This study focused on a checklist of the daily work performed in an oral outpatient department. This complicated daily work was organized to improve the efficiency of carrying out each task and to prevent the omission of work. The study was divided into two phases:
(1) Designing and producing an inspection form;
(2) Applying the checklist.
2.1. Designing and producing the checklist
The goal was to design an easy-to-use, time-saving checklist. This study was conducted based on the daily work of the outpatient department of our hospital. Before the start of daily diagnosis and treatment activities, the nursing staff should determine the hospital sense and complete equipment inspection and maintenance, epidemic prevention and control, etc., to ensure the safety and normal progress of medical activities. The items for routine inspection included the following: air disinfection machine, indoor temperature and humidity, refrigerator temperature and humidity, dental chair and terminal disinfection, soaking liquid (to determine if replacement is needed), ultraviolet disinfection, teeth cleaning machine water storage tank cleaning, leading examining table disinfection, preview triage table disinfection, instrument equipment disinfection, air compressor, video room, ultraviolet disinfection, sewage pump operation, negative pressure pump, pure water machine, and medical staff temperature measurements. Before the development of the checklist described in the current study, recording the completion of each daily inspection task required searching more than 10 other forms, which was a cumbersome process. Figure 1 depicts the record sheet applied in our outpatient department before the use of the checklist. In the checklist described herein, we simplified and organized the work and classified all the inspection items into three categories: 1) clean and disinfect surfaces; 2) inspect and maintain equipment; and 3) maintain environment and health. According to the actual situation of the outpatient department, the order of the examination items was adjusted from top to bottom to avoid repetition of the route and omission of the examination items.
All the items on the checklist were based on the daily work list (Figure 2), and all users were required to mark "yes" or "no" on the checklist based on whether each item was completed or was in good working condition. If there were abnormalities or problems related to the inspection items, the problems were traced back and solved in a timely manner, and detailed explanations were provided in the Remarks column of the inspection form. Finally, each user was required to sign and date the inspection form. Notably, the limited paper size limited the number of checklist items; however, to avoid one or more large sheets of paper, which would inconvenient, the work was sorted, integrated, and ordered to keep the list comprehensive and concise.
2.2 Application of the checklist
The outpatient routine work checklist was implemented in our hospital at the beginning of 2021, and the clinical application study of the checklist and the questionnaire evaluation of nursing staff satisfaction were conducted from May 1, 2021, to May 14, 2021.The study was approved by the Ethics Committee of the School of Stomatology, Shanxi Medical University (No.2020SLL007).This study was conducted in the outpatient department of our hospital, and informed consent was obtained from all subjects enrolled in the study. The participants were divided into two groups: the experimental group (n=14) that used the checklist and the control group (n=14) that used the original form. A nursing staff member in the experimental group and a nursing staff member in the control group performed outpatient routine work examinations at the same time every day, and the data were collected for 2 weeks (14 days) and then analysed. We evaluated three aspects associated with the use of the checklist, and our specific research questions were as follows:
Study Question 1: Can the implementation of a daily work checklist improve work efficiency and shorten the inspection time?
The inspection time of each nurse in the experimental group and the control group was recorded for statistical analysis.
Study Question 2: Can the implementation of a routine checklist reduce the incidence of omissions of inspection items?
This study included a total of 16 items of daily outpatient work. The number of items missed by each staff member in the experimental group and the control group was recorded, and the omission rate was calculated (the occurrence of omissions was expressed as a percentage) for statistical analysis.
Study Question 3: How satisfied are the nursing staff with the implementation of the routine work checklist?
By means of a questionnaire survey (Table 1), each staff member in the experimental group and the control group scored specific questions in the questionnaire, which were divided into five grades: Strongly Agree (5 points), Agree (4 points), Neutral (3 points), Disagree (2 points), and Strongly Disagree (1 point). According to the scoring situation, each question in the questionnaire was statistically analysed.
The specific contents of the questionnaire were as follows:
Ⅰ. I can clearly remember everything I need to check;
Ⅱ. My inspection items are not easily omitted;
Ⅲ. I had relatively little time to check;
Ⅳ. My inspection operation process is relatively convenient;
Ⅴ. I can complete all the inspection items by myself;
Ⅵ. My checklist is relatively easy to keep;
Ⅶ. My workload has been reduced;
Ⅷ. Work records can be easily searched;
Ⅸ. I can conduct the inspection in an orderly way, not in a hurry;
Ⅹ. I can timely and clearly record the problems encountered during the inspection.
2.3 Statistical methods
The data results were collated using the spreadsheet program Excel 2007 (Microsoft Corp, Redmond, WA). Statistical analysis was performed using SPSS 22.0 (IBM Germany GmbH, Eningen, Germany) software. The average checking time, omission rate and scores of each question in the experimental group (checklist group) and control group (original form group) were calculated, and the measurement data are expressed as the mean ± standard deviation. The one-way ANOVA test was used for comparisons between groups, and a P value less than 0.05 was considered significant.