Healthcare Improvement Project - Term Paper Example

lthсаrе Imрrоvеmеnt Рrоjесt Name Affiliated Institute Date Неаlthсаrе Imрrоvеmеnt Рrоjесt Introduction King Abdulaziz Medical City in Riyadh was established under the National Guard Health Affairs in 1983. The National Guard Health Affairs handles the provision of optimum health care as well as academic opportunities, the performance of medical research, and participation in community health programs (National Guard Health Affairs, 2012). King Abdulaziz Medical City has enjoyed its membership with National Guard Health Affairs, which has lead to its continued expansion and its increased bed capacity to 690. Besides, 30 beds have been allocated to surgical operation while 134 beds for the emergency cases admission. King Abdulaziz Medical City is consistent with its success by availing the minimum morbidity and mortality rates among the patient populace. It is also internationally acknowledged as a center in twin separation surgery with 100% successful rate in surgical twin separation procedures (Hanan et al., 2011). However, exposure to bloodborne pathogens from the need sticks poses risks to health workers at the hospital. A recent study of epidemiologic characteristics of percutaneous injuries among healthcare workers at KAMC-R reported a total of 358 needlestick injuries in 2008 (Balkhy et al., 2011). Nurses (52.8%) reported more injuries related to needle stick than other job categories in KAMC-R, followed by physicians (18.4%). Record from the workers health nursing department and employees compensation also provided incidences of needle stick injuries for the past three years. The National Guard Health Affairs challenged KAMC-R to reduce injuries related to needlestick injuries. Consequently, the National Guard Health Affairs named a team made up of nursing, safety officers, infection control, workers health staff and employee compensation. The team also partially consisted of how employees from the respiratory therapy, the lab, and interventional radiology. The members of the team understood the incidence of needle accidents, OSHA record keeping, and different incidence that demanded the use of a needle. The team members were to collect historical data related to needlestick injuries, analyze the cause, and recommend methods and procedures to prevent them. The main aim of the team was to reduce cost related to needle stick among workers within twelve months. The employee compensation record availed the exact cost of each needle stick incidence over the past three years. The initial measurement of the cost saving for the project involved the lab work, transportation, medical care and lost time. The team approximated that nearly 40,000 dollars per year could be avoided or saved by reducing these injuries. Diagnostic phase The team tried to determine the appropriate measurement tool to assess needle stick injuries. One of the instruments the team reviewed includes the Failure Mode and Effective Analysis (FMEA) which is widely applied in a healthcare setting (QRM, 2011). FMEA presents an examination of the likely modes of failure and their impact on the outcome. Risk-reducing measures are applied to the known causes of injuries by eliminating, containing, reducing and controlling the potential risks (QRM, 2011). The FMEA assessment instruments break down the complex process into suitable steps. Besides, this assessment tool summarizes significant modes of failure as well as cause factor of needle stick injuries and the possible effect of the issue. The output can be utilized to guide resource preparation and as a basis for analysis. Failure Mode, Effects and Critically Analysis (FMECA) is an extension of FMEA, although it examines the level of injury severity, their likely incidence, and their detectability (QRM, 2011). This measurement instrument identifies areas that demand extra preventive action suitable to lower injury-related risks. Fault Tree Analysis (FTA) has been applied in a process that had functionality failure. It examines system process in a sequence to determine sources of injuries by defining significant chains. The outcome of this measuring tool is presented in a tree of fault mode (QRM, 2011). An expert can use FTA measurement instrument to identify causal factors. The team opted to use European Medicines Agency recommendation of a simple tool to organize systematically the collected data and ease the process of decision making. The team decides to incorporate process map s so as to demonstration the occasion of an employee being stuck by a needle. All the steps were listed as presented in the following process map. Process map The likely risk was noted for the development of cause and effect diagram. The team members brainstormed on the cause by utilizing the cause and effect diagram. The cause and effect diagram helped the team the many likely causes if injuries related to needle sticks. The team developed the cause and effect diagram by first asking the why questions so to help in brainstorming. Cause and effect diagram Pareto chart Most incidences were due to the unsafe passing of instruments during surgery and unsafe utilization of the intramuscular (IM) needles. Disposal of the needle had the next highest incidence with nearly twenty eight sticks from needles being placed in the trash, thus, affect the service staff related to environment and cleaning. Intervention phase With high prevalence of needle stick injuries in the above mention sectors, the team agreed the need for preventing needle stick injuries as the responsibility of the hospital as it had to provide safe environment, education programs and establish an effective needle stick reporting, and ensuring adherence to guidelines when dealing with sharps. The team also came to agreement that needle stick injuries can be prevented through application of an inclusive needle stick injury avoidance program that include employee training and addressing risk of injuries, potential hazards and procedures of reporting injuries. Persistent staff training was considered the best preventive strategy while standardizing post-exposure procedures was highly recommended. To comprehensively integrate all the recommended intervention, the team proposed an online reporting system. The team proposed the use of electronic record in the health system. The team agreed that electronic record system will lead to higher quality through efficient and safer care system. It was also believed that electronic record system will significant improve the effectiveness and efficiency of health care workers, applying electronic health records is critical in changing the delivery of health care especially in those areas related to cost saving. The optimum benefits of electronic health records can be accomplished through standardization of electronic health record, reporting methods, and legal authority for using electronic health records. On-line reporting system compared to the existing paper-based system, has many advantages as it can be submitted immediately without delay and this will help the hospital to analyze the data and respond to the incidents faster and in a more coordinated way. Information obtained by the proposed system can be saved, updated later on, secured and accessed by legible personnel. Besides, it does not cost extra money if the internet services are available in the hospital. The transition and shift to electronic records are not easy, and the significance of using it are more critical than adopting and accepting it. To overcome challenges of employee resistance to using on-line reporting system, the team proposed employee involvement and management support. The team performed a pilot study to assess the risk, weakness and strengths of the online reporting form. PDSA cycle was considered an effective tool as it would foster employee collaboration while stressing on improved facts and indicators. The PDSA cycle was used to understand, investigate, and evaluate the acceptance of the proposed intervention, and thus enabling management to overcome invisible problem before the actual implementation phase. The PDSA cycle is presented in the following table. Step explanation P: Plan The team will arrange a meeting in two weeks with all staff and head nurses to announce about the proposed intervention. One week later, the team will arrange for the workshop and educational presentation to request for a pilot study of the new form. The finalized form will be uploaded in four months for implementation. D: Do Online form will be piloted for two months Workshop and educational program will be organized in three weeks. S: Study The team will apply interview and questionnaire to assess the strength and weakness of the proposed intervention A: Act Regarding pilot study and interview, the online reporting system will be continued and modified where appropriate. Impact and implementation phase The program implementation was broken down into input and outputs. The input sector was the period before the implementation of the program and output was a period after implementation of the program. The hospital safety officer collected data measures to the hospital level dashboard. Safety officer reported the recorded and measured data to the team with a normalizer of 15,000 APD (adjusted patients days) in December 2014, and went back from January 2014, establishing a threshold of 6.00 (needle injuries per 15,000 ADP). The threshold did not bypass what was established at 6.00 since this was the maximum historical level. After collecting data from the cause and effect diagram, the team noticed a 20% slight increase in the number of stick in March. Therefore they investigated the cause and developed a Pareto chart of the cause. Sustaining improvement phase The programs elements linking constructs, short term goals, long term goals and the overall program objectives from the program intended outcomes. These elements form the basis for comparing the program observed behavior and the intended program goal. The linking construct is the connector bridging the actual implementation output and the intended program purpose. The linking construct connects the implementation objectives for training employees to effectively engage in electronic records system, applying the training by engaging, evaluating and reporting the electronic recording system and eventually achieving the intended outcomes by resolving issues lingering in critical areas of significance. The training and education process puts implementation elements into a learning operation. The online reporting system consists of training employees to engage in highly emotional and high stakes confrontation where opinions differ. The education workshop consisted of a two-day seminar that took place on site venue of the hospital. The training introduced 60 video clips that provided examples of a situation where the intervention had applied. The trainer was also asked to provide their personal experiences and stress on group participation and self-reflection. The training program applied the Kotter’s eight change phases as demonstrated in the following table. Phases Time allocation Step 1: Establishing a sense of urgency 90 min Define the intervention and its application, share opinions openly and straightforwardly Step 2: develop a coalition 75 min Recognizing one’s style under stress and controlling one’s reactions and behavior Step 3: Develop a clear vision 120 min Speaking convincingly of the objective of program without insensitivity and harshness Step 4: Share the vision 90 min Step 5: Empower workers to clear obstacles 120 min Spotting impending disruptive and even violent behaviors Step 6: Secure short term wins 60 min Returning to dialogue and making a situation safe Step 7: Consolidate and keep moving 120 min making it safe for others to contribute and addressing others opinion Step 8: Anchor the change 60 minutes Applying the program to a real-world situation and achieving a result. Conclusion The acceptance and adoption of an online reporting system for needle stick are part of hospital’s vision for moving toward electronic record system. Before the intervention, there was high case linked to physical, social and psychological effects of needle stick injury. The one-year intervention has reduced the prevalence of needle stick injuries as well as addressing the staff behavior towards reporting incidences, thus reducing the hospital cost of needle stick injuries. It is significant for the hospital employees to report and document every needle stick to ensure timely and post exposure such as testing and treatment, collect data to assess the safety measure of the workplace. When the team implemented the intervention, they were a high report on needle stick injuries among the staff. This availed knowledge about the cause of needle stick injury and the environmental factors that increased the occurrence of needlestick injury. Provision of education training through workshops played a significant role in reducing the prevalence of stick injury. The electronic system also saved the hospital time and cost spent in writing forms and submitting them personally to the concern department. References Balkhy, H. H., El-Beltagy, K. E., El-Saed, A., Sallah, M. & Jagger, J. (2011). Benchmarking of percutaneous injuries at a teaching tertiary care center in Saudi Arabia relative to United States hospitals participating in the exposure prevention information network. American Journal of Infection Control, 39(7), 560-5 Gulf Cooperation Council Centre for Infection Control (2008). Infection prevention and control manual. Kingdom of Saudi Arabia: King Abdul-Aziz Medical City. McDavid, J.D., & Hawthorn, L.R.L. (2006). Program evaluation and performance Measurement: An introduction to practice. Thousand Oaks, CA: Sage. Merry, A., & Smith, A. M. (2001). Errors, medicine, and the law. Cambridge, UK: Cambridge Press. Mitchell, P.H. (2008). Defining patient safety and quality care. In R.G. Hughes (ed.), Patient Safety and quality: An evidence-based handbook for nurses. Rockville, MD: Agency for Healthcare Research and Quality. Quality Risk Management QRM (ICH Q9), (2011) European Medicines Agency. Read More