Implementing a Checklist & Hourly Huddles to Increase Situational Awareness During the Second Stage of Labor-A Perinatal Quality Improvement Project

Background: Current management of the second stage of labor often follows tradition-based routines rather than evidence-based practices. A lack of situational awareness and tunnel vision can limit medical decision-making. Northern New England Perinatal Quality Improvement Network (NNEPQIN) has listed Second Stage Situational Awareness as a priority initiative. Standardized checklists are useful for maintaining situational awareness. Regular debriefings using a standardized tool have been shown to improve communication and team based care, which generally leads to improved patient outcomes. Based on this evidence, developing a standardized checklist including regular hourly care team “huddles” is valuable and could result in improved birth outcomes. AIM Statement: The global aim of this project was to reduce variability in practice during the second stage of labor to improve neonatal birth outcomes. The specific aim was to implement a second stage situational awareness checklist with a completion percentage of 80% by July 2015. Method: The theoretical framework guiding this project was Endsley’s theory of Situation Awareness. Pre-implementation chart reviews were conducted to determine what information was currently being documented during the second stage. A 9-item checklist was developed based on hospital preference for use during hourly huddles once second stage was reached. Staff were educated on checklist use pre-implementation. Post-implementation chart reviews were conducted to determine checklist completion percentage. Results: Chart reviews demonstrated an average checklist completion percentage of 43% over the two-week implementation period with a range of 22-89%. Huddles were conducted and documented in 33% of the reviewed delivery charts. Conclusions: Continued follow up and work re-design is needed to consistently incorporate the checklist and huddles into practice. Implications for the CNL: Implications for the CNL include continuing staff education to increase awareness and acceptance of the practice change, and examining project effects on perinatal outcomes including delivery mode and neonatal Apgar scoring

Nursing judgement and decision-making using the Sedation Withdrawal Score (SWS) in children

Aims: The aim of the study was to evaluate registered children’s nurses’ approaches to the assessment and management of withdrawal syndrome in children. Background: Assessment of withdrawal syndrome is undertaken following critical illness when the child’s condition may be unstable with competing differential diagnoses. Assessment tools aim to standardize and improve recognition of withdrawal syndrome. Making the right decisions in complex clinical situations requires a degree of mental effort and it is not known how nurses make decisions when undertaking withdrawal assessments. Design: Cognitive interviews with clinical vignettes. Methods: Interviews were undertaken with 12 nurses to explore the cognitive processes they used when assessing children using the Sedation Withdrawal Score (SWS) tool. Interviews took place in Autumn 2013. Findings: Each stage of decision-making—noticing, interpreting and responding— presented cognitive challenges for nurses. When defining withdrawal behaviours nurses tended to blur the boundaries between Sedation Withdrawal Score signs. Challenges in interpreting behaviours arose from not knowing if the patient’s behaviour was a result of withdrawal or other co-morbidities. Nurses gave a range of diagnoses when interpreting the vignettes, despite being provided with identical information. Treatment responses corresponded to definite withdrawal diagnoses, but varied when nurses were unsure of the diagnosis. Conclusion: Cognitive interviews with vignettes provided insight into nurses’ judgement and decision-making. The SWS does not standardize the assessment of withdrawal due to the complexity of the context where assessments take place and the difficulties of determining the cause of equivocal behaviours in children recovering from critical illness

User Perceptions of ROTEM-Guided Haemostatic Resuscitation: A Mixed Qualitative–Quantitative Study

Viscoelastic point-of-care haemostatic resuscitation methods, such as ROTEM or TEG, are crucial in deciding on time-efficient personalised coagulation interventions. International transfusion guidelines emphasise increased patient safety and reduced treatment costs. We analysed care providers’ perceptions of ROTEM to identify perceived strengths and areas for improvement. We conducted a single-centre, mixed qualitative–quantitative study consisting of interviews followed by an online survey. Using a template approach, we first identified themes in the responses given by care providers about ROTEM. Later, the participants rated six statements based on the identified themes on five-point Likert scales in an online questionnaire. Seventy-seven participants were interviewed, and 52 completed the online survey. By analysing user perceptions, we identified ten themes. The most common positive theme was “high accuracy”. The most common negative theme was “need for training”. In the online survey, 94% of participants agreed that monitoring the real-time ROTEM temograms helps to initiate targeted treatment more quickly and 81% agreed that recurrent ROTEM training would be beneficial. Anaesthesia care providers found ROTEM to be accurate and quickly available to support decision-making in dynamic and complex haemostatic situations. However, clinicians identified that interpreting ROTEM is a complex and cognitively demanding task that requires significant training needs

A real-time test of food hazard awareness

Purpose - Food poisoning attributable to the home generates a large disease burden, yet is an unregulated and largely unobserved domain. Investigating food safety awareness and routine practices is fraught with difficulties. The purpose of this paper is to develop and apply a new survey tool to elicit awareness of food hazards. Data generated by the approach are analysed to investigate the impact of oberservable heterogeneity on food safety awareness. Design/methodology/approach - The authors develop a novel Watch-and-Click survey tool to assess the level of awareness of a set of hazardous food safety behaviours in the domestic kitchen. Participants respond to video footage stimulus, in which food hazards occur, via mouse clicks/screen taps. This real-time response data is analysed via estimation of count and logit models to investigate how hazard identification patterns vary over observable characteristics. Findings - User feedback regarding the Watch-and-Click tool approach is extremely positive. Substantive results include significantly higher hazard awareness among the under 60s. People who thought they knew more than the average person did indeed score higher but people with food safety training/experience did not. Vegetarians were less likely to identify four of the five cross-contamination hazards they observed. Originality/value - A new and engaging survey tool to elicit hazard awareness with real-time scores and feedback is developed, with high levels of user engagement and stakeholder interest. The approach may be applied to elicit hazard awareness in a wide range of contexts including education, training and research

Gender Difference in Situation Awareness when Receiving Wayfinding Direction by Landmarks and Headings

In aviation, situation awareness (SA) is a fundamental requirement for effective flying and air traffic control. This skill has greatly been associated with pilot and air traffic controller performance. Previous studies in aviation and other fields have shown that gender differences exist in SA performance. Four hypotheses were tested in this study: women navigate better from landmark cues; men navigate better from headings cues; women have better SA performance than men when receiving landmark directions; and men have better SA when receiving cardinal directions. Thirty-eight participants drove a driving simulator twice. While driving, participants were asked SA questions to assess their SA performances. The results showed participants navigate better from landmark cues regardless of gender. Men showed poorer SA in landmark conditions than in headings conditions, but there was no significant difference in women. However, overall, women performed worse in response time to answering SA questions. This study can be beneficial for pilots’ selection tests and providing special training for male and female pilots

An Evidence-Based Strategy for the Use of Simulation to Assess Situation Awareness in Applicants to Nurse Anesthesia Programs

Medical errors are considered one of the top causes of patient death. Closed claims analysis reveals an estimated 50% of claims are associated with preventable events by the anesthesia provider. Errors in anesthesia leading to critical incidents are associated with errors in situation awareness (SA). Identification of human factor variables, such as SA, provides an analysis of observable behavior and intuition necessary to guide crisis management, maintain clinical performance, and mitigate errors in patient safety. The human factor components of human error and SA play critical roles in patient safety and overall clinical anesthesia practice. The viability of simulation assessment delivers a consistent evaluation of learner progression and identifies areas of improvement to provide safe clinical practice and minimize adverse outcomes during patient interaction. Incorporating high-fidelity simulation into a multimodal admissions process for nurse anesthesia programs may provide a vital assessment of candidate SA in managing stressful scenarios and predict overall program progression and success. The evidence-based project serves to evaluate current literature for evidence-based strategies to provide a direct assessment of SA on prospective applicants during applicant interviews to nurse anesthesia programs

The Relationship Between Social Persuasion Strategies, Phishing Features and Email Exposure Time on Phishing Susceptibility

This item is only available electronically.A ‘phishing email’ aims to persuade an unsuspecting individual to reveal personal credentials and sensitive information. Currently, the global costs to businesses and individuals associated with phishing related attacks are reported in the hundreds of millions of dollars. While technological interventions capture a proportion of these phishing emails, ultimately, the human user is the last line of defence in determining the legitimacy of the email. ‘Phishers’ aim to exploit human weaknesses through the use of various persuasion strategies that create a sense of urgency and time pressure to respond to emails. Typically, individuals must also rely on subtle phishing features in an email to determine if the email is genuine or an attempted phish. Furthermore, phishers take advantage of the assumption that users determine the legitimacy of emails in a short amount of time. The present study aims to examine the impact of these email characteristics of persuasion strategies, the number of phishing features, and exposure time on phishing detection and susceptibility. Using an online survey platform, participants (N= 136) completed an email sorting task where they were required to review and sort 60 incoming emails from the inbox of ‘Professor Alex Jones’. Several significant results were obtained supporting the hypotheses. It demonstrated that individuals are better able to detect a phishing email when it utilises common persuasion strategies (authority and scarcity), and contain a greater number of phishing features. It also revealed that with increased email exposure time, individuals had a better phishing detection rate. However, the effect of identifying phishing emails with common persuasion strategies was not greater during shorter exposure time, providing a non-significant result. A greater understanding of these email factors associated with phishing susceptibility could lead to more tailored awareness campaigns and/or training programs to increase phishing detection and reduce susceptibility.Thesis (B.PsychSc(Hons)) -- University of Adelaide, School of Psychology, 202

Medición de la cultura de seguridad del paciente en un hospital público de primer nivel en el municipio de Villeta

Esta investigación midió la percepción del personal asistencial sobre la cultura de seguridad de los pacientes en un hospital de primer nivel de complejidad por medio de un estudio descriptivo de corte transversal. Se utilizó como herramienta de medición la encuesta ‘Hospital Survey on Patient Safety Cultura’ (HSOPSC) de la Agency of Healthcare Research and Quality (AHRQ) versión en español, la cual evalúa doce dimensiones. Los resultados mostraron fortalezas como el aprendizaje organizacional, las mejoras continuas y el apoyo de los administradores para la seguridad del paciente. Las dimensiones clasificadas como oportunidades de mejora fueron la cultura no punitiva, el personal, las transferencias y transiciones y el grado en que la comunicación es abierta. Se concluyó que aunque el personal percibía como positivo el proceso de mejoramiento y apoyo de la administración también sentía que era juzgado si reportaba algún evento adverso.This research measured the perception of caregivers about the culture of patient safety in a hospital first level of complexity through a descriptive cross-sectional study . It was used as a measurement tool the survey ' Hospital Survey on Patient Safety Culture ' ( HSOPSC ) of the Agency of Healthcare Research and Quality (AHRQ ) Spanish version , which evaluates twelve dimensions. The results showed strengths and organizational learning , continuous improvement and support of managers to patient safety . Dimensions classified as opportunities for improvement were non- punitive culture , staff , transfers and transitions and the degree to which communication is open . It was concluded that although the staff perceived as a positive process improvement and management support also felt it was judged whether any adverse events reported .centro de estudios de perdurabilidad empresaria

Evaluating Situation Awareness in the Nurse Anesthesia Trainee During High Fidelity Simulation

Nurse anesthetists provide anesthesia care for patients within a complex and dynamic environment. Errors and adverse events during anesthesia have declined greatly over the decades, yet when errors occur they are devastating. Anesthesia providers must train for adverse events and develop skills to provide excellent care to patients. Situation awareness skills are proven to advance safety in other complex, dynamic professions, whereas situation awareness training and research is newly evolving in anesthesia. A situation awareness seminar was developed from a review of relevant literature. A mixed methods research design was utilized for this pilot study. Nurse anesthesia trainees (NATs) were recruited and divided into two groups. Group A received the situation awareness seminar and then participated in a high fidelity simulation where their situation awareness skills were scored. Group B participated in a high fidelity simulation where their situation awareness skills were scored and then attended the situation awareness seminar. Results of the Situation Awareness Global Assessment Technique survey did not appreciate a statistically significant difference between the groups. However, questions relating to perception were most frequently missed, indicating an area for future situation awareness training. Additionally, post assessment acceptability survey questions scored high means, with narrow standard deviations indicating favorability of the seminar and simulation by NATs. The favorable responses on the Acceptability survey and the correlation of findings with other research on situation awareness in nursing demonstrate that this study design is sustainable and feasible on a larger scale. Keywords: situation awareness, nurse anesthesia trainees, high fidelity simulatio