Factors affecting effective ventilation during newborn resuscitation: a qualitative study among midwives in rural Tanzania

Background: Intrapartum-related hypoxia accounts for 30% of neonatal deaths in Tanzania. This has led to the introduction and scaling-up of the Helping Babies Breathe (HBB) programme, which is a simulation-based learning programme in newborn resuscitation skills. Studies have documented ineffective ventilation of non-breathing newborns and the inability to follow the HBB algorithm among providers. Objective: This study aimed at exploring barriers and facilitators to effective bag mask ventilation, an essential component of the HBB algorithm, during actual newborn resuscitation in rural Tanzania. Methods: Eight midwives, each with more than one year’s working experience in the labour ward, were interviewed individually at Haydom Lutheran Hospital, Tanzania. The audio recordings were transcribed and translated into English and analysed using qualitative content analysis. Results: Midwives reported the ability to monitor labour properly, preparing resuscitation equipment before delivery, teamwork and frequent ventilation training as the most effective factors in improving actual ventilation practices and promoting the survival of newborns. They thought that their anxiety and fear due to stress of ventilating a non-breathing baby often led to poor resuscitation performance. Additionally, they experienced difficulties assessing the baby’s condition and providing appropriate clinical responses to initial interventions at birth; hence, further necessary actions and timely initiation of ventilation were delayed. Conclusions: Efforts should be focused on improving labour monitoring, birth preparedness and accurate assessment immediately after birth, to decrease intrapartum-related hypoxia. Midwives should be well prepared to treat a non-breathing baby through high-quality and frequent simulation training with an emphasis on teamwork training

USE OF STAY S.A.F.E. STRATEGY DURING MEDICATION ADMINISTRATION IN REDUCING ERRORS

Healthcare related medical errors are the third leading cause of death in the United States. Interruptions and distractions can lead to an increased risk of nurses making errors in healthcare, particularly during medication administration. Student nurses should receive education during their prelicensure period on the management of interruptions especially before being given the responsibility of performing high risk tasks such as medication administration. Using a novel interruption management strategy called Stay S.A.F.E., nursing students were interrupted during a simulated medication administration. Students were evaluated on the time spent on the task and if errors were committed. Lastly, perceived workload was measured using the NASA Task Load Index (TLX) tool

Disrupting the Path from Childhood Trauma to Juvenile Justice: An Upstream Health and Justice Approach

A groundbreaking public health study funded by the U.S. Centers for Disease Control and Prevention (CDC) and the Kaiser Foundation found astoundingly high rates of childhood trauma, including experiences like abuse, neglect, parental substance abuse, mental illness, and incarceration. Hundreds of follow-up studies have revealed that multiple traumatic adverse childhood experiences (or “ACEs”) make it far more likely that a person will have poor mental health outcomes in adulthood, such as higher rates of depression, anxiety, suicide attempts, and substance abuse. Interestingly, the original ACE Study examined a largely middle-class adult population living in San Diego, but subsequent follow-up studies have examined the prevalence of ACEs and its impact on mental health in other populations, including among people involved in the juvenile and criminal justice systems. Unsurprisingly, individuals entangled in those systems are more likely to have experienced higher numbers of these traumatic events, despite a frequent lack of access to critical mental health treatment, including the treatment necessary to address past childhood trauma. The ACEs framework for understanding health and mental health outcomes resulting from childhood trauma has received a high level of attention recently following an in-depth, multi-part series on these issues by National Public Radio (NPR) and other media. Because the ACEs public health research shows us that events in childhood can cause “toxic stress” and have a lasting impact on the mental health of a child well into adulthood, this framework provides us with an opportunity to consider how to more effectively intervene to stop the pathway from ACEs to juvenile justice system involvement and address the related health, mental health, developmental, and legal needs of children and their families. Before a child becomes an adult facing a mental health crisis or incarceration, attorneys, doctors, and other professionals can collaborate to disrupt that fate. This Article argues for a more upstream approach to address mental health using a medical-legal collaboration, based on the experiences of the authors, a law professor and medical school professor who work together to try to improve outcomes for children who have experienced trauma and their families. In Part I, we begin by examining the groundbreaking ACE studies, exploring the toxic stress and health and mental health outcomes that are associated with high rates of ACEs in childhood. Next, in Part II, we analyze the research revealing high rates of trauma and ACEs among populations involved in the juvenile justice system. Finally, we conclude in Part III by arguing for a more upstream public health and justice approach. We examine a particular problem in the city of Albuquerque, the largest urban area in New Mexico: children who have a particular ACE right from birth in the form of substance abuse by a household member. These infants are born with prenatal drug exposure and many experience symptoms of withdrawal in their first weeks of life, often quickly followed by an accumulation of additional forms of early childhood trauma. We discuss an approach through which the authors work to address those issues and disrupt the path from that childhood trauma to poor outcomes and juvenile justice system involvement. This approach engages attorneys with doctors and other health and developmental professionals to address ACEs among young children ages zero to three and their siblings, parents, and other caregivers. We advocate for an early, holistic, multi-generational, multi-disciplinary public health and justice approach to address ACEs early and improve the trajectory for children who have experienced childhood trauma

Description and pilot evaluation of the Metabolic Irregularities Narrowing down Device software: a case analysis of physician programming

Background: There is a gap between the abilities and the everyday applications of Computerized Decision Support Systems (CDSSs). This gap is further exacerbated by the different ‘worlds’ between the software designers and the clinician end-users. Software programmers often lack clinical experience whereas practicing physicians lack skills in design and engineering. Objective: Our primary objective was to evaluate the performance of Metabolic Irregularities Narrowing down Device (MIND) intelligent medical calculator and differential diagnosis software through end-user surveys and discuss the roles of CDSS in the inpatient setting. Setting: A tertiary care, teaching community hospital. Study participants: Thirty-one responders answered the survey. Responders consisted of medical students, 24%; attending physicians, 16%, and residents, 60%. Results: About 62.5% of the responders reported that MIND has the ability to potentially improve the quality of care, 20.8% were sure that MIND improves the quality of care, and only 4.2% of the responders felt that it does not improve the quality of care. Ninety-six percent of the responders felt that MIND definitely serves or has the potential to serve as a useful tool for medical students, and only 4% of the responders felt otherwise. Thirty-five percent of the responders rated the differential diagnosis list as excellent, 56% as good, 4% as fair, and 4% as poor. Discussion: MIND is a suggesting, interpreting, alerting, and diagnosing CDSS with good performance and end-user satisfaction. In the era of the electronic medical record, the ongoing development of efficient CDSS platforms should be carefully considered by practicing physicians and institutions

Reducing Medical Errors for Patients with Substance Use Disorders with a Medical Information Card

Background Approximately 98,000 Americans perish annually due to medical errors and adverse events associated with the limited access to or incomplete pertinent patient health information (Centers for Disease Control and Prevention [CDC], 2022; Obrien et al., 2021). Pertinent patient health information includes patients’ allergies, current medications, current medical diagnosis, blood type, insurance, and emergency contact. The purpose of this project was to examine the efficacy in using File of Life cards in reducing medical errors among patients with substance use disorders (SUDs), and the perception of patients and healthcare providers ease of use, satisfaction of using the File of Life cards, and improving medical decision making and preventing errors. Method A two-month quality improvement project was conducted at a clinic in the Northern Midwest. Patients were individually educated about and received a File of Life card during their Medication Assistance Treatment (MAT) appointments. Questionnaires were distributed to patients and the healthcare staff. Patients’ electronic health records (EHRs) were analyzed to determine the number of times they visited the local ED and the number of reported medical inconsistencies or errors during this QI project’s implementation. Results Among patients, 16% used their cards and 100% perceived the cards easy to use and useful with their care. Two patients visited the local ED and no medical errors were reported. Among healthcare providers, 100% perceived the cards easy to use, 87% considered the cards useful with medical decision making, 93% considered the cards useful in preventing medical errors, and 0% encountered any of the patients that received the cards. Conclusion File of Life cards may improve medical decision making and decrease medical errors. They may help improve patients’ overall satisfaction and confidence with their healthcare. However, no statistical analysis was conducted due to no pre-qualitative data, short duration, and small sample size. Therefore, a larger sample size, and longer duration of time is needed to confirm these findings

CEASE: A guide for clinicians on how to stop resuscitation efforts

Resuscitation programs such as Advanced Cardiac Life Support, Cardiac Life Support, Pediatric Advanced Life Support, and the Neonatal Resuscitation Program offer inadequate guidance to physicians who must ultimately decide when to stop resuscitation efforts. These decisions involve clinical and ethical judgments and are complicated by communication challenges, group dynamics, and family considerations. This article presents a framework, summarized in a mnemonic (CEASE: Clinical Features, Effectiveness, Ask, Stop, Explain), for how to stop resuscitation efforts and communicate that decision to clinicians and ultimately the patient’s family. Rather than a decision rule, this mnemonic represents a framework based on best evidence for when physicians are considering stopping resuscitation efforts and provides guidance on how to communicate that decision

A Methodological Framework for the Integrated Design of Decision-Intensive Care Pathways\u2014an Application to the Management of COPD Patients

Healthcare processes are by nature complex, mostly due to their multi-disciplinary character that requires continuous coordination between care providers. They encompass both organizational and clinical tasks, the latter ones driven by med- ical knowledge, which is inherently incomplete and distributed among people having different expertise and roles. Care pathways refer to planning and coordination of care processes related to specific groups of patients in a given setting. The goal in defining and following care pathways is to improve the quality of care in terms of patient satisfaction, costs reduction, and medical outcome. Thus, care pathways are a promising methodological tool for standardizing care and decision-making. Business process management techniques can successfully be used for representing organiza- tional aspects of care pathways in a standard, readable, and accessible way, while supporting process development, analysis, and re-engineering. In this paper, we intro- duce a methodological framework that fosters the integrated design, implementation, and enactment of care processes and related decisions, while considering proper rep- resentation and management of organizational and clinical information. We focus here and discuss in detail the design phase, which encompasses the simulation of care pathways. We show how business process model and notation (BPMN) and decision model and notation (DMN) can be combined for supporting intertwined aspects of decision-intensive care pathways. As a proof-of-concept, the proposed methodology has been applied to design care pathways related to chronic obstructive pulmonary disease (COPD) in the region of Veneto, in Italy