwave figure changes from battle-ready robot mode to ground assault vehicle mode so he can chase down his enemies or fight the fiercest foes. His battle cannon even converts to a particle wave blaster for maximum destruction. As the battle rages on, keep converting him back and forth so he's ready to face whatever his enemies throw at him. The robot villain figure converts from vehicle mode to robot and back. The Battle Weapons work with any MechTech Transformers figure.Product Dimensions (inches): 3.9 (L) x 7.9 (W) x 9.5 (H)Age: 5 years and up

Transformers: Dark of the Moon - MechTech Voyager - Megatron Transformers: Dark of the Moon - MechTech Voyager - Megatron
List Price: $22.99
Sale Price: $26.00

Megatron has lost battles, but he has never been truly defeated. Even after his near total destruction by the AllSpark, he returned. This latest loss is nothing to him. He has plans thousands of years in the making that are finally coming to fruition. This time, nothing will stop him from annihilating the Autobots completely. Spring into action with this vehicle-to-robot villain. Switch your mighty Megatron figure from robot mode to Mack Truck Mode - and switch his blaster to a fusion canon. As the battle rages on, keep converting him back and forth, so he's ready to face whatever his enemies throw at him. The weapons work with any MechTech Transformers figure. Product Dimensions (inches): 3.9 (L) x 7.9 (W) x 9.5 (H)Age: 5 years and up

Toyota Corolla 03 - 08 DIN Toyota Corolla 03 - 08 DIN
List Price: $37.99
Sale Price: $9.99

Turbokits™ from Metra...a quick and simple way to install an aftermarket radio in the original factory radio's location. Dash Kit for the 2003 Toyota Corolla 4-door Sedan Turbokits are uniquely designed to provide a combination of strength, appearance and versatility. Because Turbokits are made from ABS plastic they can be easily modified for custom jobs. The faceplates are designed to fit the dash opening perfectly with no gaps, and DIN radio ISO mounts are included in as many Turbokits as possible. A Turbokit's brackets are designed to emulate the factory radio brackets, making the installation of an aftermarket radio the fastest in the business. Note: Except for vehicle specific kits, Turbokits are designed for multiple applications and fit multiple car models perfectly. Likewise, many vehicle makes and models have multiple kit options available. Although your specific year, make or model may not be listed above, if the Metra Installation Kit Wizard directed you to this item, then this kit is designed for use with your vehicle.

Metra 95-7801 Double DIN Installation Kit for Select 1990-2004 Acura/Honda/Isuzu Vehicles Metra 95-7801 Double DIN Installation Kit for Select 1990-2004 Acura/Honda/Isuzu Vehicles
List Price: $13.99
Sale Price: $5.99

Can acmodate either a double-DIN radio or two ISO DIN stacked radios Rear support bracket is included

Metra 99-5812 Ford/Linc/Merc Multi Kit 04-UP Dash Kit Metra 99-5812 Ford/Linc/Merc Multi Kit 04-UP Dash Kit
List Price: $29.99
Sale Price: $7.85

Metra patented quick release snap-in ISO mount system with custom trim ringRecessed DIN openingHigh grade ABS plastic contoured and textured to pliment factory dash

Rioni Medley (Cream) - Large Body Hobo Rioni Medley (Cream) - Large Body Hobo
Sale Price: $152.00

This is simply the best looking hobo you will ever find! Tan designer canvas body with multi-shade of brown scramble Rioni letters, trimmed with a dark caramel brown leather. Two side magnetic clasp pouch pockets with a zipper center divider. Zipper entrance opening opens to three separate compartments. Goldenrod fabric RIONI monogram print lining. Interior zipper pocket, cell phone pouch, pouch pocket, and rear zipper pocket. Style Number:MEC-004 Dimensions:L18 x W6 x H10.5" Drop Length:9" Handle

Rioni Medley (Cream) - Shoulder Fender Rioni Medley (Cream) - Shoulder Fender
Sale Price: $116.00

This shoulder bag is both small and practical. Tan designer canvas body with multi-shade of brown scramble Rioni letters, trimmed with a dark caramel brown leather. Zipper entrance opening. Inside is divided into three separate compartments with center zipper compartment. Goldenrod fabric RIONI monogram print lining. Interior zipper pocket, cell phone pouch, pouch pocket, and rear zipper pocket. Shoulder strap is also adjustable. Style Number:MEC-003 Dimensions:L11.5 x W3 x H6.8" Drop Length:6.5"-9.5" Strap : 18"-23" Strap

God of War: Collection God of War: Collection
List Price: $29.99
Sale Price: $19.99

Two Epic Adventures of Conquest, Destiny, and Vengeance, God of War and God of War II, return for the first time on BluRay Disc! In God of War: Colleciton, players will experience the dark world of Ancient Greece through Kratos, a brutal warrior determined to murder the God of War and alter what no mortal has ever changed fate itself.

A must-have for action/adventure fans on the PlayStation 3 platform, the God of War Collection features both PlayStation 2 single player classics, God of War and God of War II. Remastered in high definition and re-released for play on the PS3 this collection allows both longtime fans of the series and those coming to it new to indulge in the addictive action and puzzle-solving fun of taking on the gods ruling the world of ancient Greek mythology. .caption { font-family: Verdana, Helvetica neue, Arial, serif; font-size: 10px; font-weight: bold; font-style: italic; } ul.indent { list-style: inside disc; text-indent: -15px; } table.callout { font-family: verdana; font-size: 11px; line-height: 1. 3em; } td.vgoverview { height: 125px; background: #9DC4D8 url(http://images.amazon.com/images/G/01/electronics/detail-page/callout-bg.png) repeat-x; border-left: 1px solid #999999; border-right: 1px solid #999999; padding-left: 20px; padding-right: 20px; padding-bottom: 10px; width: 250px; font-family: verdana; font-size: 12px; } Over-the-top God of War combat. View larger. Addictive puzzle play Kratos style. View larger. Huge baddies and boss battles. View larger. The God of War Saga Now for the PS3 The God of War series, made up of God of War and God of War II, featuring the brutal yet tortured anti-hero Kratos, engrossing storylines based in Greek mythology, over-the-top addictive action and puzzle-solving gameplay and simple controls is often referred to as one of the best, and/or most popular single player action games series ever made for PlayStation 2. The truth in this can be seen in the fact that in an era dominated by more advanced game consoles, fans of the franchise who have held on to their PS2's still revisit these two games from time to time, while gamers who missed their initial releases are tempted to give them a try, even though they have moved on to a PS3. Regardless which side of this you find yourself on the God of War Collection holds something for you. Released in advance of the highly anticipated God of War III, the first game in the series developed for the PS3 platform and rumored to also be the last overall, this collection allows players to properly prepare themselves for the final chapter in the adventures of Kratos, entirely through their PS3. The Games God of War Unleash the power of the gods and embark on a merciless quest as Kratos, an ex-Spartan warrior driven to destroy Ares, the God of War. Armed with the lethal double chainblades known as the Blades of Chaos, Kratos must carve through mythology’s darkest creatures — including Medusa, Cyclops, the Hydra and more, while solving intricate puzzles in breathtaking environments. Driven by pure revenge, nothing can stop Kratos from achieving absolution. Over time, Kratos becomes the most vicious warrior in Ancient Greece and bathed in blood to a point where he can't bare it anymore and sets out on a journey to kill Ares. However, the only way to destroy Ares is to find Pandora's Box, which is located in a temple that's perched upon a hill and guarded by traps, puzzles, enemies, etc. The story is told as a flashback of three weeks prior to where the opening movie cutscene starts and then sets the stage for the game. God of War II God of War saw Kratos, a mortal warrior, set upon an epic quest to dethrone a god. But his journey did not end there. In God of War II, Kratos, the once mortal warrior turned ruthless god, sits atop his throne on Olympus, and is a threat far worse than his predecessor Ares had ever been, striking down anyone who crosses his path, or the path of his beloved Sparta. Filled with power and rage, the "Ghost of Sparta" sets out to alter that which no mortal or god has ever changed — his fate. Facing mythical characters, all bent on preventing him from reaching his goal, Kratos' journey brings him to the very edge of the Earth. But this is Kratos, and his defiance is filled with such arrogance and contempt that all of the ancient world still trembles at his name: Kratos, The God of War. Key Game Features God of War and God of War II on one Blu-ray Disc. Remastered in high-definition at a resolution of 720p. Anti-aliased graphics for 60 frames per second gameplay. Full PlayStation Network (PSN) Trophies support for each game. Purchase includes a PSN voucher for the God of War III E3 2009 Demo.

Xbox 360 Call of Duty: Modern Warfare 3 Wireless Headset with Bluetooth Xbox 360 Call of Duty: Modern Warfare 3 Wireless Headset with Bluetooth
List Price: $69.99
Sale Price: $26.99

Xbox 360 Call of Duty: Modern Warfare 3 Wireless Headset with Bluetooth... Chat on Xbox LIVE and also use the headset with Bluetooth-enabled mobile phones PCs and other devices; Easily switch from Xbox to Bluetooth mode to answer calls; Custom Call of Duty Modern Warfare 3 artwork designed in collaboration with Infinity Ward and Sledgehammer Games; "Night vision power on/off" sounds on power up powerdown or mode switch; Features up to eight hours of talk time; Includes ear loop ear gels and charging cradle; Xbox LIVE download code for exclusive avatar item.

Gran Turismo 5 Prologue Gran Turismo 5 Prologue
List Price: $29.99
Sale Price: $15.88

The award-winning Gran Turismo franchise returns with its 5th installment, Gran Turismo 5 Prologue, exclusively for PlayStation 3. With its signature realism and unrivaled physics, this highly anticipated precursor to Gran Turismo 5 continues to blur the line between simulation and reality."Prologue" is defined as an introductory or preceding event or development, and true to every letter, Gran Turismo 5: Prologue treats both long-time fans of the Gran Turismo franchise as well as those coming to it new, with a generous sampling of what they can expect to see in Gran Turismo 5 later in the year and further releases on the PS3.The new direction of Grand TurismoTake your ride online for the first time.View larger.Race across six international tracks.View larger.Customize your ride in the garage.View larger.Developed By the BestPolyphony Digital is the developer of the Gran Turismo franchise, led by creator Kazunori Yamauchi. Polyphony Digital is known for pushing the limits of the PlayStation hardware, and with its realistic graphics and physics, Gran Turismo 5: Prologue is no different. In addition to receiving CAD data from the auto manufacturers, they have taken thousands of photos to model each car (and track). As an example of the level of detail, a car in Gran Turismo 4 has the same number of polygons as a headlight in Gran Turismo 5: Prologue. Polyphony works even closer with the automotive industry to make sure that the cars look and drive just as they do in real life. In fact, Kazunori Yamauchi designed the on-board computer for the real Nissan GT-R. If you're lucky to buy one when it releases, you will notice the Polyphony Digital logo when you start your car.Take Your Cars and Tracks Online and OffGran Turismo 5: Prologue features over 60 stunning cars - including vehicles by Lotus, Mitsubishi, Nissan and Ferrari for you to race on seriously realistic, real-life tracks: including the Eiger Nordwand, the London City Track and Suzuka - all rendered in incredible High Definition graphics. There's also all-new driving physics for the most lifelike driving experience ever and new, improved opponent artificial intelligence for the toughest race challenge yet.But that's not all - for the first time ever in the history of Gran Turismo, players will now be able to race online. Up to 16 players will be able to go head-to-head on some of the world's best racetracks on PlayStation Network. All you need to get racing is a broadband connection and PS3. Once you're up and revving, Global Online Rankings and the My Garage homepage feature will leave the world in n o doubt as to just who is the best at Gran Turismo.And then there's the Online Dealership, providing a wealth of information on cars and manufacturers and also Gran Turismo TV - a dedicated online channel available exclusively from PSN and packed with some of the greatest content that Motorsport, car manufacturers and TV has to offer. Key Features:Race over 60 cars from worldwide automotive manufacturers, precisely modeled both inside and out.All-new interior dash view, featuring full driver animation and working gauges.Compete on 6 tracks with 12 total layouts, including Fuji Speedway, Suzuka Circuit, and for the first time ever, Daytona International Speedway.Online racing with up to 16 players, complete with detailed rankings, plus downloadable ghost cars and race replays of top racers.New online community features including Gran Turismo TV, featuring worldwide automotive and motorsport programming.Tune vehicle performance, from suspension and tires to gear ratio and engine modifications.Rendered in stunning 1080p at 60 frames per second with crisp, realistic lighting and camera effects (replays rendered in 1080p 30fps).Full Car List (71 cars):Lexus IS F '07Nissan Skyline GT-R V-spec II Nur '02Nissan Fairlady Z Version S '07Nissan Skyline Sedan 350GT Type SP '06Nissan Skyline Coupe Concept '07Nissan Skyline Coupe 370GT Type SP '07Nissan Skyline Coupe (V36) Tuned CarNissan GT-R Proto '05Nissan GT-R '07Honda Integra TYPE R '04Honda NSX Type R '02Acura NSX '91Mazda Atenza Sport (2007 Tokyo Motor Show reference exhibit)Mazda RX-8 Type S '03Mazda RX-7 Spirit R Type A (FD)Mazda RX-7 (FD) Special Tuned CarSubaru Impreza WRX STI (18inch BBS Wheel Option) '07Subaru Impreza Sedan WRX STI spec C Type RA '05Mitsubishi Lancer Evolution IX GSR '05Mitsubishi Lancer Evolution X GSR Premium Package '07Mitsubishi Lancer Evolution IX GSR Tuned CarMitsubishi Lancer Evolution X GSR Tuned CarSuzuki Cappuccino '95Suzuki Swift Sport '07 Suzuki Cervo SR '07Suzuki Cappuccino Tuned CarSuzuki Swift Sport Tuned CarDaihatsu Copen Active Top '02Daihatsu OFC-1 '07Chevrolet Corvette Z06 '06Chevrolet Corvette Z06 (C6) Tuned CarDodge Viper GTS '02Dodge Viper SRT10 Coupe '06Dodge Viper SRT10 Coupe Tuned CarFord Mustang V8 GT Coupe Premium '07Ford GT '05Ford Focus ST '06Ford GT Tuned CarAudi R8 4.2 FSI R tronic '07Audi TT Coupe 3.2 quattro '07BMW Z4 '03BMW 135i Coupe '07BMW M3 Coupe '07BMW 135tii '08Mini Cooper-S '06Mercedes-Benz SL 55 AMG '02Volkswagen Golf GTI '01Volkswagen Golf V GTI '05Alfa Romeo 147 TI 2.0 TWIN SPARK '06Alfa Romeo Brera Sky Window 3.2 JTS Q4 '06Ferrari 599 '06Ferrari F430 '06Ferrari 512BB '76Ferrari F40 '92Lancia Delta HF Integrale Evoluzione '91Citroen C4 Coupe 2.0VTS '06Renault Clio Renault Sport V6 24V '00Clio Renault Sport V6 24V Tuned CarAston Martin DB9 Coupe '06Jaguar XK Coupe '06Lotus Elise 111R '04Lotus Elise '96Lotus Elise 111R Tuned CarLotus Elise Tuned CarTVR Tuscan Speed 6 '00TVR Tamora '02Art Morrison Corvette'60Amuse/Opera Performance Gran Turismo 350Z RSAmuse S2000 GT1 TurboMine's BNR34 Skyline GT-R N1 base '06Blitz Dunlop ER34 '07

Tsunami RCA701-Y1 RCA 1/Female to 2/Male Y Connector Cable (6 Inch, Gray) Tsunami RCA701-Y1 RCA 1/Female to 2/Male Y Connector Cable (6 Inch, Gray)
List Price: $2.69
Sale Price: Too low to display

1 female-to-2 male 1' RCA Y-connector cableDouble shieldedNickel-plated split tips and rings

Pelican 1495 Computer Case (Black) Pelican 1495 Computer Case (Black)
List Price: $238.25
Sale Price: $127.99

Fits up to 17" laptopsWatertight crushproof and dust proof Fold down overmolded handle Easy open double throw latches Automatic pressure equalization valve BlackExterior: 21 5/8" W x 17 1/4" H x 4 7/8" D Interior: 18 7/8" W x 13 1/8" H x 3 13/16" DIncludes 3 dial bination lock stainless steel padlock protectors nylon padded puter sleeve and accessories pouch lid organizer shock absorbing tray and padded shoulder strap

Hot Chillys Women's Mec Boot Tec Tight Hot Chillys Women's Mec Boot Tec Tight

Hot Chillys has the apparel selection you are looking for, whether it be form-fitting or loose-fitting. Their fabrics are high tech with moisture management. You will find apparel at Hot Chillys for your favorite activity. Should you choose to go cycling, running, climbing, blading, skiing, snowboarding, etc. Apparel items range from socks to pants to tops. Crew neck, v-neck, or zip tops. Hot Chillys Pepper Skin Men's Solid Bottom. Ideal for all types of cool weather activities. Made with micro denier polyester. Hot Chillys Women's Micro Elite Chamois has versatility. 45% Micro denier polyester, 45% Bio-Silver polyester and 10% lycra. Ladies - Are you looking for a sleeveless crop top, bra or panties? Hot Chillys has them available! Kids, Men & Women - Thermal pants and tops are available as well. Thermal tops come in crew neck or zip neck. Looking for socks? Look no further - over the calf with light to heavy cushioning. Rated 6 to 10 for warmth.

Left Behind: A Novel of the Earth's Last Days (Left Behind No. 1) Left Behind: A Novel of the Earth's Last Days (Left Behind No. 1)
List Price: $14.99
Sale Price: $0.98

Piloting his 747, Rayford Steele is musing about his wife Irene's irritating religiosity and contemplating the charms of his "drop-dead gorgeous" flight attendant, Hattie. First Irene was into Amway, then Tupperware, and now it's the Rapture of the Saints--the scary last story in the Bible in which Christians are swept to heaven and unbelievers are left behind to endure the Antichrist's Tribulation. Steele believes he'll put the plane on autopilot and go visit Hattie. But Hattie's in a panic: some of the passengers have disappeared! The Rapture has happened, abruptly driverless cars are crashing all over, and the slick, sinister Romanian Nicolae Carpathia plans to use the UN to establish one world government and religion. Resembling "a young Robert Redford" and silver-tongued in nine languages, Carpathia is named People's "Sexiest Man Alive." (This reviewer, a former People writer, finds this plot twist plausible.) Meanwhile, Steele teams up with Buck Williams, a buck-the-system newshound, to form the Tribulation Force, an underground of left-behind penitents battling the Antichrist. Ex-presidential candidate Pat Robertson briefly outsold Michael Crichton with his apocalypse novel The End of the Age (now available on audiocassette), and the similar The Third Millennium sells well, but the Left Behind series is the absolute champion in the race to make the Book of Revelation into racy thriller reading. --Tim Appelo

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Mec Tech

Essentials For Checklist Implementation

CMS suggests that the cost of a single surgical site infection represents between $63,000 and $180,000.  If one were to average the results of the four hospitals in high-income countries as reported in the NEJM article, implementation of this simple and mundane protocol represents two less infections per 1000 surgeries.  Now do the same math for other complications such as retained foreign objects ($63,000), or infection after CABG ($299,000) and the picture is quite compelling.  In today's austere financial climate doing the right thing is also good business.

"Regardless of whether it's a "bundle," a checklist, or a protocol, not every healthcare facility that tries to implement these standardized practices succeeds, and they seem very surprised when they don't."

Checklists often appear intuitively easy - in fact many of us used two common checklists as we prepared to feast during the holiday season.  A grocery list is a great example of a "read-and-verify" checklist, while a recipe is a "read-and-do" checklist.  If you want to ensure that your meal will be a success, and save time and money by avoiding additional trips to the store, you use the checklists. 

Using a checklist makes sense beyond the kitchen and many clinicians have learned over time to make their own checklist.  Whether it's a surgeon triple checking that she has the correct lens for the correct patient, or the nurse ensuring that all meds are administered to the patient on time, various informal checklists are used every day in hospitals across the country.  With such obvious face validity, success should be simple: just find one that works somewhere else, make it policy that it be used, drop it off in the OR, and watch outcomes improve. If only it were that easy.

LifeWings Partners, LLC has been helping innovative healthcare organizations implement standardized processes for ten years.  In our work from New York to California, we've learned some very important lessons about successfully implementing standardized, evidence-based, high reliability processes.  Here are ten important lessons you shouldn't ignore, and while they're written for checklists they apply to any standardized process:

Everyone's responsible: Compliance is a team issue and anyone on the team from the newest OR tech to the most seasoned surgeon is responsible to hold all other team members accountable for the proper use of the tool they created and collectively agreed to use.  Given that there is joint responsibility, successful implementation requires a strong endorsement, or better yet a mandate, from leadership, MEC, and others.

Someone's responsible: There must be one member of the OR team who is ultimately responsible for completion of the checklist.  This person must be empowered to "stop the line," and held accountable for doing so, until the checklist is properly completed.

Physicians must lead: Aside from patients, physicians have the most to gain from the correct use of a checklist and their behavior sets the tone for the OR. Yes, getting physician buy-in is hard work - sometimes even painful. It can be done. The secret is good data, constant communication, an appeal to what matters most to physicians (their patients' well being), and strong leadership.

Physician leadership must demand that physicians lead: It's so important that it deserves mentioning again.  Medical staff really can't "sit this one out."

Make it organic: "Drop In" checklists never work. There's no buy-in or investment in its success. The people that will actually use the checklist must understand the clinical need, and then create, or modify, the tool that facilitates the work here. The World Health Organization agrees, advising "The checklist is not intended to be comprehensive.  Additions and modifications to fit local practice are encouraged."  There are no shortcuts on this step, and all disciplines must be involved in thoughtful dialogue about what will keep the patient safe.

Persistence required: Checklists are NEVER perfect the first time they are used. The clinical team must know going into the checklist building process that it is an iterative process.  This process is sometimes known as "kaizen," a) adopt a standard for the work, b) adhere to the standard, c) continually refine the standard, and d) repeat steps a, b, and c endlessly.

Design matters: In fact, it is extremely important if you want your checklist to be used consistently and reliably. The checklist should be: a) Simple and intuitive to use; b) Easy to see and to read, using the fonts and font sizes consistent with the best science on the design of checklists; c) Inclusive of amplifying information (expanded checklist) to clearly define expectations and roles; and d) Designed to minimize distraction from clinical priorities.

Adopt a culture of discipline: Even the perfectly constructed checklist imposes nothing - it is just a tool designed to "hardwire" the right behaviors at the right time, making it easy to do the right thing and hard to make a mistake.  A checklist doesn't impose discipline, rather it flourishes in a leadership environment where compliance is rewarded and non-compliance is promptly addressed with coaching and significant negative consequences for continued non-compliance. Implementing a checklist without the proper leadership actions is a futile and frustrating experience.

A paradigm shift: Many professionals think that a checklist is "good for those who need it."  This mindset springs from the idea that "a medical error hasn't happened to me (because I'm really good, and very careful), so it can never happen to me." A safer mindset is that "Use of a checklist is the hallmark of a true professional." Unfailing use of well-designed checklist becomes part of your personal ethos and to skip the use of this valuable tool would be unthinkable - just as failing to scrub your hands prior to surgery would be unthinkable in the modern era.  The motivation for use is intrinsic, not extrinsic.  To put things in perspective, imagine that you were sitting on an airplane and the pilot said, "Ladies and gentlemen, I'm Captain Smith and I've been flying airplanes for 27 years without an accident.  Today I've decided that I don't need to use the checklist because I'm very good, and very careful."  What would you feel?  What would you do?  As a professional pilot with twenty-seven years of accident-free flying I would urge you to get up out of your seat, calmly collect your belongings, and walk off the airplane!

The time is now: There's never a convenient time to implement a new process.  The excuses, and costs to patients (preventable morbidity and mortality), for delaying implementation are increasingly unacceptable.  Plan, educate, create, and implement... then do the hard work of following through with continuous measurement, refinement, and improvement.

Change is never easy. The cost of not changing is too dear.  Margaret Meade provides us this assurance: "Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it's the only thing that ever has."

About the Author

Steve Montague is a Vice President for LifeWings and has worked with many clients, including Vanderbilt University Medical Center, Missouri University Health Center, Vassar Brothers Medical Center, and University of California – Los Angeles, to implement LifeWings aviation-based safety programs and trainings. A former Naval Aviator, Steve served as a fighter pilot, flight instructor, course developer, procurement consultant, and Program Model Manager at the U.S. Navy’s Landing Signal Officer School. He has over 12,000 flight hours and more than 350 carrier landings and currently serves as a Captain and First Officer for a major international airline. A graduate of the U.S. Naval Academy with a Bachelor of Science degree in Aerospace Engineering, Steve has an Airline Transport Pilot rating and is qualified in the MD80, B757, B767, DC10, and MD11.

LifeWings Partners was founded by a former U.S. Navy Top Gun instructor, a commercial airline pilot, and two physicians who are former NASA astronauts. LifeWings’ practical and effective teamwork training programs are highly effective in reducing human error and currently involve the training of more than 13,000 high-performance medical team members per year. Measurable results are found in all LifeWings’ initiatives. To find out more, please visit www.SaferPatients.com.

CAN I GET SEAT IN SASTRA IF I GET 96%IN INTERMEDIATE BOARD?

FOR B.TECH MEC

you have to appear in the aieee entrance and cross the cut off,for certain univ like NIT's u have to get a better rank and also sastra takes only 30% of students through aieee so 70% are taken through 12th mark %.

R5.5bn for Gauteng roads
The Gauteng department of roads and transport says that R5.5bn has been allocated towards the construction and upgrading of roads in the province.

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