Nursing handover from ICU to cardiac ward: standardised tools to reduce safety risks

BACKGROUND: Standardising handover processes and content, and using context-specific checklists are proposed as solutions to mitigate risks for preventable errors and patient harm associated with clinical handovers. OBJECTIVES: Adapt existing tools to standardise nursing handover from the intensive care unit (ICU) to the cardiac ward and assess patient safety risks before and after pilot implementation. METHODS: A three-stage, pre-post interrupted time-series design was used. Data were collected using naturalistic observations and audio-recording of 40 handovers and focus groups with 11 nurses. In Stage 1, examination of existing practice using observation of 20 handovers and a focus group interview provided baseline data. In Stage 2, existing tools for high-risk handovers were adapted to create tools specific to ICU-to-ward handovers. The adapted tools were introduced to staff using principles from evidence-based frameworks for practice change. In Stage 3, observation of 20 handovers and a focus group with five nurses were used to verify the design of tools to standardise handover by ICU nurses transferring care of cardiac surgical patients to ward nurses. RESULTS: Stage 1 data revealed variable and unsafe ICU-to-ward handover practices: incomplete ward preparation; failure to check patient identity; handover located away from patients; and information gaps. Analyses informed adaptation of process, content and checklist tools to standardise handover in Stage 2. Compared with baseline data, Stage 3 observations revealed nurses used the tools consistently, ward readiness to receive patients (10% vs 95%), checking patient identity (0% vs 100%), delivery of handover at the bedside (25% vs 100%) and communication of complete information (40% vs 100%) improved. CONCLUSION: Clinician adoption of tools to standardise ICU-to-ward handover of cardiac surgical patients reduced handover variability and patient safety risks. The study outcomes provide context-specific tools to guide handover processes and delivery of verbal content, a safety checklist, and a risk recognition matrix.

Residual DNA on examination tools following use

Recent studies observing the transfer of DNA via examination tools used within forensic laboratories (scissors, forceps and gloves) have highlighted the contamination risk of such implements if protocols following their use and replacement are not adhered to. Whilst these previous studies focus primarily on the transfer of biological substances to a substrate via high-risk vectors, this investigation considers the proportion of DNA that remains on the high-risk vectors following contact with the substrate. Dried blood or touch DNA was deposited on cotton or glass substrates to create mock exhibits. Following primary contact with the deposit, the vector similarly contacted a secondary DNA-free substrate. Combinations of singular and multiple contacts were applied. Immediately following contact with the secondary substrate, the vector was sampled in order to determine the proportion of DNA-containing material remaining on the vectors following contacts. Residual DNA was detected on the vectors in most instances, with the amount retained influenced by the vector, substrates and biological substance applied. The results demonstrate the potential for inter- and intra-exhibit contamination through further contacts.

A taxonomy and mapping of computer-based critiquing tools

Critics have emerged in recent times as a specific tool feature to support users in computer-mediated tasks. These computer-supported critics provide proactive guidelines or suggestions for improvement to designs, code, and other digital artifacts. The concept of a critic has been adopted in various domains, including medical, programming, software engineering, design sketching, and others. Critics have been shown to be an effective mechanism for providing feedback to users. We propose a new critic taxonomy based on extensive review of the critic literature. The groups and elements of our critic taxonomy are presented and explained collectively with examples, including the mapping of 13 existing critic tools, predominantly for software engineering and programming education tasks to the taxonomy. We believe this critic taxonomy will assist others in identifying, categorizing, developing, and deploying computer-supported critics in a range of domains.

Generating domain-specific visual language tools from abstract visual specifications

Domain-specific visual languages support high-level modeling for a wide range of application domains. However, building tools to support such languages is very challenging. We describe a set of key conceptual requirements for such tools and our approach to addressing these requirements, a set of visual language-based metatools. These support definition of metamodels, visual notations, views, modeling behaviors, design critics, and model transformations and provide a platform to realize target visual modeling tools. Extensions support collaborative work, human-centric tool interaction, and multiplatform deployment. We illustrate application of the metatoolset on tools developed with our approach. We describe tool developer and cognitive evaluations of our platform and our exemplar tools, and summarize key future research directions.