Study: Five solutions to patient safety change initiatives
Researchers identified five solutions to issues encountered during the implementation of procedures to reduce transmission of methicillin-resistant Staphylococcus aureus (MRSA) in six intensive care units. Those lessons “can serve as building blocks for future change initiatives,” authors asserted in a study published in Infection Control and Hospital Epidemology.
Catherine Amber Welsh, PhD, research faculty at the Indiana University in Indianapolis, and colleagues identified key solutions through interviews with staff from six ICUs in five Indianapolis hospitals that collaborated on implementing evidence-based practices to reduce MRSA transmission. The practices included active surveillance, hand hygiene, patient isolation and the use of personal protective equipment (gowns and gloves).
Interviews were conducted with 24 team members—38 percent of whom were infection control practitioners, 29 percent clinical unit personnel, 25 percent nonclinical employees and 8 percent educators. “Of the 42 themes generated from interview data, five trended across all hospitals and offered successful solutions to common issues encountered,” the authors wrote.
Researchers noted the following solutions:
Authors cited a few limitations in their study, including the small sample group, but maintained that, because the five hospitals ranged in structure, management and culture—number of beds, nonprofit/for-profit status—the results sufficiently reflect urban, acute care facilities to draw conclusions.
Catherine Amber Welsh, PhD, research faculty at the Indiana University in Indianapolis, and colleagues identified key solutions through interviews with staff from six ICUs in five Indianapolis hospitals that collaborated on implementing evidence-based practices to reduce MRSA transmission. The practices included active surveillance, hand hygiene, patient isolation and the use of personal protective equipment (gowns and gloves).
Interviews were conducted with 24 team members—38 percent of whom were infection control practitioners, 29 percent clinical unit personnel, 25 percent nonclinical employees and 8 percent educators. “Of the 42 themes generated from interview data, five trended across all hospitals and offered successful solutions to common issues encountered,” the authors wrote.
Researchers noted the following solutions:
- Engage frontline staff: Identify champions, have unit kickoff events, conduct conversations with staff to understand their perspectives, post process maps for staff input, make the project personal by sharing stories of patient and employee experiences, involve staff in creating educational videos and podcasts, and create isolation sign demonstrating proper protocols. “The inability to engage physicians was cited as the most difficult and least successful element of staff engagement; however, participants found that much progress was made even without physician champions,” wrote Welsh et al.
- Build the right multidisciplinary team: Successful teams include personnel from the unit, as well as ancillary departments—such as environmental services, laboratory, infection prevention, respiratory therapy, pharmacy, materials management and IT. Successful teams include a mix of formal authority and frontline staff, personality and team leadership, according to the study.
- Commit to data collection, management and feedback: Interviewees cited difficulties in tracking data, including complexity of tracking transmissions; lack of resources for collection, entry and analysis; and issues inherent in manual compliance tracking. “Hospitals used several solutions to manage the data issues, such as utilizing spreadsheets, purchasing MedMined, hiring interns, and moving from daily to weekly posting of unit-swabbing compliance,” authors wrote.
- Acquire and maintain management support: “Support in the form of money, personnel and sponsorship was vital to success, and sometimes education of hospital executives was required for MRSA bundle implementation.”
- Value of process mapping: “By evaluating each process and breaking it down into its concomitant steps, teams were able to understand each others’ roles in the process identify barriers, generate solutions and move past feeling overwhelmed by the amount of work required to implement the bundle,” wrote Welsh et al.
Authors cited a few limitations in their study, including the small sample group, but maintained that, because the five hospitals ranged in structure, management and culture—number of beds, nonprofit/for-profit status—the results sufficiently reflect urban, acute care facilities to draw conclusions.