Literature Review on Structural Resuscitation Checklist for Cardiopulmonary Resuscitation (CPR)

CPR, an acronym for Cardiopulmonary Resuscitation, is a technique where one applies artificial ventilation and chest compressions to ensure there are oxygenation and circulatory flow during a cardiac arrest (Schexnayder, 2013). CPR is a recommendation to all despite the lower chances of those suffering from a heart attack recovering fully. In the exposition, I will visit three articles that discuss on the structural resuscitation checklist for CPR. It is important for individuals to understand that CPR is a priority whenever an individual becomes unconscious and lacks pulse rates (Leis et al., 2010). Following the structural resuscitation, checklist assists an individual in the process of administering CPR to a needy patient thus reducing the risks of fatal outcomes such as paralysis or even worse - death. A cardiac arrest can occur at any time in ones life and to be surrounded by people with the required skill helps make life better. Training on CPR should be a mandatory task to all regardless of their profession as it can be a definer between life and death (DeMartino, Kelm, Srivali, & Ramar, 2016).

Using the structural resuscitation checklist for CPR increases the quality care delivery to patients compared to the routine CPR (Biswas, Alpert, Lyon, & Kaufmann, 2017). The checklist offers directions one should follow to ensure effective delivery of CPR, unlike the routine CPR where individuals offer CPR directly without weighing existing factors that can determine the success or failure of the entire process (Beck & Dewolf, 2016). It is an obligation to the healthcare organisations to ensure their staff and the members of the public receive adequate training on a regular basis to ensure they have the required level of proficiency appropriate for their various roles (Breckwoldt, Lingemann, & Wagner, 2016). There are standards that those giving CPR to people should adhere to for enhancing the quality of healthcare (Dilley et al., 2015). In the next sections of the paper, I will review three articles in detail and give a recommendation or conclusion on the benefits of structural resuscitation checklist for cardiopulmonary resuscitation (CPR).

Article One

Ward, P., Johnson, L., Mulligan, N., Ward, M., & Jones, D. (1997). Improving cardiopulmonary resuscitation skills retention: effect of two checklists designed to prompt correct performance. Resuscitation, 34(3), 221-225. http://dx.doi.org/10.1016/s0300-9572(96)01069-6 (Elsevier)

Description of the Article

The article sheds light on the effectiveness of CPR. Additionally, it reveals how long it takes before an individual forgets the basics of the training. According to the researchers, it takes roughly a month before an individual starts to forget some of the basics in the training. The researchers did use control groups to determine their results. The use of control groups reduces the margins of errors in a research study by offering different sets of data (Snopce & Tanushevski, 2016). For instance, when one of the test groups is exposed to various variables, the other group is not exposed to the variables to determine if the presence of the variables has an effect on the test groups.

Critical Appraisal

Recruitment

The test was carried out on 169 undergraduate students during and after training on CPR. Their performance formed the basis of the research findings; after the training, the students were given a two-month break and a test was conducted on their retention abilities. The initial testing took place during the course assessment and was by the use of two Laerdal Skillmeter Resusci Anne recording manikins. There is information on how the students were divided into the test groups that the researchers used to validate their findings. However, there is no mention of the age of the students forcing one to make assumptions. Age among other factors may be limiting factors when it comes to retention rates of an individual (Saive et al., 2013).

Allocation/Adjustment

There were two groups involved in the study; a control and intervention group in the study; all the students were subjected to the same variables. Students were picked at random, as they attended their course assessment. They had to follow an instructor who tested what they could recall on the CPR training. The instructors tested binary variables using tests of independence. To make the results more solid, the researchers introduced a comparison group that yielded significant differences.

Maintenance

The undergraduate students received similar tests and training. Additionally, no student or group of students received preferential treatment despite some having low retention rates than others. No follow-up ensued after the last tests were conducted; the only follow-ups were before the lapse of the two months. The tests were conducted by various instructors hence the margin for error was reduced. When one instructor conducts tests on a large population, there is a likelihood of errors occurring due to various factors such as getting tired. The control group ensured that the test group offered accurate results. Any research with a hope of accurate findings requires a control measure that will ensure variables used have an effect on the subjects.

Measurement

In the study, two types of variables were utilized; a compression-ventilation variable and procedural variable. The procedural variable represents critical fundamentals of what was include in the CPR procedure. The compression-ventilation variable on the other hand is obtained through measuring ventilation and compression accuracy.

Results

Some significant findings stand out from the research. The outcomes from the summary variable point to the fact that the students using detailed checklist were more efficient in carrying out correct CPR compared to those who used the short version or those who did not use a checklist. Moreover, the findings from the analysis of individual variables utilized for the process were equally as efficient with the comprehensive checklist. Similarly, results show than in some cases they were even more effective.

Strengths and Limitations

The strength of the study is derived from the fact that information from the initial tests proved essential in verifying that there were no group changes prior to the commencement of the experimental manipulation. However, the approach used in reporting the results of the study is too complicated for non-technical individuals to understand.

Relevance and Impact

The use of a detailed checklist played an essential role in helping to improve the effectiveness of performing the correct CPR. From the result, it is important to point out that the use of a checklist may be valuable in helping to improve the efficiency of its use.

Article Two

Sarcevic, A., Zhang, Z., Marsic, I., & Burd, R. Checklist as a Memory Externalization Tool during a Critical Care Process, 1080 - 1089.

Description of the Article

Checklists have been used to great effect in general hospital care making. As such, this shows that checklists can be used in other areas that are error prone. In the article, the authors take a close look at a paper-based checklist in a trauma center to help inform the design of digital cognitive aids for use by a safety-critical medical team. In an effort to find out more about the effectiveness of the method under investigation, the authors undertake to review and analyze a total of 163 checklists collected over four months. According to the authors, findings from the analysis assert that checklists designed for high-risk, fast-paced medical use now are used as a functional tool which provides dual functions as the checklists help in compliance and act as a compliance tool. The authors use the finding of their research into how checklists are used to derive requirements for digital cognitive aids that can be used to support safety-critical medical teams.

Critical Appraisal

Recruitment

The research for the study was conducted in an urban, pediatric teaching hospital and a regional level one trauma center. The centers received approximately 600 high-acuity and high-risk injured children to the emergency department at the hospital. Data collection began three months after the checklist was implemented and the process got underway for four months. During the period of the research, the process checklists from 163 resuscitations that had occurred were obtained. The checklists that were obtained had been administered by physician leaders who led a team of up to 15 specialists.

Allocation/Adjustment

The research focused on the checklists that had been filled when patients had been admitted to the facility in the period of which the checklist had been implemented. Nonetheless, before analysis, the checklists were subdivided into groups based on the level of experience of the leaders experience; with the levels of experience being subdivided into surgical resident [PGY-4], a surgical fellow, surgical attending, and emergency medicine physician. Based on the experience of the leaders, the notes were subdivided into two categories, those administered by experienced leaders; attending surgeons and emergency medicine physicians and those administered by less experienced leaders; surgical residents and fellows.

Maintenance

In the course of the research, 163 checklists are gathered from the operations of the hospital in the course of four months. The analysis process comes after three months of the lists being in operation. All the checklists are analyzed the same way. However, the only difference that arises when the checklists have to be subdivided into groups.

Measurement

Quantitative analysis was conducted on the data to establish the frequency of the elements that had been checked or unchecked. The process also involved determining the amount of notes in each section of any given checklist. Apart from the intervention involved in the analysis process, the data gathered was treated the same way. For instance, the analysis process focused on 125 checklists which contained handwritten notes. A number of codes were identified and the analysis team had to conduct discussions to establish what to keep and the elements to remove or merge.

Results

The reporting of findings was conducted in three parts. The results from general observations come first and then followed by categorizing and describing information types that physician leaders had recorded on the checklists. Finally, note-taking differences evident from the experience of the leader. The general observations recorded a trend in the way the checklists were being used. Based on the analysis, it was evident that the frequency of checked and unchecked boxes revealed two groups of checklist items; almost always checked, and rarely checked. Almost always checked items consisted of primary and secondary survey items such as Confirm O2 placement and State GCS [Glasgow Coma Score], which were checked in 80% to 95% of the checklists. Optional items such as For attending activations in the pre-arrival plan section and Prepare patient for travel in the departure plan section were rarely checked (7%), as was the primary survey item Give fluid or blood (14%). Considering the data from the findings, it is evident that that a multi-tiered organization and adaptation of the checklist to specific contexts may be beneficial. However, previous studies of checklist usage showed that users often did check a box without performing the equivalent task or perform a task without checking the corresponding box. Nonetheless, it is evident that the items that were less checked were rarely used, considering that based on the evidence, no physician made a decision not to...