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Rapolti D, Kisa P, Situma M, Nico E, Lobe T, Sims T, Ozgediz D, Klazura G. The Creation of a Pediatric Surgical Checklist for Adult Providers. RESEARCH SQUARE 2023:rs.3.rs-3269257. [PMID: 37790469 PMCID: PMC10543282 DOI: 10.21203/rs.3.rs-3269257/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Purpose To address the need for a pediatric surgical checklist for adult providers. Background Pediatric surgery is unique due to the specific needs and many tasks that are employed in the care of adults require accommodations for children. There are some resources for adult surgeons to perform safe pediatric surgery and to assist such surgeons in pediatric emergencies, we created a straightforward checklist based on current literature. We propose a surgical checklist as the value of surgical checklists has been validated through research in a variety of applications. Methods Literature review on PubMed to gather information on current resources for pediatric surgery, all papers on surgical checklists describing their outcomes as of October 2022 were included to prevent a biased overview of the existing literature. Interviews with multiple pediatric surgeons were conducted for the creation of a checklist that is relevant to the field and has limited bias. Results 42 papers with 8529061 total participants were included. The positive impact of checklists was highlighted throughout the literature in terms of outcomes, financial cost and team relationship. Certain care checkpoints emerged as vital checklist items: antibiotic administration, anesthetic considerations, intraoperative hemodynamics and postoperative resuscitation. The result was the creation of a checklist that is not substitutive for existing WHO surgery checklists but additive for adult surgeons who must operate on children in emergencies. Conclusion The outcomes measured throughout the literature are varied and thus provide both a nuanced view of a variety of factors that must be taken into account and are limited in the amount of evidence for each outcome. We hope to implement the checklist developed to create a standard of care for pediatric surgery performed in low resource settings by adult surgeons and further evaluate its impact on emergency pediatric surgery outcomes. Funding Fulbright Fogarty Fellowship, GHES NIH FIC D43 TW010540.
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Affiliation(s)
- Diana Rapolti
- University of Illinois Hospital and Health Sciences System
| | | | | | - Elsa Nico
- University of Illinois Hospital and Health Sciences System
| | - Thom Lobe
- University of Illinois Hospital and Health Sciences System
| | - Thomas Sims
- University of Illinois Hospital and Health Sciences System
| | | | - Greg Klazura
- University of Illinois Hospital and Health Sciences System
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Lopezosa-Reca E, Martínez-Nova A, Sánchez-Rodríguez R, Gijon-Nogueron G, Marchena-Rodriguez A, Martinez-Rico M, Alabau-Dasi R. Effectiveness of hyaluronic acid in post-surgical cures following partial matricectomies with the phenol/alcohol technique: A randomized clinical trial. J Tissue Viability 2023; 32:59-62. [PMID: 36725463 DOI: 10.1016/j.jtv.2023.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 01/26/2023] [Indexed: 01/30/2023]
Abstract
BACKGROUND Post-operative cures with hyaluronic acid (HA) could potentially shorten the period recovery involved in the phenol technique for ingrown toenail. The aim of this study was therefore to compare a standard healing protocol with the experimental one based on hyaluronic acid cream. MATERIAL AND METHODS 70 patients who had undergone phenol technique surgery for ingrown toenail were divided into two groups - control (n = 35) who received post-operative cures following the standard protocol with povidone iodine gel, and experimental (n = 35) who received cures with HA in the first 3 visits. Bleeding, total healing time, and perceived pain were assessed. RESULTS Patients in the control group recovered from the intervention in a total of 26.17 ± 7.75 days, while those in the HA group recovered in a significantly shorter time - 22.42 ± 2.41 days (p = 0.007, effect size 0.653). However, there were no between-group statistical differences in bleeding or perceived pain over the course of the post-surgery visits. CONCLUSIONS The use of low molecular weight hyaluronic acid is effective in reducing the phenol-technique healing time by 4 days compared with the standard cure. However, no extra effects such as reductions in bleeding or perceived pain can be expected in choosing this healing protocol.
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Affiliation(s)
| | | | | | - Gabriel Gijon-Nogueron
- Department of Nursing and Podiatry, Universidad de Málaga, Spain; Instituto de Investigación Biomédica de Málaga IBIMA, Spain
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Munthali J, Pittalis C, Bijlmakers L, Kachimba J, Cheelo M, Brugha R, Gajewski J. Barriers and enablers to utilisation of the WHO surgical safety checklist at the university teaching hospital in Lusaka, Zambia: a qualitative study. BMC Health Serv Res 2022; 22:894. [PMID: 35810290 PMCID: PMC9271243 DOI: 10.1186/s12913-022-08257-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/16/2022] [Indexed: 12/04/2022] Open
Abstract
Background Surgical perioperative deaths and major complications are important contributors to preventable morbidity, globally and in sub-Saharan Africa. The surgical safety checklist (SSC) was developed by WHO to reduce surgical deaths and complications, by utilising a team approach and a series of steps to ensure the safe transit of a patient through the surgical operation. This study explored barriers and enablers to the utilisation of the Checklist at the University Teaching Hospital (UTH) in Lusaka, Zambia. Methods A qualitative case study was conducted involving members of surgical teams (doctors, anaesthesia providers, nurses and support staff) from the UTH surgical departments. Purposive sampling was used and 16 in-depth interviews were conducted between December 2018 and March 2019. Data were transcribed, organised and analysed using thematic analysis. Results Analysis revealed variability in implementation of the SSC by surgical teams, which stemmed from lack of senior surgeon ownership of the initiative, when the SSC was introduced at UTH 5 years earlier. Low utilisation was also linked to factors such as: negative attitudes towards it, the hierarchical structure of surgical teams, lack of support for the SSC among senior surgeons and poor teamwork. Further determinants included: lack of training opportunities, lack of leadership and erratic availability of resources. Interviewees proposed the following strategies for improving SSC utilisation: periodic training, refresher courses, monitoring of use, local adaptation, mobilising the support of senior surgeons and improvement in functionality of the surgical teams. Conclusion The SSC has the potential to benefit patients; however, its utilisation at the UTH has been patchy, at best. Its full benefits will only be achieved if senior surgeons are committed and managers allocate resources to its implementation. The study points more broadly to the factors that influence or obstruct the introduction and effective implementation of new quality of care initiatives. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08257-y.
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Affiliation(s)
- Judith Munthali
- University Teaching Hospital, Nationalist Rd, Lusaka, Zambia.
| | - Chiara Pittalis
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Leon Bijlmakers
- Department for Health Evidence, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - John Kachimba
- Department of Surgery, Surgical Society of Zambia, University of Zambia University Teaching Hospital, Lusaka, Zambia
| | - Mweene Cheelo
- Department of Surgery, Surgical Society of Zambia, University of Zambia University Teaching Hospital, Lusaka, Zambia
| | - Ruairi Brugha
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jakub Gajewski
- Institute of Global Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Effect of Phenol Application Time in the Treatment of Onychocryptosis: A Randomized Double-Blind Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910478. [PMID: 34639778 PMCID: PMC8508160 DOI: 10.3390/ijerph181910478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/08/2021] [Accepted: 10/02/2021] [Indexed: 11/30/2022]
Abstract
Background: In the treatment of Onychocryptosis, chemical matricectomy with 88% phenol solution is one of the most common surgical procedures due to a recurrence rate of less than 5%, but it may produce a delay in healing time. The objective was to compare the healing time between phenol applications of 30 or 60 s. Methods: A comparative, prospective, parallel, randomized, and blinded clinical trial was registered with the European Clinical Trials Database. Twenty-seven patients (54 feet) with 108 affected nail folds were randomized and treated with chemical matricectomy with phenol. Each hallux was randomly assigned to one of two groups (60 vs. 30 s phenolization). Each patient and one investigator were blinded to the phenol application time in each foot. The outcome measurements were healing time, recurrence, pain, post-surgical bleeding, inflammation, and infection rate. Results: The 30 s application presents a shorter healing time (14.93 ± 2.81 days vs. 22.07 ± 3.16 days; p < 0.001) with a similar recurrence rate (p = 0.99). Post-operatory bleeding, pain, inflammation, and the infection rate did not show significant differences (p > 0.05). Conclusions: The 30 s phenol application time offers a shorter healing time than 60 s without affecting the effectiveness of the procedure, showing the same rate of complications.
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Ramírez-Torres CA, Pedraz-Marcos A, Maciá-Soler ML, Rivera-Sanz F. A Scoping Review of Strategies Used to Implement the Surgical Safety Checklist. AORN J 2021; 113:610-619. [PMID: 34048038 DOI: 10.1002/aorn.13396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/01/2020] [Accepted: 11/06/2020] [Indexed: 12/11/2022]
Abstract
In 2007, the World Health Organization initiated the Surgical Safety Checklist (SSC) as part of an initiative to improve patient outcomes. After publication of the SSC, perioperative nurses identified challenges with implementing it and questioned its effectiveness. We desired to summarize the state of the science on the effectiveness of strategies that perioperative personnel have used to implement and assess the SSC; therefore, we conducted a scoping review. We searched several databases and identified 28 articles that described the three key stages of SSC implementation (ie, before, during, and after). Half of the identified articles addressed intervention strategies and most articles provided strategies for SSC implementation. The literature also indicated that effective implementation occurred when there was adequate planning. Perioperative leaders should work with nurses when implementing the SSC and monitor its use after implementation to verify compliance and help prevent negative patient outcomes.
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Coheña-Jiménez M, Chicharro-Luna E, Del-Castillo JA, Chacón-Giráldez F, Paéz-Tudela A, Montaño-Jiménez P. Medium-Term Outcomes of Chevron Osteotomy for Hallux Valgus Correction in a Spanish Population: Radiologic and Clinical Parameters and Patient Satisfaction. J Am Podiatr Med Assoc 2021; 111:447931. [PMID: 33196776 DOI: 10.7547/18-159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Chevron osteotomy for mild and moderate hallux valgus obtains good effects. It is suitable for a variety of cases, allowing for a significant degree of correction. This study aimed to investigate chevron osteotomy for the correction of hallux valgus in the medium-term by podiatric surgeons. It considers clinical and radiologic findings and patient perspectives and level of satisfaction. METHODS Forty-five patients (50 feet) were assessed preoperatively, postoperatively, and at final follow-up. Mean patient age was 59.43 years (range, 32-80 years). The protocols include medical record review, clinical examination, and radiologic assessment. Anteroposterior weightbearing radiographs were analyzed preoperatively and at final follow-up. Clinical effects were analyzed with visual analog scale and American Orthopaedic Foot and Ankle Society (AOFAS) scores. RESULTS Interobserver and intraobserver reliability were evaluated. Mean ± SD hallux valgus angle decreased at final follow-up (25.30° ± 7.21° versus 17.25° ± 10.32°; P = .041). There was no significant reduction in mean ± SD intermetatarsal angle at final follow-up (13.13° ± 3.03° versus 7.65° ± 3.47°; P = .078). Final AOFAS score was 82.08 ± 17.66. This study showed the relevance of magnet therapy, nail surgery, and other procedures. No patient was dissatisfied with the aesthetic scarring. CONCLUSIONS The radiologic results at final follow-up were not compatible with relapse of the deformity. The definitive clinical results and the degree of patient satisfaction achieved with this technique were favorable from the patients' point of view.
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Coheña-Jiménez M, Chicharro-Luna E, Algaba-Del-Castillo J, Páez-Tudela A. Foot health among the Roma population of southern Spain according to the foot health status questionnaire. BMC Public Health 2020; 20:462. [PMID: 32252719 PMCID: PMC7137201 DOI: 10.1186/s12889-020-08571-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Foot health of the Roma population is a challenge for the health professionals where this minority is significant, as is the case in Spain. At present, little is known about foot health of the Roma population and their knowledge would promote the training of these professionals at the community level. Foot pain is common and a reason for consulting podiatry services. The purpose of this study was to determine foot health among the Roma population according to the Foot Health Status Questionnaire. METHOD An observational, cross-sectional and quantitative study conducted at the Roma population living in Spain in 2018. Self-reported data and the Foot Health Status Questionnaire were recorded. Examining the general health and foot health (foot pain, foot function, footwear and general health) and general (general health, social capacity, physical activity and vigour). This questionnaire is recommended as a valid and reliable patient-reported outcome. The obtained scores were compared. RESULTS A sample made up of 624 men and women from the Roma population took part in this study. 45% were Roma men and 55% Roma women. In the first section of the FHSQ, a lower score of values was recorded in the footwear domain (62.5) and in the general foot health domain (60). Gypsy women obtained lower scores in all the domains. In the second section, lower scores were obtained in the vigour (56) domain and in the general health (60) domain. A large effect size (r-Rosenthal) was found by gender in the footwear domain (0.334) and in the vigour domain (0.195). Roma women showed higher values in cardiac disorders, serious illnesses, doctor visits and foot problems. 67.8% reported that they had never been assisted by a podiatrist. CONCLUSIONS The studied Roma population has foot health problems, and these are more pronounced among women. They show lower values in the footwear and vigour domains. More professional training is required for health workers in this field to avoid cultural diversity stereotypes.
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Affiliation(s)
- Manuel Coheña-Jiménez
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Avicena st, 41009 Sevilla, Spain
| | - Esther Chicharro-Luna
- Department of Behavioral Sciences and Health, Faculty of Medicine, University Miguel Hernández, San Juan de Alicante, Spain
| | - José Algaba-Del-Castillo
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Avicena st, 41009 Sevilla, Spain
| | - Amanda Páez-Tudela
- Department of Podiatry, Faculty of Nursing, Physiotherapy and Podiatry, University of Sevilla, Avicena st, 41009 Sevilla, Spain
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The Treatment of Ingrown Nail: Chemical Matricectomy With Phenol Versus Aesthetic Reconstruction. A Single Blinded Randomized Clinical Trial. J Clin Med 2020; 9:jcm9030845. [PMID: 32244966 PMCID: PMC7141528 DOI: 10.3390/jcm9030845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 03/10/2020] [Accepted: 03/18/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In onychocryptosis surgery, incisional and non-incisional matricectomy is indicated according to the stage. The chemical matricectomy with 88% phenol solution is the gold standard and a wedge resection is indicated for more advanced stages. The aesthetic reconstruction has the advantages of the incisional procedure without eponychium incisions and an effectiveness similar to the chemical matricectomy with phenol. OBJECTIVE To compare the recurrence and the healing time between the chemical matricectomy with phenol and the aesthetic reconstruction. METHODS A comparative, prospective, parallel, randomized, and one-blinded clinical trial was registered with the European Clinical Trials Database (EudraCT) with identification number 2019-001294-80. Thrity-four patients (56 feet) with 112 onychocryptosis were randomized in two groups. Thirty-six were treated with chemical matricectomy with phenol and 76 with aesthetic reconstruction. Each patient was blind to the surgical procedure assigned by the investigator. The primary outcome measurements were healing time and recurrence. The secondary outcome measurements were post-surgical bleeding, pain, inflammation, and infection rate. RESULTS The aesthetic reconstruction procedure presents a shorter healing time (8.2 ± 1.4 days vs. 21.3 ± 3.1 days; p < 0.001) with a similar recurrence rate (p = 0.98). Post-operatory bleeding, pain, inflammation, and the infection rate did not show significant differences (p > 0.05). CONCLUSIONS The aesthetic reconstruction presents a shorter healing time, favoring the patients' recuperation, with a recurrence similar to the chemical matricectomy with 88% phenol solution.
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Yu D, Zhao Q. Effect Of Surgical Safety Checklists On Gastric Cancer Outcomes: A Single-Center Retrospective Study. Cancer Manag Res 2019; 11:8845-8853. [PMID: 31632144 PMCID: PMC6790110 DOI: 10.2147/cmar.s218686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 09/17/2019] [Indexed: 12/30/2022] Open
Abstract
Aims Surgery is the primary treatment option for patients with gastric cancer, however the rate of postoperative complications are still high. The implementation of surgical safety checklists (SSCs) has been shown to reduce morbidity and mortality. This study aimed to evaluate the effect of SSCs on the clinical outcomes of gastric cancer. Methods A total of 881 gastric cancer patients who underwent D2 gastrectomy from May 2009 to April 2011 in a large teaching hospital in China were included in this retrospective study. Patients were matched and divided into the control group (SSC nonimplementation) and intervention group (SSC implementation). The outcomes including intraoperative condition, postoperative complications, and prognosis were then compared between the groups. Results The control group comprised 414 patients (47.0%), and the intervention group included 467 patients (53.0%). Patients in the intervention group had a significantly shorter length of postoperative stay (P < 0.001). Operation time, blood loss, blood transfusion, and hospital charges were comparable between the two groups (all P > 0.05). SSC was not associated with postoperative complications (all P > 0.05). Overall survival was also comparable between patients in the two groups (P > 0.05). Conclusion The implementation of an SSC was associated with a decreased length of postoperative stay in gastric cancer patients following D2 gastrectomy but did not significantly affect the other outcomes.
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Affiliation(s)
- Deliang Yu
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, Shaanxi 710032, People's Republic of China
| | - Qingchuan Zhao
- Department of Digestive Surgery, Xijing Hospital of Digestive Diseases, Air Force Military Medical University, Xi'an, Shaanxi 710032, People's Republic of China
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Implementation strategies to reduce surgical site infections: A systematic review. Infect Control Hosp Epidemiol 2019; 40:287-300. [PMID: 30786946 DOI: 10.1017/ice.2018.355] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) portend high patient morbidity and mortality. Although evidence-based clinical interventions can reduce SSIs, they are not reliably delivered in practice, and data are limited on the best approach to improve adherence. OBJECTIVE To summarize implementation strategies aimed at improving adherence to evidence-based interventions that reduce SSIs. DESIGN Systematic reviewMethods:We searched PubMed, Embase, CINAHL, the Cochrane Library, the WHO Regional databases, AFROLIB, and Africa-Wide for studies published between January 1990 and December 2015. The Effective Practice and Organization Care (EPOC) criteria were used to identify an acceptable-quality study design. We used structured forms to extract data on implementation strategies and grouped them into an implementation model called the "Four Es" framework (ie, engage, educate, execute, and evaluate). RESULTS In total, 125 studies met our inclusion criteria, but only 8 studies met the EPOC criteria, which limited our ability to identify best practices. Most studies used multifaceted strategies to improve adherence with evidence-based interventions. Engagement strategies included multidisciplinary work and strong leadership involvement. Education strategies included various approaches to introduce evidence-based practices to clinicians and patients. Execution strategies standardized the interventions into simple tasks to facilitate uptake. Evaluation strategies assessed adherence with evidence-based interventions and patient outcomes, providing feedback of performance to providers. CONCLUSIONS Multifaceted implementation strategies represent the most common approach to facilitating the adoption of evidence-based practices. We believe that this summary of implementation strategies complements existing clinical guidelines and may accelerate efforts to reduce SSIs.
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Macedo RSD, Bohomol E. Validation of self-assessment instrument for the Patient Safety Center. Rev Bras Enferm 2019; 72:259-265. [DOI: 10.1590/0034-7167-2017-0657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/16/2018] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To develop and validate an instrument for the self-assessment of the Patient Safety Centers in health care institutions. Method: Non-experimental methodological study. Divided in the following stages: literature review and construction of the preliminary instrument; content validation by nine professionals with experience in Quality Management and patient safety, who contributed to the adequacy of the items in terms of clarity and relevance; finally, 12 PSC coordinators, which conducted the reliability validation of the final instrument, using Cronbach's Alpha. Results: The instrument presented content validity regarding clarity and relevance, evidenced by an agreement level greater than 70%. The internal consistency presented high reliability, with a Cronbach's alpha of 0.857 for the general instrument, 0.825 for the domain Structure, and 0.809 for the domain Process. Conclusion: The instrument presented evidence of content validity and reliability for self-assessment, implementation and evaluation of the PSC in health institutions.
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Gillespie BM, Hamilton K, Ball D, Lavin J, Gardiner T, Withers TK, Marshall AP. Unlocking the "black box" of practice improvement strategies to implement surgical safety checklists: a process evaluation. J Multidiscip Healthc 2017; 10:157-166. [PMID: 28435283 PMCID: PMC5388350 DOI: 10.2147/jmdh.s124298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Compliance with surgical safety checklists (SSCs) has been associated with improvements in clinical processes such as antibiotic use, correct site marking, and overall safety processes. Yet, proper execution has been difficult to achieve. Objectives The objective of this study was to undertake a process evaluation of four knowledge translation (KT) strategies used to implement the Pass the Baton (PTB) intervention which was designed to improve utilization of the SSC. Methods As part of the process evaluation, a logic model was generated to explain which KT strategies worked well (or less well) in the operating rooms of a tertiary referral hospital in Queensland, Australia. The KT strategies implemented included change champions/opinion leaders, education, audit and feedback, and reminders. In evaluating the implementation of these strategies, this study considered context, intervention and underpinning assumptions, implementation, and mechanism of impact. Observational and interview data were collected to assess implementation of the KT strategies relative to fidelity, feasibility, and acceptability. Results Findings from 35 structured observations and 15 interviews with 96 intervention participants suggest that all of the KT strategies were consistently implemented. Of the 220 staff working in the department, that is, nurses, anesthetists, and surgeons, 160 (72.7%) knew about the PTB strategies. Qualitative analysis revealed that implementation was generally feasible and acceptable. A barrier to feasibility was physician engagement. An impediment to acceptability was participants’ skepticism about the ability of the KT strategies to effect behavioral change. Conclusion Overall, results of this evaluation suggest that success of implementation was moderate. Given the probable impact of contextual factors, that is, team culture and the characteristics of participants, the KT strategies may need modification prior to widespread implementation.
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Affiliation(s)
- Brigid M Gillespie
- School of Nursing & Midwifery, Griffith University, Gold Coast.,Gold Coast University Hospital and Health Service, Southport.,Nursing & Midwifery Education & Research Unit (NMERU), National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast
| | - Kyra Hamilton
- School of Applied Psychology, Griffith University, Mt Gravatt
| | | | | | | | - Teresa K Withers
- Surgical and Procedural Services, Gold Coast University Hospital and Health Service, Southport, Australia
| | - Andrea P Marshall
- School of Nursing & Midwifery, Griffith University, Gold Coast.,Gold Coast University Hospital and Health Service, Southport.,Nursing & Midwifery Education & Research Unit (NMERU), National Centre of Research Excellence in Nursing, Menzies Health Institute of Queensland, Griffith University, Gold Coast
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Harris AM, Preece K, Harris C. Using a STOP/GO protocol in the preoperative area to increase patient safety. J Perioper Pract 2016; 26:229-231. [PMID: 29328740 DOI: 10.1177/175045891602601004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/22/2016] [Indexed: 11/17/2022]
Abstract
A multitude of surgeries are performed each year and 15% of cases have an adverse event, most of which are preventable. A culture of safety must be adopted by the entire surgical team. A preoperative checklist in addition to the intraoperative checklist can help decrease errors. We adapted a Stop/Go process in the preoperative area which had to be completed prior to moving the patient into the operating room. We examined adverse events before and after this process. Adverse events decreased from 1.5% to nearly 0% over the time examined. The Stop/Go preoperative checklist, adapted to our specific operating room needs, helped to decrease adverse events.
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Affiliation(s)
| | - Keen Preece
- Paul B Hall Regional Medical Center, Paintsville, KY, USA
| | - Chris Harris
- Harris Leans Systems, Inc. Murrells Inlet, SC, USA
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Gillespie BM, Withers TK, Lavin J, Gardiner T, Marshall AP. Factors that drive team participation in surgical safety checks: a prospective study. Patient Saf Surg 2016; 10:3. [PMID: 26793274 PMCID: PMC4719703 DOI: 10.1186/s13037-015-0090-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 12/23/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Team-based group communications using checklists are widely advocated to achieve shared understandings and improve patient safety. Despite the positive effect checklists have on collaborations and reduced postoperative complications, their use has not been straightforward. Previous research has described contextual factors that impact on the implementation of checklists, however there is limited understanding of the issues that impede team participation in checklist use in surgery. The aim of this prospective study was to identify and describe factors that drive team participation in safety checks in surgery. METHODS We observed ten surgical teams and conducted 33 semi-structured interviews with 70 participants from nursing, surgery and anaesthetics, and the community. Constant comparative methods were used to analyse textual data derived from field notes and interviews. Observational and interview data were collected during 2014-15. RESULTS Analysis of the textual data generated from the field notes and interviews revealed the extent to which members of the surgical team participated in using the surgical safety checklist during each phase of patient care. These three categories included: 'using the checklist'; 'working independently'; and, 'communicating checks with others'. The phases in the checking process most vulnerable to information loss or omission were sign in and sign out. CONCLUSIONS Team participation in safety checks depends on a convergence of intertwined factors; namely, team attributes, communication strategies and checking processes. A whole-of-team approach to participation in surgical safety checks is far more complex when considering the factors that drive participation. Strategies to increase participation in safety checks need to target professional communication practices and work processes such as workflow which curtail team members' ability to participate.
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Affiliation(s)
- Brigid M. Gillespie
- />NHMRC Centre for Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation (HPI), Menzies Health Institute Qld (MHIQ), Griffith University, Parklands Drive, Gold Coast Campus, Gold Coast, QLD 4222 Australia
| | - Teresa K. Withers
- />Gold Coast University Hospital, Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, QLD 4215 Australia
| | - Joanne Lavin
- />Gold Coast University Hospital, Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, QLD 4215 Australia
| | - Therese Gardiner
- />Gold Coast University Hospital, Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, QLD 4215 Australia
| | - Andrea P. Marshall
- />NHMRC Centre for Research Excellence in Nursing (NCREN), Centre for Health Practice Innovation (HPI), Menzies Health Institute Qld (MHIQ), Griffith University, Parklands Drive, Gold Coast Campus, Gold Coast, QLD 4222 Australia
- />Gold Coast University Hospital, Gold Coast Hospital and Health Service, 1 Hospital Boulevard, Southport, QLD 4215 Australia
- />School of Nursing and Midwifery, Griffith University, Gold Coast Campus, Nathan, QLD 4222 Australia
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