Adaptation of the World Health Organization (WHO) Safe Surgery Checklist for Use With Cesarean Sections: Implementation and Outcomes With the Safe Cesarean Section Checklist.

Introduction The World Health Organization (WHO) Safe Surgery Checklist significantly decreases morbidity and mortality in regular operating room cases. However, significant differences in workflow and processes exist between regular operating room cases and cesarean sections performed on the labor and delivery unit. The aim of this study is to adapt the WHO Safe Surgery Checklist for the labor and delivery unit and cesarean sections to improve communication and patient safety. Methods A multidisciplinary team consisting of all major stakeholders reviewed and revised the WHO Safe Surgery Checklist making it more applicable to cesarean section operations. The new Safe Cesarean Section Checklist was tested and then integrated into the electronic medical record and utilized on the labor and delivery unit. A specific cesarean section safety attitudes questionnaire was developed, validated, and administered prior to and one year after implementation. Results Usage of the Safe Cesarean Section Checklist was greater than 95% after initial implementation. Significant improvements were reported by the staff on the cesarean section attitudes questionnaire for several key areas including the feeling that all necessary information was available at the beginning of the procedure, decreases in communication breakdowns and delays, and fewer issues related to not knowing who was in charge during the procedure. Discussion Implementation of the Safe Cesarean Section Checklist was successfully adopted by the staff, and improvements in staff perceptions of several key safety issues on our unit were demonstrated. Additional studies should be undertaken to determine if clinical outcomes from this intervention are comparable to those seen with the use of the WHO Safe Surgery Checklist.

Meeting effective care measures.

Hospital nurses play a central role in evaluating data to ensure patient safety and improve quality.

Teaching undergraduate nurses nursing phenomena.

Nursing phenomena, complex and dynamic conceptual building blocks, are the basis of our nursing language. Students have difficulty understanding what nursing phenomena are and how to link them to practice and research. The authors describe incremental experiential learning strategies that were used to help students learn and apply the basic concepts of their nursing language.

Improving combat medic learning using a personal computer-based virtual training simulator.

The new military occupational specialty for combat medics, the 91W, requires that all medics successfully pass the National Registry of Emergency Medical Technicians examination. The objective of this study was to supplement standard emergency medical technician training with a three-dimensional, computer-based, virtual training simulator and to assess whether scores and pass rates could be increased. Combat medics (N=167) were selected for training through the usual noncommissioned officer unit selection process and were randomized by cohort to the training simulator. Results showed no significant differences in National Registry of Emergency Medical Technicians examination scores (t = 1.019, df = 153, p = 0.745, one-tailed) or pass rates (chi2 = 1.575, df = 1, p = 0.209). The findings, however, were used to construct two models of combat medic characteristics that can be used to assist in initial selection for emergency medical technician courses and subsequent counseling of soldiers on course completion. With further research, these models could be refined for Army-wide use to increase the cost-effectiveness of combat medic recruitment, training, and testing.

What really matters to healthcare consumers.

Consumer satisfaction with healthcare is an important quality and outcome indicator. Satisfaction may be at the crux of survival for healthcare delivery systems because it creates the competitive edge in healthcare. To better understand patient satisfaction by examining consumer healthcare experiences and expectations, a study was conducted. An important concept identified in the data, MY CARE, refers to a constellation of quality healthcare features that were wished for by all participants and realized by only some of them. The features of MY CARE offer lessons for all healthcare leaders to use when making improvements in care delivery systems-improvements that could create a more patient-centered healthcare system and boost patient satisfaction.

Soldiers' experiences with military health care.

Patient satisfaction can be enhanced by narrowing gaps between what health care consumers experience and what they expect. A study was therefore conducted to better understand health care experiences and expectations among Army beneficiaries. Data collected using focus groups were analyzed by using qualitative research methods. A concept was identified and labeled "Soldier Care." It involves first-line care delivered at the unit level as well as the interface between first-line care and military treatment facilities. There are four features of Soldier Care, i.e., provider competence, the sick call cycle, getting appointments, and unit leadership. Together, these features affect soldiers' time from injury to recovery. Insights about Soldier Care can provide decision-makers with direction for initiating changes that may contribute to improved soldier satisfaction with health care.

Creating healthcare cultures of patient safety.

With the release of the Institute of Medicine's report on patient safety, a national agenda was set to rebuild the public's trust and create cultures of safety within all healthcare organizations. This vision of improvement is driving changes in healthcare organizations, educational institutions, and regulatory agencies to remove the blame and improve their systems. Understanding historical events, strategies for organization change, and current patient safety initiatives will assist nursing leaders to become active participants at the local, state, and national level as cultures are changed and solutions are developed to prevent patient injuries.