Preventable Harm Research Articles

Organizational strategies to optimize women’s safety during labor and birth: A scoping review

Safety is a priority for organizations that provide maternity care, however, preventable harm and errors in maternity care remain. Maternity care is considered a high risk and high litigation area of health care. To mitigate risk and litigation, organizations have implemented strategies to optimize women's safety. Our objectives were to identify the strategies implemented by organizations to optimize women's safety during labor and birth, and to consider how the concept of safety is operationalized to measure and evaluate outcomes of these strategies. This scoping review was conducted using the Joanna Briggs Institute Scoping Review Methodology. Published peer-reviewed literature indexed in CINAHL, Medline, and Embase, databases from 2010 to 2020, were reviewed for inclusion. Fifty studies were included. Data were extracted and thematically analyzed. Three categories of organizational strategies were identified to optimize women's safety during labor and birth: clinical governance, models of care, and staff education. Clinical governance programs (n=30 studies), specifically implementing checklists and audits, models of care, such as midwifery led-care (n=11 studies), and staff training programs (n=9 studies), were predominately for the management of obstetric emergencies. Outcome measures included morbidity and mortality for woman and newborns. Three studies discussed women's perceptions of safety during labor and birth as an outcome measure. Organizations utilize a range of strategies to optimize women's safety during labor and birth. The main outcome measure used to evaluate strategies was focused on clinical outcomes for the mother and newborn.

Epidemiology of healthcare harm in New Zealand general practice: a retrospective records review study

ObjectivesTo determine the epidemiology of healthcare harm observable in general practice records.DesignRetrospective cohort records review study.Setting72 general practice clinics were randomly selected from all 988 New Zealand clinics stratified by...

Determinants of hazardous alcohol use among pregnant women attending antenatal care at public health facilities in Gondar town, Northwest Ethiopia: A nested case-control study.

BackgroundAlcohol use during pregnancy has a potential negative impact on the health of women and children. Binge or hazardous drinking may do greater alcohol-related damage to the developing fetus than drinking a comparable amount spread over several days or weeks. This study aimed to identify determinants of hazardous alcohol use among pregnant women attending antenatal care at Gondar town public health facilities, Northwest Ethiopia.MethodsAn unmatched facility-based nested case-control study was carried out to identify the determinants of hazardous alcohol use among pregnant women within a prospective cohort study from 29 October 2019 to 7 May 2020. A two-stage random sampling technique was used to select 455 (113 cases and 342 controls) pregnant women. Data collection was performed using the AUDIT-C standardized and pretested questionnaire. Bivariable and multivariable logistic regression analyses were computed to identify the predictors of alcohol consumption using the odds ratio, 95% CI, and p-value < 0.05.ResultsMultivariable logistic regression model revealed that no formal education of the husbands [AOR = 2.79; 95%CI: 1.24, 6.29], being housewife[AOR = 2.43; 95%CI: 1.12, 5.26], poor household wealth index[AOR = 2.65; 95%CI: 1.07, 6.54], unplanned pregnancy [AOR = 4.36;95%CI: 2.44, 7.79], poor social support [AOR = 4.9;95%CI: 2.4, 10.04], depression[AOR = 3.84;95%CI: 2.16, 6.82], and not ever heard the risk of alcohol drinking during pregnancy [AOR = 1.97; 95%CI: 1.08, 3.58] were significantly associated with hazardous alcohol use.ConclusionsRoutine alcohol screening during ANC visits creates an appropriate referral system for clinical management and provides an opportunity for healthcare workers to offer information on the potential risks associated with alcohol use in pregnancy. Antenatal care providers have a special role to play in assuring that women receive adequate advice about alcohol use and care to manage the problems especially for pregnant women with depression, poor social support, unplanned pregnancy, low socioeconomic status, and for housewives during the antenatal visits. The warning marks on alcoholic beverages including an ongoing message about the risks of alcohol use during pregnancy could be public health good strategies to minimize preventable harms attributed to alcohol consumption during pregnancy.

PERCEPTION, KNOWLEDGE AND ATTITUDE TOWARDS PATIENT SAFETY AMONG NURSING STUDENTS IN PRIVATE COLLEGE

Background: Patient safety is defined as the absence of preventable harm to a patient while providing health care, as well as the reduction of unnecessary harm associated with health care. The delivery of better healthcare requires the protection of patients. It's crucial to evaluate nursing students' attitudes toward patient safety in order to identify deficiencies in the educational curriculum and encourage students in patient safety activities. Given the importance of patient safety today, the purpose of this study was to appraise nursing students' expectations, attitudes, and awareness regarding patient safety. Methods: This cross-sectional study was conducted in 2020 at one of the private university colleges in Malaysia. Ninety-two nursing students were recruited using the purposive sampling method. A self-administered questionnaire on patient safety was adapted. This data, analyzed using SPSS Version 20, and descriptive analysis and Chi-square test were used. A total of 92 questionnaires were completed. Results: The findings show that the nursing students had a positive perception of the importance of patient safety in both education and the need for adequate skills. Moreover, 90.3 % of students demonstrated a positive attitude toward the importance of patient safety. The majority (98.9%) of the nursing students also demonstrated good knowledge about patient safety. The minimum desirable rates of positive responses (Likert 4 or 5) of 60% were exceeded among nursing students in all the three aspects. Conclusion: Our findings can contribute to the growing knowledge base about students' learning of patient safety competencies from various perspectives. A better understanding of these interconnected factors can help new graduates feel more confident in their patient safety skills. High patient safety skills can help nursing students provide safe patient care.

The Child Health PSO at 10 Years: An Emerging Learning Network.

Introduction:The 2005 Patient Safety and Quality Improvement Act, actualized as a Learning Network (LN), has enabled the Child Health Patient Safety Organization (PSO) to play a vital and novel role in improving the quality and safety of care. This article describes the Child Health PSO and proposes PSOs as a new construct for LNs.Methods:A PSOs ability to affect patient care depends on member organizations’ integration of PSO output into their individual Learning Healthcare Systems. Therefore, the Child Health PSO developed tenets of an LN to improve member engagement in PSO outputs.Results:All Child Health PSO members participate in case-based learning, requiring ongoing and robust participation by all members. The engagement has been strong, with 86% of children’s hospitals achieving a case learning activity metric and 60% of children’s hospitals submitting cases. From this LNs perspective, 53% of children’s hospitals are considered highly engaged.Conclusions:In the last 10 years, the Child Health PSO has evolved as a viable LN and, to sustain this, has set a target of 100% of participating children’s hospitals being highly engaged. The previously inconceivable notion of sharing information to improve patient safety among hospitals is now an expected result of the formation of trusting relationships under a federally certified PSO. According to participants, collaboration is an essential element that empowers individual children’s hospitals to eliminate preventable harm.

Assessment of an electronic patient record system on discharge prescribing errors in a Tertiary University Hospital

BackgroundPrescribing error represent a significant source of preventable harm to patients. Prescribing errors at discharge, including omission of pre-admission medications (PAM), are particularly harmful as they frequently propagate following discharge. This study assesses the impact of an educational intervention and introduction of an electronic patient record (EPR) in the same centre on omission of PAM at discharge using a pragmatic design. A survey of newly qualified doctors is used to contextualise findings.MethodsDischarge prescriptions and discharge summaries were reviewed at discharge, and compared to admission medicine lists, using a paper-based chart system. Discrepancies were noted, using Health Information and Quality Authority guidelines for discharge prescribing. An educational intervention was conducted. Further review of discharge prescriptions and discharge summaries took place. Following introduction of an EPR, review of discharge summaries and discharge prescriptions was repeated. A survey was administered to recently qualified doctors (interns), and analysed using descriptive statistics and thematic analysis.ResultsOmission of PAM as prescribed or discontinued items at discharge occurs frequently. An educational intervention did not significantly change prescribing error rates (U = 1255.5, p = 0.206). EPR introduction did significantly reduce omission of PAM on discharge prescribing (U = 694, p < 0.001), however there was also a reduction in the rate of deliberate discontinuation of PAM at discharge (U = 1237.5, p = 0.007). Survey results demonstrated that multiple sources are required to develop a discharge prescription. Time pressure, access to documentation and lack of admission medicine reconciliation are frequently cited causes of discharge prescribing error.ConclusionThis study verified passive educational interventions alone do not improve discharge prescribing. Introduction of EPR improved discharge prescribing, but negatively impacted deliberate discontinuation of PAM at discharge. This is attributable to reduced access to key sources of information used in formulating discharge prescriptions, and separation of the discontinuation function from the prescribing function on the EPR discharge application.

Standard risk assessment forms help reduce preventable harm in older adult inpatients: A retrospective chart review study.

To examine nurse documentation of assessments using standard risk assessment forms in older inpatients, and to determine the value of such assessment. Cross-sectional retrospective chart review. This retrospective review of risk evaluation documentation in patients' medical records focused on skin, continence, medical complications, nutrition, cognition, mobility, medications and pain. A total of 1000 medical records from Taiwan hospitals were reviewed from January 2016 to December 2017, and 379 from Australian hospitals were reviewed from March 2011 to February 2012. Taiwanese patients with documented assessment of skin (aOR=2.94, 95%CI=1.88-4.54), nutrition (aOR=3.22, 95%CI=1.08-9.59), cognition (aOR=2.61, 95%CI=1.32-5.16) and pain (aOR=5.01, 95%CI=1.63-15.38) had significantly higher odds of developing new problems; while Australian patients with documented assessments of continence (aOR=11.55, 95%CI=1.48-90.45) and nutrition (aOR=12.90, 95%CI=1.67-99.06) had significantly higher odds of developing new problems. Nursing assessments and interventions documented in standard risk assessment forms help clinical nurses detect new preventable problems and prevent harm in older hospital inpatients across geographic locations and hospital types. Standard nursing forms can be used in clinical practice to guide proactive care by nurses to prevent harm during hospitalisation. Older inpatients are at risk of preventable harm and new health problems. The present study found that incorporating eight factors sensitive to nursing care into standard risk assessment forms can help reduce preventable harm in older inpatients. In addition, these forms guide assessment and intervention effectively in different countries.

Development and piloting of a prevention assessment and response tool for healthcare-associated Staphylococcus aureus bloodstream infection (the SAB-PART Study) using a Delphi method

Healthcare-associated Staphylococcus aureus bloodstream infection (HA-SAB) causes preventable harm in hospitalized patients. Currently, there is no standardized method available to review HA-SAB events in order to identify and target preventable risks requiring action at an organizational level. To develop a tool to classify SAB events, and the necessary response actions, according to the degree of preventability. Following a literature review, a tool was developed. Consensus feedback and development of the tool was sought from experts (N= 11) in healthcare-associated infection surveillance using a Delphi technique. The completed tool was retrospectively applied to HA-SAB events (N= 43) that occurred at a large healthcare organization. Survey completion rates were high (91-100%). Clinicians' poor adherence to infection prevention practices and lack of engagement with feedback processes was established as the key modifiable element. A second key theme was the need for structured and detailed response actions. This feedback was incorporated into the tool and refined until consensus on all elements was achieved. Pilot application of the tool found that 56% of HA-SAB events were highly or possibly preventable; modifiable factors for HA-SAB prevention were not present in the remainder of cases. A prevention assessment and response tool was successfully developed via a consensus method to assist organizations in investigating and responding to individual cases of HA-SAB and identify future priority areas for SAB reduction strategies. Wider use of the tool with routine surveillance activities is required to evaluate impact upon infection prevention programmes and patient outcomes.

Safeguarding in Australia’s new disability markets: Frontline workers’ perspectives

Despite significant efforts to end it, violence, abuse and neglect continue to contribute to preventable harms and deaths among people using disability services. To explore why these harms persist and what is needed to prevent them, we examine the safety-related attitudes and practices among frontline staff delivering services in the context of an individualized funding scheme, Australia’s National Disability Insurance Scheme (NDIS). Analysis of survey data (n=2341) showed almost half of frontline disability workers were aware of harms affecting clients in the past year, and three in five felt their employers’ safety and incident reporting protocols were inadequate. Workers’ accounts of barriers to performing their safeguarding roles underline how government’s meta-regulatory approach is enabling provider organizations to prioritise financial concerns and tolerate high safety risks. We argue that advancing the rights of people with disability to be safe from harm whilst engaged in social services requires changes in their external regulatory environments and in structures of power between workers and managers, so that policy, funding and regulatory settings enable appropriate local safety practices to flourish.

Intentional Leadership Rounds: A Proactive Approach to CAUTI Reduction

Background Catheter-associated urinary tract infections (CAUTI) are the most common preventable hospital-acquired infection. Our facility's rate of CAUTI was above the risk adjusted expected rate. Using intentional leadership rounds, we sought to reduce indwelling urinary catheter (IUC) utilization and thus reduce CAUTI events. Methods Using the Plan-Do-Study-Act model and a Pareto tool for data collection, intentional leader rounds were completed by an Infection Prevention (IP) nurse on two 20-bed medical-surgical units (Neuro-Oncology and Surgical). Units were identified using the National Healthcare Safety Network (NHSN) targeted assessment for prevention (TAP) strategy as units with excess burden of CAUTIs. An IP nurse rounded with nurse providers on each of these units daily (Monday – Friday) for five months, interacting with the nurse to determine if the indication for the IUC was appropriate, if care and maintenance were completed, and if the catheter could be removed or an external catheter placed. The standardized utilization ratio (SUR) was used to determine a decrease in catheter utilization and the standardized infection ratio (SIR) was used to track CAUTIs over time. Results After five months of leadership rounding on Neuro-Oncology and Surgical, the SUR decreased 22% and 12% respectively on each of these units. There were no additional CAUTI events identified during this time frame. Observations from leader rounds identified collaboration between IP and staff nurses to discover barriers on the units and engaged staff in problem-solving. In addition, sustained change was facilitated through the building of interpersonal relationships between IP and the bedside nurse. Conclusions Urinary device utilization was reduced on each unit and there were no additional CAUTI events identified. Integrating leader rounds as an added strategy to reduce CAUTIs connects leaders with clinical staff. Intentional leader rounding along with evidence-based practices to reduce preventable infections and patient harm should be integrated as a proactive overall prevention strategy.

Implementing a Watcher Program to Improve Timeliness of Recognition of Deterioration in Hospitalized Children

PurposeEarly recognition and response to clinical deterioration is critical to patient safety. Failures or delays in recognition and response often manifest as emergency transfers to the intensive care unit (ICU). We describe implementation of a program to improve recognition and response to clinical deterioration within the pediatric inpatient acute care setting (i.e., medical-surgical, hematology-oncology, and intermediate care units). Design and methodsWe assembled an inter-professional team including nurses, physicians, and hospital leaders to evaluate preventable patient harm events associated with failures in identifying and responding to clinical deterioration and resultant emergency transfers to the intensive care unit (ICU). We evaluated an existing situational awareness framework incorporating principles of high-reliability organizations, refined the framework utilizing internal event analyses data, and subsequently implemented a program reducing emergency transfers. ResultsEmergency transfers to the ICU from acute care settings decreased by more than 70%, and to date, this improvement has sustained. Nurses report increased satisfaction and empowerment to proactively escalate their concerns, respond to changes in a patient's condition, and reduce uncertainty about the plan of care. ConclusionsThe program has enhanced situational awareness, reduced emergency transfers, and fostered a culture of accountability and collaboration in alignment with the organizational core value of safety. Practice implicationsDeveloping a reliable system to support the healthcare team in recognizing and responding to clinical deterioration reduces the risk of care delays. Applying situational awareness to other high-risk situations, additional areas for program expansion were identified, to include emergency department admissions and behavioral health patients.

Implementing a Robust Process Improvement Program in the Neonatal Intensive Care Unit to Reduce Harm.

ABSTRACTIntroduction:Preventable harm continues to occur with critically ill neonates despite efforts by hospital neonatal intensive care units (NICUs) to improve processes and reduce harm. Attaining significant and sustainable improvements will require training including leadership support, mentoring, and patient family engagement to improve care processes. This paper describes the implementation of a robust process improvement (RPI) program in the NICU to reduce harm.Methods:Leaders, staff, and parents were trained in RPI concepts and tools. Multidisciplinary teams including parent members applied the training and received regular mentorship for their improvement initiatives.Results:Participants (N = 67) completed pretraining and post-training surveys. Training scores (0–10 scale) improved from an average of 4.45–7.60 (p < .001) for confidence in leading process improvement work, 2.36 to 7.49 (p < .001) for RPI knowledge, and 2.19 to 7.30 (p < .001) for confidence in using RPI tools; relative improvement of 71%, 217%, and 233% respectively. Participants applied their RPI training on improvement initiatives that resulted in improvements of central line blood stream infections, very low birth weight infant nutrition, and unplanned extubations.Conclusions:Implementing an RPI program in the NICU to reduce harm resulted in significant and sustainable improvements on their improvement initiatives.

Using Fitbit data to predict clinical deterioration and unplanned treatment events in cancer outpatients.

e13560 Background: A common cause of preventable harm is the failure to detect and appropriately respond to clinical deterioration. Timely intervention is needed, particularly in cancer patients, to mitigate the effects of adverse events, disease progression, and medical error. This problem requires effective clinical surveillance, early recognition, timely notification of the appropriate clinician, and effective intervention. Methods: Applying a user-centered systems engineering design approach, we designed and implemented a surveillance-and-response system to improve the detection and response to clinical deterioration in cancer outpatients. The surveillance system predicts 7-day risk of UTEs, defined as clinically meaningful changes in the patient’s treatment course or cancer care pathway (e.g., any unplanned/unexpected: clinic or ER visit, hospital admission, or major treatment change and/or delays, and/or death). Data inputs consist of: 1) patient activity and health data collected by a Fitbit monitor; 2) geolocation data to measure activity outside the home (i.e., locations preselected at study onset); 3) clinical data from the hospital’s electronic health record; and 4) patient-reported outcomes measures (i.e., PROMs; the NCCN Distress Thermometer, the Comprehensive OpeN-Ended Survey or CONES, Global Health Score, items from the Consumer Assessment of Healthcare Providers and Systems (CAHPS)). Herein, we measured the effectiveness of Fitbit data alone to UTEs in a pilot sample of patients. Dimension reduction of Fitbit variables was first carried out by using Pearson correlation analysis to eliminate redundant variables. As UTEs are rare events, they were oversampled using the Synthetic Minority Oversampling Technique (SMOTE) to balance the dataset. A random forest classification model was trained to predict 7-day UTE risk. Model accuracy was determined by calculating the mean of Stratified 5-Fold Cross-Validation with 10 repeats. Results: Fitbit data was collected over a 6-8-week period from 14 head and neck cancer patients receiving surgical resection, outpatient chemotherapy, and/or radiotherapy. We identified six UTEs in 5 patients. A random forest classification model was developed from 10 variables derived from 7 Fitbit measures. The following variables were averaged or summed daily: average heart rate (HR), resting HR, below 50% or zone 1 of maximum HR, zone 2 and zone 3 HR combined (i.e., 70-100% of max HR), total daily calories, steps, and sleep in minutes. We achieved a model accuracy of 94% (ROC AUC: 0.984, Precision-Recall AUC: 0.985). Conclusions: Activity and health data collected by a commercial activity monitor demonstrated effectiveness in predicting patient UTEs when an oversampling procedure was used to adjust for class imbalance (i.e., low UTE rate). Future studies are recommended to verify and validate this result in a larger patient sample.

Delayed access to care and late presentations in children during the COVID-19 pandemic New Zealand-wide lockdown: A New Zealand Paediatric Surveillance Unit study.

AimDescribe paediatricians' experience of adverse health outcomes for children during the New Zealand‐wide level 4 lockdown in response to the COVID‐19 pandemic.MethodsWeekly national survey of paediatricians with an open‐ended questionnaire.ResultsDuring the 6‐week study survey period, the New Zealand Paediatric Surveillance Unit received 33 reports about 55 instances where paediatricians believed care may have been compromised, about half (56%) relating to infants aged from birth to 6 weeks. Compromised care was for acute presentations in 75%, acute complications of a chronic illness in 14%, with 11% for chronic conditions. Paediatricians reported the outcome as moderately severe (short‐term morbidity, increased length of stay, higher level of care) in 38 cases (69%) and in a further 4 (7%) as severe (potential to be life‐threatening or result in permanent disability).ConclusionDespite clear messaging, hospital avoidance and reduced access to primary and secondary care were associated with significant potential harm for children in New Zealand during a strict lockdown, with newborn infants disproportionately affected. During the implementation of interventions to eliminate community transmission of COVID‐19, New Zealand paediatricians note the importance of face‐to‐face post‐natal visits for newborns and primary care services for children with acute illness, to avoid preventable harm.

Towards an AI Coach to Infer Team Mental Model Alignment in Healthcare.

Shared mental models are critical to team success; however, in practice, team members may have misaligned models due to a variety of factors. In safety-critical domains (e.g., aviation, healthcare), lack of shared mental models can lead to preventable errors and harm. Towards the goal of mitigating such preventable errors, here, we present a Bayesian approach to infer misalignment in team members' mental models during complex healthcare task execution. As an exemplary application, we demonstrate our approach using two simulated team-based scenarios, derived from actual teamwork in cardiac surgery. In these simulated experiments, our approach inferred model misalignment with over 75% recall, thereby providing a building block for enabling computer-assisted interventions to augment human cognition in the operating room and improve teamwork.

Venous Thromboembolism among Noncritically Ill Hospitalized Children: Key Considerations for the Pediatric Hospital Medicine Specialist.

Venous thromboembolism (VTE) is a leading cause of morbidity and preventable harm among noncritically ill hospitalized children. Several clinical factors relevant to the noncritically ill hospitalized child significantly increase the risk of VTE including the presence of central venous catheters, systemic inflammation, and prolonged immobilization. Although risk mitigation strategies have been described, the diagnosis, treatment, and prevention of VTE require standardization of institutional practices combined with multidisciplinary collaboration among pediatric hospitalists, hematologists, and other care providers. In this narrative review, we summarize the epidemiology of VTE, risk models identifying high-risk conditions associated with VTE, and prevention and treatment strategies. We further describe successful quality improvement efforts implementing institutional VTE risk stratification and thromboprophylaxis procedures. Finally, we highlight unique challenges facing pediatric hospital medicine specialists in the era of the COVID-19 pandemic, including caring for adults admitted to pediatric hospital units, and describe future research opportunities for VTE in the noncritically ill hospitalized child.

Do people living in rural and urban locations experience differences in harm when admitted to hospital? A cross-sectional New Zealand general practice records review study

ObjectiveLittle is known about differences in hospital harm (injury, suffering, disability, disease or death arising from hospital care) when people from rural and urban locations require hospital care. This study...

Reducing Surgical Specimen Errors Through Multidisciplinary Quality Improvement.

Each year, our institution performs more than 34,000 surgical cases and obtains close to 10,000 surgical specimens. Within those procedures, we averaged 10 errors for every 1,000 surgical specimens. Any level of preventable harm is unacceptable, as it could lead to risks of treatment delay, improper therapy selection, or missed diagnoses. This quality improvement (QI) effort aimed to decrease errors in surgical specimens from 10 errors per 1,000 surgical specimens to 0 errors each month. Using the Institute for Healthcare Improvement Model for Improvement QI methodology, we determined the root causes of error, identified key drivers, and tested change interventions. We implemented changes in surgical specimen labeling, standardized specimen time-out and reconciliation processes, and optimized a method of communication between consultants, surgeons, operating room staff, and laboratory staff with the implementation of a Specimen Request Form. Over 46 months, we identified 234 specimen errors in 33,962 surgical pathology specimens. The error rate was reduced from 10 to 2.31 errors per 1,000 specimens. The mean rate of order errors decreased from 3.66 to 0.13 per month, and the mean rate of labeling-related errors decreased from 1.5 to 0.5 per month. A multidisciplinary project team implemented changes to specimen test requesting and intraoperative specimen handling with an associated reduction in errors to reduce potential patient harm involving surgical specimen errors. This article demonstrates how applying these methods and interventions can be associated with a reduction in surgical specimen errors.

RCT comparing the clinical effectiveness of conventional instructor-facilitated cardiac compression training to technology enhanced training using high-fidelity mannequins-A pilot study

Introduction: Healthcare professionals often provide substandard chest compression following cardiac arrest. This is deemed a preventable harm because this skill can be acquired. The recent development of technology-enhanced cardiac compression training devices provides an alternative to traditional instructor-facilitated training. This pilot study compared the effectiveness of conventional and technology-enhanced training modalities.Methods: A pilot randomised controlled trial design was used in a regional hospital in Queensland. Following baseline assessment, healthcare staff were randomised to one of three groups: traditional instructor-facilitated training; high-fidelity mannequin training and continuous access to the training system to practise skills; and, high-fidelity mannequin training with no further access to the training system to practise skills. The primary outcome, cardiac compression skill levels, was analysed using analysis of co-variance, adjusting for predictive co-variates. Secondary measures were analysed using inferential statistics or presented descriptively.Results: Between January and February 2017, 502 healthcare staff were recruited. At baseline, 21\% were competent in cardiac compression, increasing to 38% on reassessment. The mode of training did not affect skill level (F(92,392) = 0.061, p = .94), however, participants in the high-fidelity mannequin training group who practised their skills had statistically significantly higher reassessment scores (z = -2.34, p = .019). Baseline score and the number of times participants practised their skills were significant predictors of reassessment scores (F(2,392) = 7.73, p = .001).Conclusions: Most hospital staff who may need to perform cardiac compression were not competent in this skill. Neither training modality was more effective. Both training and practise increased cardiac compression skill levels, indicating that frequent, low-dose training is required.

Capital and Chlordecone Poisoning in the French Caribbean Islands of Guadeloupe and Martinique: A Thesis on Crimes of the Market

ABSTRACT Guadeloupe and Martinique, two French overseas territories located in the Caribbean, are today facing serious public health crises; particularly, the highest rates of prostate cancer in the world. These crises resulted from the French colonial policy of primitive accumulation, which authorized two decades of the use of a carcinogenic pesticide, chlordecone (a.k.a. Kepone), by French settler farmers to control banana weevil pests. This was despite evidence of its lethal toxicity. Deploying the theoretical arguments of Market Criminology, this paper discusses the current health crises in both islands and the political economy of predation which created them as criminal. This is in sync with a growing body of literature which contextualizes preventable market-generated harms as criminal.