Completed Checklists Research Articles

Development of a strategic process using checklists to facilitate team preparation and improve communication during neonatal resuscitation

BackgroundTo improve our neonatal resuscitations we review video recordings of actual high-risk deliveries as an ongoing quality review process. In order to help identify and review errors that occurred during resuscitation we educated our resuscitation teams using crew resource management and in March 2009 developed a checklist to be used for potentially high-risk resuscitations. ObjectiveTo describe our experience using checklists as an essential component of the actual resuscitation of potentially high-risk infants. Design/methodsThe checklist includes pre- and debrief components, along with duty-specific sub-lists (MD, RT, RN). The debrief is conducted upon completion of the resuscitation and addresses what was done well, what was not done well, and how it could have been improved. We reviewed all available checklists from March 2009 to November 2011 (n=260). We then performed a second review to determine if experience has changed the leaders perception of how resuscitation was being performed from November 2011 to May 2012 (n=185). ResultsWe reviewed 445 completed checklists with quality assurance video review. During the initial cohort the most commonly described problems were: communication (n=58), equipment preparation and use (n=56), inappropriate decisions (n=87), leadership (n=56), and procedures (n=25). The number of debriefs where communication was identified as a problem decreased from 23% in the first time period to 4% (p<0.001) in the latter. ConclusionsThe use of checklists during neonatal resuscitation was helpful in improving overall communication, and allowed for rapid identification of issues that need to be addressed by institutional leaders. There needs to be further evaluation of the utility and benefit of checklists for neonatal resuscitation. Based on our past and present experience we encourage the use of checklists for neonatal resuscitation teams.

Positive Daily Family Interactions Eliminate Gender Differences in Internalizing Symptoms Among Adolescents

By the age of 18, girls are more than twice as likely as boys to experience internalizing symptoms. Focusing upon the family, a significant factor for adolescent mental health, we examined how positive and negative daily family interactions relate to gender differences in internalizing symptoms. 681 12th grade students (54 % female) completed diary checklists each night for 2 weeks in which they indicated whether they got along with their family (positive family interactions) and argued with their family (negative family interactions). Results indicate that negative daily family interactions explain, in part, why females experience heightened internalizing symptoms. Yet, even in the face of negative family interactions, positive daily family interactions have salutatory effects, reducing females' emotional distress and eliminating gender differences in internalizing symptoms at high levels of positive interactions. These findings underscore the importance of positive family interactions for adolescent girls' mental health.

Communicating risk of hereditary breast and ovarian cancer with an interactive decision support tool

ObjectiveWomen with hereditary breast and ovarian cancer syndrome (HBOC) face a higher risk of earlier, more aggressive cancer. Because of HBOC's rarity, screening is recommended only for women with strong cancer family histories. However, most patients do not have accurate history available and struggle to understand genetic concepts. MethodsCancer in the Family, an online clinical decision support tool, calculated women's HBOC risk and promoted shared patient–provider decisions about screening. A pilot evaluation (n=9 providers, n=48 patients) assessed the tool's impact on knowledge, attitudes, and screening decisions. Patients used the tool before wellness exams and completed three surveys. Providers accessed the tool during exams, completed exam checklists, and completed four surveys. ResultsPatients entered complete family histories (67%), calculated personal risk (96%), and shared risk printouts with providers (65%). HBOC knowledge increased dramatically for patients and providers, and many patients (75%) perceived tool results as valid. The tool prompted patient–provider discussions about HBOC risk and cancer family history (88%). ConclusionsThe tool was effective in increasing knowledge, collecting family history, and sparking patient–provider discussions about HBOC screening. Practice implicationsInteractive tools can effectively communicate personalized risk and promote shared decisions, but they are not a substitute for patient–provider discussions.

Daily School Peer Victimization Experiences Among Mexican-American Adolescents: Associations with Psychosocial, Physical and School Adjustment

School bullying incidents, particularly experiences with victimization, are a significant social and health concern among adolescents. The current study extended past research by examining the daily peer victimization experiences of Mexican-American adolescents and examining how chronic (mean-level) and episodic (daily-level) victimization incidents at school are associated with psychosocial, physical and school adjustment. Across a two-week span, 428 ninth and tenth grade Mexican-American students (51 % female) completed brief checklists every night before going to bed. Hierarchical linear model analyses revealed that, at the individual level, Mexican-American adolescents' who reported more chronic peer victimization incidents across the two-weeks also reported heightened distress and academic problems. After accounting for adolescent's mean levels of peer victimization, daily victimization incidents were associated with more school adjustment problems (i.e., academic problems, perceived role fulfillment as a good student). Additionally, support was found for the mediation model in which distress accounts for the mean-level association between peer victimization and academic problems. The results from the current study revealed that everyday peer victimization experiences among Mexican-American high school students have negative implications for adolescents' adjustment, across multiple domains.

Benefits of psychosocial intervention and continuity of care by child and family health nurses in the pre‐ and postnatal period: process evaluation

To report a programme theory for pre-natal home visiting by nurses in the context of a sustained nurse home visiting programme by exploring pre- and postnatal outcomes and characteristics of the intervention that may have contributed to the outcomes. Studies have shown sustained nurse home visiting commencing pre-natally to be effective. Few studies have explored the processes by which pre-natal activities by nurses contribute to achieving effective outcomes. Process evaluation. Process and outcome data from a randomized controlled trial of sustained nurse home visiting in an area of socioeconomic disadvantage in Western Sydney between 2005-2008 were collated. The pre-natal intervention focused on improving transition to parenting by supporting mothers through pregnancy. Health and service use outcome data were analysed for 208 women (111 intervention; 97 comparison receiving usual care). Five nurses delivering the intervention completed checklists detailing activities undertaken. Nurses provided information, psychosocial support, and health promoting activities for families. Intervention mothers had a higher rate of unassisted vaginal births than the general population. Compared with comparison mothers, intervention mothers at 4-6 weeks postnatally reported better general health and felt significantly more enabled to cope with and understand their baby and to care for themselves and their baby. Comprehensive support, in a context of enabling client-nurse relationships and continuity of carer are the ways by which antenatal nurse home visiting achieves benefits for women and infants, having an impact on both clinical outcomes such as rates of normal vaginal delivery and maternal service engagement.

The Effect of Preoperative Checklists on Final Histology and Rates of Hysterectomy for Benign Conditions

Our null hypothesis was that the introduction of preoperative hysterectomy checklists for fibroids, dysfunctional uterine bleeding (DUB), and chronic pelvic pain (CPP) would not affect the rate of hysterectomy or the proportion of cases with nonconfirmable final pathology. Using a prospective 6-month cohort, we compared the rate of hysterectomy (using ambulatory current procedural terminology codes for all eligible patients) and the preoperative diagnoses to final histologic diagnoses, to a baseline 6-month retrospective cohort. We also sought to determine the proportion of completed preoperative checklists among eligible cases. Checklist implementation was associated with a significant decrease in the hysterectomy rate for DUB: 25 (15.2%) of 165 fell to 12 (6.5%) of 185 (P = 0.014): for CPP: 11 (10.9%) of 101 to 3 (2.9%) of 105 (P = 0.044), as well as for the combined total rate: 86 (25.2%) of 341 to 52 (15.2%) of 342 (P = 0.002). There was a 50% decrease in nonconfirmable pathology for all cases: 21 of 86 at baseline compared to 6 of 52 after intervention (P = 0.049). In this 6-month pilot analysis, the use of preoperative hysterectomy checklists for 3 common nonmalignant conditions (fibroids, DUB, and CPP) was associated with a statistically significant decrease in hysterectomy rates and overall nonconfirmable pathology.

Nature and timing of incidents intercepted by the SURPASS checklist in surgical patients

IntroductionMore than half of in-hospital adverse events can be attributed to a surgical discipline. Checklists can effectively decrease errors and adverse events. However, the mechanisms by which checklists lead to...

The digital pen as a novel device to facilitate the feedback process

Background: To improve clinical performance assessment, checklist data should be immediately available to students to offer them detailed feedback and be stored in a database for quality assurance purposes.Aim: To introduce the digital pen as clinical performance assessment tool, report examiner satisfaction and explore the utility of generated checklist data for quality assurance purposes.Methods: The digital pen technology transmits examiners’ handwritten assessments to a database and exports PDF-files to students’ mailboxes. Descriptive statistical analysis of examiner satisfaction and the generated checklist data was performed.Results: The examiners were satisfied with the digital pen. Valuable data were obtained to improve objective structured clinical examination stations and rating criteria, identify training needs for future students and provide examiners with feedback on their rating skills.Conclusion: The digital pen technology is a practical device for sending completed checklists to students and providing valuable data for quality assurance purposes.

Trait Anxiety Predicts Outcome 6 Weeks After Cholecystectomy. A Prospective Follow-Up Study

BackgroundA substantial group of patients with gallstone disease experience negative outcome after surgical removal of the gallbladder (cholecystectomy). Early identification of these patients is important.PurposeThe aim of the study is to identify predictors (clinical symptoms and trait anxiety) of negative symptomatic outcomes at 6 weeks after cholecystectomy.MethodsConsecutive patients (n = 133), 18–65 years, with symptomatic gallstone disease, completed symptom checklists and the state-trait anxiety inventory preoperatively and at 6 weeks after cholecystectomy.ResultsHigh trait anxiety was the only predictor of persistence of biliary symptoms at 6 weeks after cholecystectomy (OR = 6.88).ConclusionIn addition to clinical symptoms, high trait anxiety is a predictor of negative symptomatic outcome at 6 weeks after cholecystectomy. Trait anxiety should be evaluated to aim at a patient-tailored approach in gallstone disease.

Cost savings from dose rounding of biologic anticancer agents in adults

The purpose of this project was to determine the cost savings related to a dose-rounding process for adult biologic anticancer agents. Biologic anticancer agents prepared by the inpatient pharmacy were identified retrospectively through completed chemotherapy preparation checklists and medication orders on file in the pharmacy or by the clinical pharmacist for adult oncology from the medical records of patients in her practice. The specific products screened for evaluation were aldesleukin, bevacizumab, cetuximab, denileukin diftitox, gemtuzumab, rituximab, and trastuzumab. Data collected included drug name, ordered dose, rounded dose, and product vials not wasted. Specific drug costs were provided by the department's purchasing office. The project was reviewed and approved by the institutional review board to allow retrospective data collection from patient records. Cost savings were evaluated retrospectively for the time period of January 1, 2005 through March 31, 2005. One hundred and twenty-six orders for biologic anticancer agents were processed by the pharmacy department during the 3-month time period of data collection. Dose rounding could reduce drug wastage for 42% of these orders. Potential cost savings from dose rounding was $24,434 for the 3-month interval evaluated. However, nonadherence to dose rounding for 29 rituximab orders decreased the actual cost savings to $15,922. Individual staff education was reinforced to address nonadherence. Routine dose rounding of biologic anticancer agents to an amount within 10% of the ordered dose achieved cost savings through reduction of drug wastage at our institution.

The Clinical and Technical Evaluation of a Remote Telementored Telesonography System During the Acute Resuscitation and Transfer of the Injured Patient

Ultrasound (US) has an ever increasing scope in the evaluation of trauma, but relies greatly on operator experience. NASA has refined telesongraphy (TS) protocols for traumatic injury, especially in reference to mentoring inexperienced users. We hypothesized that such TS might benefit remote terrestrial caregivers. We thus explored using real-time US and video communication between a remote (Banff) and central (Calgary) site during acute trauma resuscitations. A existing internet link, allowing bidirectional videoconferencing and unidirectional US transmission was used between the Banff and Calgary ERs. Protocols to direct or observe an extended focused assessment with sonography for trauma (EFAST) were adapted from NASA algorithms. A call rota was established. Technical feasibility was ascertained through review of completed checklists. Involved personnel were interviewed with a semistructured interview. In addition to three normal volunteers, 20 acute clinical examinations were completed. Technical challenges requiring solution included initiating US; audio and video communications; image freezing; and US transmission delays. FAST exams were completed in all cases and EFASTs in 14. The critical anatomic features of a diagnostic examination were identified in 98% of all FAST exams and a 100% of all EFASTs that were attempted. Enhancement of clinical care included confirmation of five cases of hemoperitoneum and two pneumothoraces (PTXs), as well as educational benefits. Remote personnel were appreciative of the remote direction particularly when instructions were given sequentially in simple, nontechnical language. The remote real-time guidance or observation of an EFAST using TS appears feasible. Most technical problems were quickly overcome. Further evaluation of this approach and technology is warranted in more remote settings with less experienced personnel.

Dimensions of family connectedness among adolescents with mexican, chinese, and european backgrounds.

Multiple dimensions of adolescents' connectedness with their families were investigated among 489 9th-grade students (M = 14.86 years) from families with Mexican, Chinese, and European backgrounds. Participants reported on various aspects of their family relationships and completed diary checklists of daily behaviors for a 2-week period. Adolescents from European backgrounds reported levels of family identification and dyadic closeness with parents similar to or greater than those reported by their peers. For adolescents from Mexican and Chinese backgrounds, particularly those from immigrant families, family connectedness included a stronger emphasis on family obligation and assistance. The extent to which family demographic variables, including parental level of education and residence in a single-parent family, accounted for group differences was examined.

A preliminary investigation into the internal consistency and construct validity of the Triple C: Checklist of Communicative Competencies

Background The Triple C was designed to assess the communication skills of people with severe disabilities and to sensitise support workers to their communicative behaviours. The study aim was to investigate the Triple C's internal consistency and construct validity.Method Deidentified data from the completed checklists of 172 adults with severe disabilities were collected.Results Overall internal consistency was found to be high. Internal consistency was found to be high also for Stages 2 to 6, and acceptable for Stage 1. A measure of association between item and stage totals indicated a hierarchy of skills. Although the factor analysis revealed two underlying factors, most stages loaded highly onto only one factor, interpreted to be early intentional‐presymbolic communication.Conclusions The results indicated good internal consistency, and promising construct validity. They also pointed to a need to modify the Triple C for both clinical and research purposes.

Psychosocial Adjustment in Children and Adolescents with a Craniofacial Anomaly: Age and Sex Patterns

To examine rates of psychosocial adjustment problems and competencies in a sample of children with congenital craniofacial anomalies (CFAs). Retrospective chart review. Urban hospital plastic surgery primary care unit. A total of 724 children aged 2 to 18 years with completed Child Behavior Checklists in their medical charts. Child Behavior Checklist. Higher rates of problems in the clinical range were seen for withdrawn, attention, social, thought, and internalizing problems and lower rates for externalizing and somatic complaints; specific patterns varied according to age and sex. Elevated rates of competency deficits were seen in some groups. Most children with CFAs do not appear to experience psychosocial adjustment problems. Although elevated risk may be seen for certain problems, this group may be protected in other areas. Research identifying the mechanisms responsible for varying age and sex patterns of adjustment is needed.

Emotional numbing in relation to stressful civilian experiences among college students

Investigators have shown that hyperarousal is the best predictor of emotional numbing (EN), as compared with avoidance and reexperiencing. The aim of the present study was to extend this finding to the context of stressful civilian experiences among college students. Participants (N = 1,292) completed self-report checklists of stressful civilian experiences and PTSD symptoms. The results of multiple regression analyses in two subsamples consistently indicated that both hyperarousal and avoidance were good predictors of EN. These findings suggest that avoidance may play a more important role in the relationship between hyperarousal and EN in college students.

Screening for Mental Illness in Primary Care Clinics

To assess the prevalence of mental disorders in inner city outpatient clinics and to improve the diagnosis of mental illness in primary care. The Problem Oriented Patient Report (POPR), a patient self-report checklist, was administered to 362 outpatients at two inner-city Buffalo primary care clinics. Patients' completed POPR checklists were evaluated to identify those with potential mental illness diagnoses and were available for the physicians' review during the patients' visits. After the visit, clinical charts were reviewed to determine the frequency of new mental illness diagnoses among continuing and new patients. The screening checklist (POPR) revealed potential mental illnesses in 148/362 outpatients, of which 98% had not been identified by the physicians who had reviewed the patients' completed POPR forms. Only five new diagnoses of mental illnesses were independently made by clinics' physicians-all in follow-up (continuing) patients. The physicians in the two clinics did not diagnose mental illnesses in their patients, even when written checklists of self-reports were available to them. Differences in staff attitudes may influence the data collection process, and patients' as well as physicians' responses. A weakness of this study is that the POPR might generate false positive results. Even if this were the case, the rate of previous diagnoses was still extremely low.

Assessing the head-to-toe physical examination skills of medical students

Second-year medical students performed a head-to-toe screening physical examination on trained patient instructors (PIs) as a high-stakes examination before beginning clinical clerkships. PIs completed a 138-item checklist and instructed the students in the proper performance of any incorrectly executed or omitted items. To assess the accuracy of the PI ratings, 'monitor' PIs watching the encounter by video completed checklists for 11 retests of failed students in 2001 and for 28 randomly selected encounters in 2002. Checklist-level discrepancies measured by mean absolute checklist difference were 8% in 2001 and 9% in 2002. Case-level mean difference between raters in 2002 was -2.9%. The inter-rater reliability for a single rater, estimated by the intra-class correlation coefficient for total encounter scores, was 0.95. The assessment and feedback were well received by the students. The Head-to-Toe examination provides a reliable assessment of a student's ability to carry out a complete screening physical examination. Patient instructors can be trained to acceptable accuracy and reliability despite the length and complexity of the exercise, and can provide effective feedback and teaching targeted to individual student deficiencies.

Assessing simulated patients in an educational setting: the MaSP (Maastricht Assessment of Simulated Patients).

For more than two decades the Medical School in Maastricht, the Netherlands, has used simulated patients (SPs) to provide students with opportunities to practise their skills in communication and physical examination. In this educational setting a student meets a SP in a videotaped session. Feedback by the SP to the student at the end of the session is considered an important educational feature. We found no instruments to assess individual SP performance during those sessions. To develop a valid, reliable and feasible instrument to evaluate the performance of SPs. The content of the instrument was validated through interviews with students, teachers and experts who are involved with SPs. They were asked to indicate key features of good SP performance. Based on the interviews, a written checklist was developed to measure individual SP performance. The instrument was evaluated in a regular SP session at the medical school, involving 152 students and their teachers. All interviewees considered the scale to be satisfactory and the instrument to be valid. The feasibility and reliability of the checklists were investigated using the data of 398 returned checklists. Cronbach's alpha was found to be 0.73. Generalizability analysis showed that 12 completed checklists were required to obtain a reliable assessment of one SP. The Maastricht Assessment of Simulated Patients (MaSP) appears to be a valid, reliable and feasible tool to assess the performance of SPs in an educational setting.

Adolescents' behavioral autonomy related to diabetes management and adolescent activities/rules.

The purpose of this preliminary study was to describe and explore the behavioral autonomy (both independent functioning and decision making) of adolescents with type 1 diabetes. A sample of 34 adolescents with type 1 diabetes completed checklists on independent functioning and decision making for daily and nondaily diabetes management as well as typical adolescent activities/rules. Independent functioning in daily diabetes management was greater for older adolescents. Independent functioning and decision making for daily diabetes management, nondaily diabetes management, and typical adolescent activities/rules were strongly correlated. Independent decision making, but not independent functioning for daily diabetes management, was significantly correlated to metabolic control. The strong relationship between independent decision making and functioning suggests that both aspects are important parts of behavioral autonomy to be assessed by healthcare professionals working with adolescents with type 1 diabetes. Healthcare professionals should encourage parental involvement that facilitates adolescents' independent decision making, which was related to better metabolic control in this study.

The impact of family obligation on the daily activities and psychological well-being of Chinese American adolescents.

A daily diary method was employed to examine the extent to which Chinese adolescents in the United States assist and spend time with their families, and the implications of such behaviors for their involvement in other activities and psychological well-being. Adolescents (N = 140) completed checklists in which they reported their activities and psychological well-being every day for a period of 2 weeks. Adolescents showed a greater propensity to balance family obligations with their academic demands than with their social life with peers on a daily basis. Girls experienced slightly more daily conflict between activities than boys. Neither the extent of involvement in family obligations nor the balancing of family obligations with other activities were associated with psychological distress among adolescents. These findings demonstrate the complex manner in which adolescents from immigrant families attempt to combine their cultural traditions with selected aspects of American society on a daily basis. In contrast to the expectations of some observers, the youths in this study appeared to accomplish such an integration with little cost to their psychological well-being.