Using a Critical Safety Behavior Scoring Tool for Just-in-Time Training for N95 Respirator Use

Background Historically, health care workers (HCWs) have exhibited marginal adherence to proper N95 respirator use. During the COVID-19 pandemic, HCWs with little to no prior training on N95 respirator use are relying on N95s as their primary respiratory protection. There is a need for simple, effective, and easily implementable just-in-time training (JITT) interventions to improve N95 respirator-related safety behavior. This study investigated two JITT interventions. Methods A pilot experimental pretest posttest study design was used to evaluate two training interventions for N95 respirator donning/doffing performance at a Midwestern hospital system. HCW participants were randomly assigned to an intervention: one used a 4-minute instructional video alone, while the other used the same video but added a video reflection intervention (participant watched and scored a video of their own performance). All performances were scored using a 10-point Critical Safety Behavior Scoring Tool (CSBST). Findings Sixty-two HCWs participated (32 video alone, 30 video reflection). The two groups’ CSBST scores were not significantly different at pretest. Averaged participant scores on the CSBST improved immediately following both interventions. Scores were significantly higher on the posttest for the reflective practice intervention ( p<.05). Years of experience and frequency of N95 respirator use did not predict pre or post scores. Conclusions/Applications to Practice We provide evidence to support the use of a time-efficient JITT intervention to improve HCW N95 respirator donning/doffing practices during the COVID-19 pandemic and beyond. Hospital safety professionals should consider this type of training for HCWs required to wear respiratory protection.

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Using a Critical Safety Behavior Scoring Tool for N95 Respirator Use to Evaluate Training Interventions

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1083 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s425-s425

Author(s):

Elizabeth Beam ◽

Kevin Kupzyk ◽

Jocelyn Herstein ◽

Shawn Gibbs

Keyword(s):

Healthcare Workers ◽

Worker Safety ◽

Instructional Video ◽

Just In Time ◽

Safety Behaviors ◽

Safety Behavior ◽

Training Interventions ◽

Video Reflection ◽

Scoring Tool ◽

The Impact

Background: Hospitals struggle nationally to educate healthcare workers on the safe use of N95 respirators as part of their respiratory protection programs. Practical and effective interventions are needed to improve this clinical behavior, which is critical to healthcare worker safety in airborne precautions, hazardous drug administration, and pandemic response. Objective: In this analysis, we specifically investigated 2 just-in-time training interventions that would be practical to implement in a hospital setting. Methods: A simulation approach was used to evaluate 2 interventions for N95 respirator use at a Midwestern Academy Hospital system (n = 62 respirators: 32 control and 30 treatment). Healthcare workers were asked to don and doff an N95 respirator while being video-recorded in an empty hospital corridor and room. After a randomized intervention was applied, they repeated the respirator donning and doffing while being video-recorded. One intervention used an instructional video alone, and the other used the same instructional video but added a video reflection intervention. The video reflection intervention asked the participant to review and score their first performance of N95 donning and doffing using the Critical Safety Behavior Scoring Tool (CSBST). The research team used the same CSBST to score all performances of donning and doffing for comparison and evaluation. Result: The critical safety behaviors at the pretest and posttest for the 2 intervention groups reveal the impact of the 2 types of just-in-time training on demonstrated N95 respirator skills. The video alone and video reflection scores were not significantly different at pretest between the 2 groups. Scores were significantly higher on the posttest for the reflective practice intervention. Findings related to demographic information included years in healthcare, frequency of use, history of needlestick, and fatigue. Conclusions: Video reflection may improve compliance with critical safety behaviors for just-in-time training on N95 respirator use. Further research should examine the video-recorded findings for measurement elements that can be expanded in a scoring tool such as facial hair, hairstyle, and the quality of hand hygiene. Intervention studies should also examine how often the training must be repeated to maintain competency. This intervention may have implications for the training of other critical safety behaviors in infection control and other high-risk procedures.Funding: NoneDisclosures: None

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Resilience of the Canterbury Hospital System to the 2011 Christchurch Earthquake

Earthquake Spectra ◽

10.1193/032013eqs074m ◽

2014 ◽

Vol 30 (1) ◽

pp. 533-554 ◽

Cited By ~ 50

Author(s):

Caitlin C. Jacques ◽

Jason McIntosh ◽

Sonia Giovinazzi ◽

Thomas D. Kirsch ◽

Thomas Wilson ◽

...

Keyword(s):

Multidisciplinary Approach ◽

Fault Tree Analysis ◽

Acute Care Hospital ◽

Care Hospital ◽

Contributing Factors ◽

Hospital System ◽

Nonstructural Components ◽

Survey Tool ◽

Future Performance ◽

Hospital Safety

The paper analyzes the performance of a hospital system using a holistic and multidisciplinary approach. Data on impacts to the hospital system were collected using a standardized survey tool. A fault-tree analysis method is adopted to assess the functionality of critical hospital services based on three main contributing factors: staff, structure, and stuff. Damage to utility networks and to nonstructural components was found to have the most significant effect on hospital functionality. The functional curve is integrated over time to estimate the resilience of the regional acute-care hospital with and without the redistribution of its major services. The ability of the hospital network to offer redundancies in services after the earthquake increased the resilience of the Christchurch Hospital by 12%. The resilience method can be used to assess future performance of hospitals, and to quantify the effectiveness of seismic retrofits, hospital safety legislation, and new seismic preparedness strategies.

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Teaching Splinting Techniques Using a Just-in-Time Training Instructional Video

Pediatric Emergency Care ◽

10.1097/pec.0000000000000390 ◽

2017 ◽

Vol 33 (3) ◽

pp. 166-170 ◽

Cited By ~ 9

Author(s):

Yu-Tsun Cheng ◽

Deborah R. Liu ◽

Vincent J. Wang

Keyword(s):

Instructional Video ◽

Just In Time

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Warning Compliance: Effects of a Video Warning Sign and Modeling on Behavior

Proceedings of the Human Factors Society Annual Meeting ◽

10.1518/107118192786751024 ◽

1992 ◽

Vol 36 (8) ◽

pp. 608-610 ◽

Cited By ~ 1

Author(s):

Bernadette M. Racicot ◽

Michael S. Wogalter

Keyword(s):

Video Modeling ◽

Training Programs ◽

Research Literature ◽

Future Research ◽

Warning Sign ◽

Safety Behaviors ◽

Safety Behavior ◽

Training Interventions ◽

Effectiveness Of Training ◽

Video Model

The effectiveness of warnings and social influence (modeling) for improving safety behavior was examined in a laboratory setting. Although training programs aimed at improving safety behavior in the workplace frequently use videotapes with models portraying safe and unsafe behaviors, the effectiveness of training interventions of this type are rarely evaluated nor have results been published in the research literature. Training to increase safety behaviors can translate into large savings to an organization in terms of reductions in equipment damage, cost of liability litigation, and decreases in injury to both consumers and employees. The present research examined the effects of a posted (video) warning, video role-modeling, and a voice warning on compliance with safety behaviors. Participants were randomly assigned to one of three conditions, warning alone, warning and exposure to a video model performing the appropriate safety behaviors, or warning, video modeling, and a voice warning. The results showed that behavioral modeling presented through a video display significantly enhanced behavioral compliance compared to a video sign warning alone. The addition of a voice warning did not further increase compliance due to ceiling effects produced by the powerful influence of the modeling. Implications of this research for safety training programs and forensic human factors as well as suggestions for future research are discussed.

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Surgical, Economic, and Psychological Impacts of SARS-COV-2 on a Kansas Community Hospital System

The American Surgeon ◽

10.1177/0003134820924394 ◽

2020 ◽

Vol 86 (6) ◽

pp. 599-601 ◽

Cited By ~ 1

Author(s):

James J. Hamilton

Keyword(s):

Health Care ◽

Supply Chain ◽

Community Hospital ◽

Care Facility ◽

Emergency Operation ◽

Just In Time ◽

Emotional Impact ◽

Excess Capacity ◽

Hospital System ◽

Outpatient Visits

The chief of surgery of a 264-bed acute care facility and clinic system in Topeka, KS, USA, gives a chronology that illustrates the rapid and profound clinical, economic, and emotional impact of the SARS-CoV-2 outbreak on his hospital and community. In his view, the pandemic has laid bare the weaknesses of several factors basic to the modern US health care system and the resulting economic crisis: just-in-time supply chain technology; foreign sourcing of masks, gowns, and critical equipment, all at critical shortages during the crisis; rural hospital closings; lack of excess capacity through maximization of utilization for efficiency; and an overreliance on high revenue elective procedures and tests. His team was tested by an emergency operation for bowel obstruction that put all the isolation protocols into action. Despite their readiness and the success of the operation and the potential for telemedicine as an alternative to in-person evaluations and outpatient visits, the forced cancellation of all elective operations have led to the loss of revenue for both hospital system and providers, furlough and termination of workers, and financial hardship and uncertainty.

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Hospital safety climate and safety behavior

Health Care Management Review ◽

10.1097/hmr.0000000000000118 ◽

2017 ◽

Vol 42 (4) ◽

pp. 341-351 ◽

Cited By ~ 7

Author(s):

Alessandro Ancarani ◽

Carmela Di Mauro ◽

Maria D. Giammanco

Keyword(s):

Safety Climate ◽

Safety Behavior ◽

Hospital Safety

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Debiasing Decisions

Policy Insights from the Behavioral and Brain Sciences ◽

10.1177/2372732215600886 ◽

2015 ◽

Vol 2 (1) ◽

pp. 129-140 ◽

Cited By ~ 78

Author(s):

Carey K. Morewedge ◽

Haewon Yoon ◽

Irene Scopelliti ◽

Carl W. Symborski ◽

James H. Korris ◽

...

Keyword(s):

Decision Making ◽

Computer Game ◽

Blind Spot ◽

Bias Reduction ◽

Private Life ◽

Instructional Video ◽

Training Intervention ◽

Intelligence Analysis ◽

Training Interventions ◽

Bias Blind Spot

From failures of intelligence analysis to misguided beliefs about vaccinations, biased judgment and decision making contributes to problems in policy, business, medicine, law, education, and private life. Early attempts to reduce decision biases with training met with little success, leading scientists and policy makers to focus on debiasing by using incentives and changes in the presentation and elicitation of decisions. We report the results of two longitudinal experiments that found medium to large effects of one-shot debiasing training interventions. Participants received a single training intervention, played a computer game or watched an instructional video, which addressed biases critical to intelligence analysis (in Experiment 1: bias blind spot, confirmation bias, and fundamental attribution error; in Experiment 2: anchoring, representativeness, and social projection). Both kinds of interventions produced medium to large debiasing effects immediately (games ≥ −31.94% and videos ≥ −18.60%) that persisted at least 2 months later (games ≥ −23.57% and videos ≥ −19.20%). Games that provided personalized feedback and practice produced larger effects than did videos. Debiasing effects were domain general: bias reduction occurred across problems in different contexts, and problem formats that were taught and not taught in the interventions. The results suggest that a single training intervention can improve decision making. We suggest its use alongside improved incentives, information presentation, and nudges to reduce costly errors associated with biased judgments and decisions.

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