Use Of Checklist Research Articles

Enhancing the utility of tuberous sclerosis complex-associated neuropsychiatric disorders checklist in China.

The tuberous sclerosis complex (TSC)-associated neuropsychiatric disorders (TAND) Checklist is a reliable global screening tool for TAND in clinical settings, with six dimensions and 12 sections. For Chinese individuals with TSC, the implementation of the TAND Checklist provides a comprehensive approach to evaluating potential manifestations across various domains.

What’s inside matters: an assessment of the family planning content of digital self-care platforms

BackgroundDigital technology has proliferated rapidly in low- and middle-income countries in recent decades. This trend will likely persist as costs decrease, dramatically expanding access to reproductive health and family planning (FP) information. As many digital tools aim to support informed choice among individuals with unmet contraceptive need, it is essential that high-quality information is provided. We set out to assess the accuracy and comprehensiveness of FP content in select user-facing digital self-care platforms.MethodsWe identified 29 digital tools in circulation between 2018–2021 and selected 11 that met our eligibility criteria for analysis. Referencing global guidance documents such as the Family Planning Handbook, Medical Eligibility Criteria for Contraceptive Use, and the Digital Health for Social and Behavior Change High Impact Practice Brief, we developed an original rubric outlining 12 key content areas necessary to support informed, person-centered counseling. We applied this to each tool, enabling assignment of a numerical score that represents content accuracy and comprehensiveness across the 12 key areas.ResultsFP content of digital tools varied greatly in accuracy and comprehensiveness. Of the 12 identified key content areas, 5 were included in all 11 tools, while 6 were addressed inconsistently or not at all. Four content areas were the most accurate and comprehensive: complete list of modern methods, duration of protection, dual method use, and return to fertility. The lowest scoring content areas were side effect management, non-contraceptive benefits, effectiveness, side effects, and instructions for use. ConclusionsComplete, accurate, and evidence-based FP content is a foundational element of quality digital self-care. Inaccuracies and omissions can impact individual user experiences and decision-making in critical ways. FP content quality should be verified before digital tools are scaled or researched at the programmatic level. From this exercise, we developed a checklist for use in conjunction with global guidance documents to improve future FP content of user-facing digital tools.

Critical Event Checklists for Simulated In-Hospital Dysrhythmias in Children with Heart Disease.

Children with heart disease are at increased risk of unstable dysrhythmias and in-hospital cardiac arrest (IHCA). Clinician adherence to lifesaving processes of care is an important contributor to improving patient outcomes. This study evaluated whether critical event checklists improve adherence to lifesaving processes during simulated acute events secondary to unstable dysrhythmias. A randomized controlled trial was conducted in a cardiac ward in a tertiary care, academic children's hospital. Unannounced simulated emergencies involving dysrhythmias in pediatric patients with underlying cardiac disease were conducted weekly. Responders were pediatric and anesthesiology residents, respiratory therapists, and bedside registered nurses. Six teams were randomized into two groups-three received checklists (intervention) and three did not (control). Each team participated in four simulated scenarios over a 4-week pediatric cardiology rotation. Participants received a brief slideshow presentation, which included a checklist orientation, at the start of their rotation. Simulations were video and audio recorded and those with three or more participants were included for analysis. The primary outcome was team adherence to lifesaving processes, expressed as the percentage of completed critical management steps. Secondary outcomes included participant perceptions of the checklist usefulness in identifying and managing dysrhythmias. We used generalized estimating equations (GEE) models, which accounted for clustering within groups, to evaluate the effects of the intervention. A total of 24 simulations were conducted; one of the 24 simulations was excluded due to an insufficient number of participants. In our GEE analysis, 81.21% (78.96%, 83.47%) of critical steps were completed with checklists available versus 68.06% (59.38%, 76.74%) without checklists (p = 0.004). Ninety-three percent of study participants reported that they would use the checklists during an unstable dysrhythmia of a child with underlying cardiac disease. Checklists were associated with improved adherence to lifesaving processes during simulated resuscitations for unstable pediatric dysrhythmias. These findings support the use of scenario specific checklists for the management of unstable dysrhythmias in simulations involving pediatric patients with underlying cardiac disease. Future studies should investigate whether checklists are as effective in actual pediatric in-hospital emergencies.

An analysis of the evidence underpinning the surgical treatment of hepatocellular carcinoma.

e16278 Background: The American Association for the Study of Liver Diseases (AASLD) and National Comprehensive Cancer Network (NCCN) guidelines on Hepatocellular Carcinoma (HCC) surgery are based on evidence from many different systematic reviews (SRs) and meta-analyses (MAs). Quality of these studies needs to be standardized. Methods: SRs and MAs cited in AASLD and NCCN HCC (2023) surgery guidelines were collated by two independent reviewers. An independent third reviewer acted as tie-breaker when necessary. The standardized assessment tools, the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and Assessing the Methodological Quality of Systematic Reviews (AMSTAR) were used to evaluate the quality of these studies. Quality of studies was determined based on adherence to items of the checklist. The PRISMA and AMSTAR checklists consist of 41 and 16 items, respectively. Results: Overall, 13 studies were identified, 9 from AASLD guidelines and 4 from the NCCN. Studies were published between 2007 and 2023, with 38% being published in the last 5 years. Studies had an average of 23,829 patients. Many of the studies (71%) reported use of the PRISMA checklist, but no studies cited the AMSTAR checklist. Studies had an average adherence of 68% to the PRISMA checklist, with a median of 76% (range 17-88%). 23% of studies adhered to less than half of the PRISMA checklist. Looking at the AMSTAR checklist, studies had an average adherence of 51%, with a median of 56% (range 4-72%). 31% of studies adhered to less than half the AMSTAR checklist. Adherence was lowest in items involving availability and accessibility of protocols, assessing risk of bias, and transparency of protocols. Additionally, no papers reported funding sources of their reviewed articles. Conclusions: There is significant room for improvement in MAs and SRs about HCC surgical management. Many quoted studies needed more rigorous methodology and quality control for conducting and reporting. It is important to fully investigate and communicate the biases present in MAs and SRs to readers. PRISMA and AMSTAR checklists can be used when reviewing and selecting evidence for future guideline development to offer the most complete and transparent understanding of data presented.

Adapting the World Health Organization's Surgical Safety Checklist to High-Income Settings: A Hybrid Effectiveness-Implementation Trial Protocol.

The proposed study aims to assess users' perceptions of a surgical safety checklist (SSC) reimplementation toolkit and its impact on SSC attitudes and operating room (OR) culture, meaningful checklist use, measures of surgical safety, and OR efficiency at 3 different hospital sites. The High-Performance Checklist toolkit (toolkit) assists surgical teams in modifying and implementing or reimplementing the World Health Organization's SSC. Through the explore, prepare, implement, and sustain implementation framework, the toolkit provides a process and set of tools to facilitate surgical teams' modification, implementation, training on, and evaluation of the SSC. A pre-post intervention design will be used to assess the impact of the modified SSC on surgical processes, team culture, patient experience, and safety. This mixed-methods study includes quantitative and qualitative data derived from surveys, semi-structured interviews, patient focus groups, and SSC performance observations. Additionally, patient outcome and OR efficiency data will be collected from the study sites' health surveillance systems. Statistical data will be analyzed using Statistical Product and Service Solutions, while qualitative data will be analyzed thematically using NVivo. Furthermore, interview data will be analyzed using the Consolidated Framework for Implementation Research and reach, effectiveness, adoption, implementation, maintenance implementation frameworks. The toolkit will be introduced at 3 diverse surgical sites in Alberta, Canada: an urban hospital, university hospital, and small regional hospital. We anticipate the results of this study will optimize SSC usage at the participating surgical sites, help shape and refine the toolkit, and improve its usability and application at future sites.

Perioperative patient safety indicators-A Delphi study.

To identify, define and achieve consensus on perioperative patient safety indicators within a Swedish context. A modified Delphi method. A purposeful sample of 22 experts, all experienced operating room nurse specialists, was recruited for this study. A questionnaire was constructed incorporating statements derived from a preceding study. The experts were asked to rate the importance of each statement concerning patient safety during the perioperative phase. The data collection occurred through an online survey platform between November 2022 and April 2023. The CREDES checklist guided the reporting of this study. The three-round Delphi study resulted in consensus on 73 statements out of 103, encompassing 74% process indicators and 26% structure indicators. Key areas of consensus included the use of the Surgical Safety Checklist and optimizing the operating room environment. Consensus was reached on perioperative safety indicators, underscoring the intricate challenges involved in ensuring patient safety in the operating room. It emphasizes the important integration of both structure and process indicators for comprehensive safety assessment during surgical procedures. Recognizing the difficulty in measuring factors like teamwork and communication, essential for patient safety, the study offers practical guidance. It underlines a balanced approach and specific consensus areas applicable in clinical practice to enhance perioperative patient safety. This study provides concrete practice guidance and establishes a structured framework for evaluating perioperative care processes. It emphasizes the critical role of professionals having the necessary skills and being present during surgical procedures. Additionally, the study underscores the paramount importance of effective communication and teamwork within the operating room team, substantively contributing to overall patient safety enhancement. The study focused on addressing the challenge of ensuring patient safety in operating rooms, acknowledging the persistent complications related to surgery despite global efforts to eliminate avoidable harm in healthcare. Consensus was reached on 73 crucial indicators for perioperative patient safety, emphasizing a balanced approach integrating both process and structure indicators for a comprehensive assessment of safety during surgical procedures. The study has a broad impact on professionals and healthcare systems, providing concrete guidance for practice and offering a structured process for evaluating perioperative care. The study is reported informed by 'Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations derived from a methodological systematic review'. No patient or public contribution.

A short guide to addressing accessibility at scientific conferences.

Although encouraging progress to address issues of accessibility at scientific conferences has been made in recent years, further efforts are required to enact the comprehensive solutions necessary to accommodate the diverse needs of disabled scientists. This Opinion provides an easy-to-follow guide to ensuring that scientific conferences are accessible to disabled scientists and is aimed at conference organizers and funders in the field of cell biology. In this piece, I, a person who identifies as a disabled scientist, advocate for collective action within the cell biology community to promote the routine inclusion of accessibility officers on conference organizing panels and the use of accessibility checklists as part of applications for conference funding in order to build inclusive practices into conference planning and organization. I propose a move away from requiring personal disclosures of disability needs on a person-to-person basis towards community-agreed guidelines that ensure accessibility for scientists with a wide variety of needs. To that end, I detail a list of practical, cost-effective adjustments to standard conference activities that can enhance accessibility. Moreover, I suggest several long-term, high-impact changes - including guaranteeing the availability of wheelchair-accessible facilities and making hybrid meeting formats standard - aimed at enabling conference participation for all scientists.

Simulation-Based Cardiopulmonary Examination Skills Checklist: Assessment of Inter-rater Reliability

Purpose: Experiential learning using high-fidelity simulation is a valuable tool for teaching Doctor of Physical Therapy (DPT) students the cardiopulmonary examination. There are currently no standardized assessment tools to evaluate student performance and provide feedback on these skills. The cardiovascular and pulmonary section of the American Physical Therapy Association recently published recommended competency levels for entry-level physical therapists including examination skills. The primary aim of this study was to create and assess inter-rater reliability of a cardiopulmonary examination skills checklist that aligns with these recommendations and can be used in the simulation environment. Methods: A skills checklist with 6 sections was developed to assess student performance on the cardiopulmonary examination within a high-fidelity simulation experience. Training videos on the cardiopulmonary examination and checklist use were created and given to 3 graders. Seventy-three DPT students performed the cardiopulmonary examination within simulation while being recorded. Three graders then assessed the same 25 randomly selected videos using the checklist. Inter-rater reliability, item % agreement and student performance were analyzed. Results: The overall interclass correlation coefficient (ICC) of the checklist was calculated to be 0.858, demonstrating strong agreement between graders. The ICC for individualized checklist sections ranged from 0.659 to 0.960, demonstrating good to near perfect agreement. The average percent correct achieved by students was 80.48 (6.91%), R = 65% to 93.33%. There were >80% agreement for 55/60 items and >90% agreement for 44/60 items. Conclusion: The checklist provided an effective tool to assess student performance on the cardiopulmonary examination and demonstrated consistent scoring between graders.

ACcurate COnsensus Reporting Document (ACCORD) explanation and elaboration: Guidance and examples to support reporting consensus methods.

When research evidence is limited, inconsistent, or absent, healthcare decisions and policies need to be based on consensus amongst interested stakeholders. In these processes, the knowledge, experience, and expertise of health professionals, researchers, policymakers, and the public are systematically collected and synthesised to reach agreed clinical recommendations and/or priorities. However, despite the influence of consensus exercises, the methods used to achieve agreement are often poorly reported. The ACCORD (ACcurate COnsensus Reporting Document) guideline was developed to help report any consensus methods used in biomedical research, regardless of the health field, techniques used, or application. This explanatory document facilitates the use of the ACCORD checklist. This paper was built collaboratively based on classic and contemporary literature on consensus methods and publications reporting their use. For each ACCORD checklist item, this explanation and elaboration document unpacks the pieces of information that should be reported and provides a rationale on why it is essential to describe them in detail. Furthermore, this document offers a glossary of terms used in consensus exercises to clarify the meaning of common terms used across consensus methods, to promote uniformity, and to support understanding for consumers who read consensus statements, position statements, or clinical practice guidelines. The items are followed by examples of reporting items from the ACCORD guideline, in text, tables and figures. The ACCORD materials - including the reporting guideline and this explanation and elaboration document - can be used by anyone reporting a consensus exercise used in the context of health research. As a reporting guideline, ACCORD helps researchers to be transparent about the materials, resources (both human and financial), and procedures used in their investigations so readers can judge the trustworthiness and applicability of their results/recommendations.

Adaptation of the World Health Organization (WHO) Safe Surgery Checklist for Use With Cesarean Sections: Implementation and Outcomes With the Safe Cesarean Section Checklist.

Introduction The World Health Organization (WHO) Safe Surgery Checklist significantly decreases morbidity and mortality in regular operating room cases. However, significant differences in workflow and processes exist between regular operating room cases and cesarean sections performed on the labor and delivery unit. The aim of this study is to adapt the WHO Safe Surgery Checklist for the labor and delivery unit and cesarean sections to improve communication and patient safety. Methods A multidisciplinary team consisting of all major stakeholders reviewed and revised the WHO Safe Surgery Checklist making it more applicable to cesarean section operations. The new Safe Cesarean Section Checklist was tested and then integrated into the electronic medical record and utilized on the labor and delivery unit. A specific cesarean section safety attitudes questionnaire was developed, validated, and administered prior to and one year after implementation. Results Usage of the Safe Cesarean Section Checklist was greater than 95% after initial implementation.Significant improvements were reported by the staff on the cesarean section attitudes questionnaire for several key areas including the feeling that all necessary information was available at the beginning of the procedure, decreases in communication breakdowns and delays, and fewer issues related to not knowing who was in charge during the procedure. Discussion Implementation of the Safe Cesarean Section Checklist was successfully adopted by the staff, and improvements in staff perceptions of several key safety issues on our unit were demonstrated. Additional studies should be undertaken to determine if clinical outcomes from this intervention are comparable to those seen with the use of the WHO Safe Surgery Checklist.

Deliberate Problem-solving with a Large Language Model as a Brainstorm Aid Using a Checklist for Prompt Generation.

Large language models (LLMs) use autoregression to generate text in response to queries. Crafting an appropriate prompt to elicit the desired response from these generative artificial intelligence (AI) models to solve a clinical problem can be a challenge to clinicians who may be unfamiliar with this technology. The use of checklists to generate carefully worded queries can leverage the potential of LLMs as a brainstorming aid for medical problem-solving. Systematically using different prompts to generate the most appropriate differential diagnoses for selected clinical case scenarios, a potential checklist for prompt generation has been created and is reported here.

Competency-Based Medication Administration and Error Reporting.

Accuracy is needed with medication administration, a skill that involves rule-based habits and clinical reasoning. This pilot study investigated the use of an evidence-based checklist for accuracy with oral medication administration and error reporting among prelicensure nursing students. Checklist items were anchored in the mnemonic C-MATCH-REASON© (Client, Medication, ADRs, Time, Client History, Route, Expiration date, Amount, Site, Outcomes, Notation). Nineteen participants randomly assigned to crossover sequence AB or BA (A: checklist; B: no checklist) practiced simulation scenarios with embedded errors. Nursing faculty used an observation form to track error data. Using the C-MATCH-REASON© checklist compared with not using the checklist supported rule adherence (p = .005), knowledge-based error reduction (p = .011), and total error reduction (p = .010). The null hypothesis was not rejected for errors found (p = .061) nor reported (p = .144), possibly due to sample size. C-MATCH-REASON© was effective for error reduction. Study replication with a larger sample is warranted. [J Nurs Educ. 2024;63(5):320-327.].

General Surgery Resuscitation Preference Documentation: A Quality Improvement Initiative.

Documentation of resuscitation preferences is crucial for patients undergoing surgery. Unfortunately, this remains an area for improvement at many institutions. We conducted a quality improvement initiative to enhance documentation percentages by integrating perioperative resuscitation checks into the surgical workflow. Specifically, we aimed to increase the percentage of general surgery patients with documented resuscitation statuses from 82% to 90% within a 1-year period. Three key change ideas were developed. First, surgical consent forms were modified to include the patient's resuscitation status. Second, the resuscitation status was added to the routinely used perioperative surgical checklist. Finally, patient resources on resuscitation processes and options were updated with support from patient partners. An audit survey was distributed mid-way through the interventions to evaluate process measures. The initiatives were successful in reaching our study aim of 90% documentation rate for all general surgery patients. The audit revealed a high uptake of the new consent forms, moderate use of the surgical checklist, and only a few patients for whom additional resuscitation details were added to their clinical note. We successfully increased the documentation percentage of resuscitation statuses within our large tertiary care center by incorporating checks into routine forms to prompt the conversation with patients early.

Reflexivity in pharmacy practice qualitative research: systematic review of twelve peer-reviewed journals

Abstract Introduction Reflexivity is named as an important component for establishing trustworthiness and authenticity within qualitative research. Depending on the philosophical stance of the researcher, subjectivity is often intertwined with qualitative research, thus engagement in reflexivity accounts for how this subjectivity shapes the study and aids to increase its rigor. Walsh’s typology[1] proposed personal, interpersonal, methodological, and contextual dimensions of reflexivity, which are overlapping and interacting, and was endorsed by the International Association for Medical Education (AMEE).[2] As pharmacy professionals conducting research, we bring many aspects (personal and professional experiences, beliefs, values) that can help us develop deeper and richer insights into our work; if not considered through reflexivity, this may have unrealised impacts which can bring the findings under scrutiny. Aim This systematic review aimed to explore reflexivity reporting, type, and strategies in qualitative studies published in peer-reviewed pharmacy journals. Methods Two reviewers screened twelve pharmacy related peer-reviewed journals from inception to 1st August 2023 for qualitative studies; these were identified as the ‘top’ pharmacy practice journals in JANE (Journal/Author Name Estimator). Then, studies were independently reviewed against inclusion criteria. Any disagreements were discussed to reach a consensus. Qualitative studies discussing reflexivity, having dedicated reflexivity sections in the manuscript, or providing quality checklists with reflexivity were included. Quantitative, mixed methods, and educational research studies were excluded. Two reviewers completed data extraction: reflexivity methods, where discussed in the paper and to what extent, and type of reflexivity as per Walsh’s typology to determine the dimension of reflexivity.[1] Data were synthesised narratively. Quality appraisal of study conduct was not completed and all eligible papers were included. Results 452 qualitative studies were reviewed and 102 were included from seven journals. Thirty-four studies provided quality checklists and 18 had personal (n=10), interpersonal (n=2), methodological (n=1), or multi-type (n=5) reflexivity. In the remaining 68 articles, reflexivity was personal (n=20), interpersonal (n=3), methodological (n=16), multi-type (n=28), or unclear (n=1). Where reflexivity was presented, it was mostly reported in the manuscript’s methods section or within limitations sections of discussions; some had reflexivity named sections. However, reviewed studies lacked true reflexive comments, and often descriptions of research team backgrounds were provided without consideration of the impact on the study, or the focus was on minimising study bias. Twelve studies alluded to the use of reflexive diaries, journals, or note sheets but lacked detail in how they were implemented. Conclusion This is the first systematic review, to our best knowledge, focused on reflexivity reporting in pharmacy practice qualitative studies. It highlighted that reflexivity reporting was poor, often misunderstood, and use of the quality checklist did not increase appropriate reporting. Reflexivity was often described as something researchers ‘did’ to minimise bias, rather than something to embrace and explore as part of qualitative research process. We posit that this could be due to a lack of understanding of what true reflexivity is, unclear quality checklist instructions and limited potential to include it meaningfully in the final manuscript. The review was limited to twelve pharmacy practice journals and articles published in English.

Evaluation of a novel clinical pharmacy tool in identifying and categorising drug-related problems in hospitalised patients: The MA2VER2ICK Tool Study

Abstract Introduction Literature searching has revealed a lack of high-quality research outlining the use of tools or checklists in hospitalised patients. Additionally, few tools identified relate directly to clinical pharmacy practice. The tools identified focus on specific disciplines (e.g. critical care) or specific tasks (e.g. handover). The MA2VER2ICK Tool is a novel clinical pharmacy tool which has recently undergone review and adaptation.[1] The tool is unique as it is comprehensive and applicable to all hospitalised patients, regardless of clinical discipline. The intended purpose of the tool is to assist clinical pharmacists in comprehensive pharmaceutical care planning. Aim Demonstrate the utility of the MA2VER2ICK tool in pharmaceutical care planning, by outlining the type and frequency of drug-related problems occurring in hospitalised patients. Methods A prospective, observational, cross-sectional study was conducted in a 560-bed acute university teaching hospital. Clinical pharmacists adopted the tool in their daily practice, in a mixed medical-surgical inpatient population, over four weeks. All drug-related problems identified were recorded and assigned to the applicable category within the tool, by the clinical pharmacist. Additionally, all drug-related problems were retrospectively assigned to applicable categories of the Pharmaceutical Care Network Europe Classification for Drug Related Problems Version 9.1,[2] for comparison, by two independent researchers. Results All identified drug-related problems identified were successfully categorised using the MA2VER2ICK Tool. In total, 753 drug-related problems were identified in 180 patients over four weeks, with 233 patient-pharmacist encounters occurring. The mean age of patients was 68.9±16 years, while 51.7% (93/180) were female and 48.3% (87/180) were male. The mean number of drug-related problems identified per patient was 4.2±3.6. The highest number of drug-related problems experienced by an individual was 20, while 17 patients experienced no drug-related problem. The majority of drug-related problems identified using the tool related to medication reconciliation (52.7%; 397/753), followed by prescription endorsement and administration (17.3%; 130/753) and pharmacotherapy optimisation (9.3%; 70/753). In comparison with the MA2VER2ICK Tool, the Pharmaceutical Care Network Europe classification system has a much larger range of categories for assigning drug-related problems. Despite this, a proportion of identified drug-related problems 1.6% (12/753) could not be categorised using this tool, while there were also several categories within the tool 43.2% (19/44) whereby no drug-related problems were assigned. Conclusion This study demonstrates that the MA2VER2ICK Tool is a robust clinical pharmacy tool, that is effective and practical in assisting clinical pharmacists with the identification of drug-related problems and thus is a useful guide to facilitate pharmaceutical care planning at the patient’s bedside. This is in comparison with the Pharmaceutical Care Network Europe classification system, which has less utility as a clinical pharmacy tool, but is better placed as a research instrument. Despite demonstrating the usefulness of the MA2VER2ICK Tool in identifying drug-related problems, the clinical significance of those identified was not assessed during this study. However, data collection occurred in real time, facilitating the identification of actual and potential problems, thus reducing the likelihood of underestimating the incidence rate.

Twelve tips for developing simulation-based mastery learning clinical skills checklists

Simulation-based mastery learning is a powerful educational paradigm that leads to high levels of performance through a combination of strict standards, deliberate practice, formative feedback, and rigorous assessment. Successful mastery learning curricula often require well-designed checklists that produce reliable data that contribute to valid decisions. The following twelve tips are intended to help educators create defensible and effective clinical skills checklists for use in mastery learning curricula. These tips focus on defining the scope of a checklist using established principles of curriculum development, crafting the checklist based on a literature review and expert input, revising and testing the checklist, and recruiting judges to set a minimum passing standard. While this article has a particular focus on mastery learning, with the exception of the tips related to standard setting, the general principles discussed apply to the development of any clinical skills checklist.

The Effect of an Oxytocin Decision Support Checklist on Oxytocin Use and Maternal and Neonatal Outcomes: A Retrospective Cohort Study.

To assess the association between use of an oxytocin decision support checklist with oxytocin usage and clinical outcomes. We conducted a retrospective cohort study of patients with singleton gestations at 370/7 weeks or greater who received oxytocin during labor from October 2012 to February 2017 at an integrated community health care system during three exposure periods: (1) prechecklist; (2) after paper checklist implementation; and (3) after checklist integration into the electronic medical record (EMR). The checklist was a clinical decision support tool to standardize the dosing and management of oxytocin. Thus, our primary outcomes included oxytocin infusion rates and cumulative dose. Secondary outcomes included maternal and neonatal outcomes. We controlled for maternal risk factors with multivariable regression analysis and stratified by mode of delivery. A total of 34,269 deliveries were included. Unadjusted analyses showed that compared with prechecklist, deliveries during the paper and EMR-integrated periods had a lower cumulative dose (4,670 ± 6,174 vs. 4,318 ± 5,719 and 4,286 ± 5,579 mU, p < 0.001 for both), lower maximal infusion rate (9.9 ± 6.8 vs. 8.7 ± 5.8 and 8.4 ± 5.6 mU/min, p < 0.001 for both), and longer duration of oxytocin use (576 ± 442 vs. 609 ± 476 and 627 ± 488 minutes, p < 0.001 and p = 0.01, respectively). The unadjusted rates of cesarean, 5-minute Apgar <7, mechanical ventilation, and neonatal hospital length of stay were similar between periods. The adjusted mean difference in time from admission to delivery was longer during the EMR-integrated period compared with prechecklist (3.0 [95% confidence interval: 2.7-3.3] hours, p < 0.001). Oxytocin checklist use was associated with decreased oxytocin use patterns at the expense of longer labor times. Findings were more pronounced with EMR integration. · An oxytocin decision support checklist is associated with reduced amounts of oxytocin used.. · However, checklists were associated with longer duration of oxytocin use and of labor.. · Results were more pronounced in the EMR-integrated checklist compared with paper checklist..

L’impact de la simulation en santé et l’importance des facteurs humains

Medical simulation is extensively developing over the recent years. It is based on the acquired experience in aircraft industry simulation with the use of different supportive check-lists. In healthcare settings, the first initiatives came from the learning of surgical techniques. Simulation on manikins allowed training of surgeons before they shift to patients. A new step has occurred with the development of non technical skills evaluations of operating theatre teams, through concrete scenarios.

Use of Rounding Checklists to Improve Communication and Collaboration in the Adult Intensive Care Unit: An Integrative Review.

Intensive care units are complex settings that require effective communication and collaboration among professionals in many disciplines. Rounding checklists are frequently used during interprofessional rounds and have been shown to positively affect patient outcomes. To identify and summarize the evidence related to the following practice question: In an adult intensive care unit, does the use of a rounding checklist during interprofessional rounds affect the perceived level of staff collaboration or communication? An integrative review was performed to address the practice question. No parameters were set for publication year or specific study design. Studies were included if they were set in adult intensive care units, involved the use of a structured rounding checklist, and had measured outcomes that included staff collaboration, communication, or both. Seven studies with various designs were included in the review. Of the 7 studies, 6 showed that use of rounding checklists improved staff collaboration, communication, or both. These results have a variety of practice implications, including the potential for better patient outcomes and staff retention. Given the complexity of the critical care setting, optimizing teamwork is essential. The evidence from this review indicates that the use of a relatively simple rounding checklist tool during interprofessional rounds can improve perceived collaboration and communication in adult intensive care units.

Use of Postpartum Hemorrhage Checklist during Vaginal Deliveries: A Quality Improvement Study.

Postpartum hemorrhage (PPH) protocols improve patient safety and reduce utilization of blood products; however, few data exist on sustainability of PPH checklist use, how use affects care delivery, and variation of use among patient subgroups. This study aimed to (1) examine compliance with PPH checklist use during vaginal deliveries, (2) evaluate whether checklist use varied by patient and/or care team characteristics, and (3) evaluate whether checklist use was associated with increased use of recommended medications/interventions. This was a quality improvement study performed from April 2021 through June 2023. A multidisciplinary team developed a revised PPH checklist and used quality improvement methodology to increase checklist use following vaginal birth. Data were collected from medical records and clinician survey. Control charts were generated to track checklist use and evaluate special cause variation. Chi-square tests and logistic regression were used to evaluate variation in medications/interventions and across subgroups. During the study period, there were 342 cases of PPH at the time of vaginal birth. The checklist was used in 67% of PPH cases during the 20-month period after implementation in a setting where no checklist was previously being used. We found no statistically significant differences in checklist use by patient or health care team characteristics. Use of tranexamic acid, carboprost, and misoprostol were significantly associated with checklist use. This study demonstrated successful implementation of a checklist protocol where no checklist was previously being used, with sustained use in an average of 67% of PPH cases over 20 months. Checklist use was consistent across subgroups and was associated with higher use of interventions shown to lower blood loss. · Our study showed sustainability of PPH checklist use over a 20-month period.. · PPH checklist use was associated with increased use of interventions known to reduce blood loss.. · Checklist was used consistently across patient subgroups; may help address inequities in obstetric outcomes..