NAPPSI & ICT Anounce 2004 Primary Prevention Safety Award Winners
First Place: Health First, Rockledge, Fla.
By Brad Poulos
The Primary Prevention Safety Award is sponsored by the National Alliance for the Primary Prevention of Sharps Injuries (NAPPSI) and ICT. The award recognizes a healthcare facility that has demonstrated efforts to prevent sharps injuries and champion primary prevention techniques and technologies.
Health First is a Florida-based, private, not-for-profit healthcare provider comprised of three medical centers: Holmes Regional Medical Center in Melbourne (550 beds); Cape Canaveral Hospital in Cocoa Beach (150 beds); Palm Bay Community Hospital in Palm Bay (60 beds). Health First is part of VHA, a nationwide cooperative of community-owned healthcare organizations.
Health Firsts mission is to improve the health of individuals within our communities through disease prevention, health education, and the delivery of quality healthcare services. Their philosophy of caring for patients, not for profit was demonstrated in fiscal year 2003 by providing more than $81million in charity care to patients who were unable to pay for their care.
Healthcare Worker Safety Culture
ICU Medical Clave needle-free connector
Health First embraced sharps safety products more than 10 years ago, even before the 2001 changes to the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standards (BBP). The infection control department led efforts to introduce safety syringes and a needleless IV system shortly after their introduction to the marketplace. Health Firsts members of administration and risk management have been strong supporters of safety initiatives and prevention strategies. Until recently, commercial availability of safer medical devices was limited, and the devices did not always meet clinical requirements.
The Health First Exposure Prevention Program was developed in 2001 with an initial safety product survey and needs assessment. The survey is a comprehensive list of all categories of sharps devices in use throughout the organization. Each category is assessed for current safety product use, and commercial availability of safety products. The Medical Product Standards Committee is responsible for review, evaluation and implementation of new products where appropriate. The ultimate goal of the program and the committee is to systematically convert all sharps to a safety device.
Implementation of a new safety device can be the most challenging aspect of an exposure-prevention program. At Health First, the Medical Product Standards Committee uses a multi-disciplinary approach to facilitate change. Members of the committee are assigned roles for introduction of each new device. Patient care services plays a key role in product evaluations and contract and supply chain; administration provides the cost analysis, product alternatives and coordinates the new product entry; and human resource development organizes the training of end users. Infection control, employee health, and safety and security monitor compliance and efficacy through exposure reports and employee feedback.
Recent successes at Health First include a state-of-the-art needle-less IV system, safety IV catheters and a safety bone marrow biopsy needle. Today, virtually all percutaneous puncture (IV placement, injections, biopsies, blood draws, etc.) is done with a sharps safety device.
Of course, education plays a huge role in work practices and compliance when changing to a safety product. Educational tools at Health First include Prevention (an infection control newsletter) Safety On The Go (an environment-of-care newsletter); the Associates Press (monthly employee newsletter), an Intranet education site; and an online learning program covering the OSHA BBP standards and sharps safety. Annual skill fairs focus on providing information about sharps-safety products.
The primary prevention technologies implemented by Health First are:
- Sutureless catheter-securement products
- Needleless IV connectors
- Surgical glues
- Needleless drug-delivery products
- Needleless hemodynamic monitoring
- Pre-filled syringes
- Plastic blood culture bottles
BD Insyte Autoguard
Using primary prevention technologies whenever possible is a constant goal at Health First. For example, the IV team recognized the value of using catheter-securement devices as a way to not only reduce sharps injuries from suture needles and IV needles due to unscheduled restarts, but also to enhance patient safety, improve healthcare worker productivity, and reduce costs. Intravenous therapy at Health First begins with insertion using a safety IV catheter, the BD Insyte Autoguard (a secondary prevention technology) and the ICU Medical Clave® needle-free connector (a primary prevention technology). The Venetec StatLock® IV (a primary prevention technology) is used to secure the catheter, thus maximizing healthcare worker safety. Health First recognizes the fact that it is less expensive to prevent sharps injuries than to treat them.
The secondary prevention technologies implemented by Health First are:
- Safety IV catheters
- Safety syringes
- Safety blood-collection devices
- Safety lancets
- Safety scalpels
- Safety biopsy needles
Venetec StatLock IV
The NAPPSI Clinician Advisory calls upon clinicians to employ both primary and secondary prevention measures to maximize sharps injury protection in the healthcare workplace. Clearly, Health First has taken the spirit of the advisory to heart. By implementing and reinforcing primary prevention strategies, long before they became mandatory under federal law, countless sharps injuries have doubtless been prevented and thousands of sharps have been kept out of this exemplary healthcare workplace. Congratulations to the Health First system for their wise and widespread implementation of sharps injury prevention. Clearly, they have earned the 2004 Primary Prevention Sharps Safety Award.
Brad Poulos is director of the National Alliance for the Primary Prevention of Sharps Injuries (NAPPSI).
HealthEast Care System Named First Runner-Up in the 2004 Primary Prevention Safety Award
By Brad Poulos
HealthEast Care System in St. Paul, Minn. was selected as the first runner- up in the 2004 Primary Prevention Safety Award. HealthEast Care System is a network of integrated care services, including four hospitals, which serve the cities of Minneapolis and St. Paul, Minn. and the surrounding communities. In 1999, a system-wide, multi-disciplinary needle-safety committee was formed to assist in creating a culture of sharps safety. The committee developed a mission, vision and goal for this important work. The mission was to effectively reduce occupationally acquired sharps injuries through elimination of sharps where possible, and use safety devices and safer work practices and education as part of a comprehensive, systematic process for improvement. The vision was to develop a culture where prevention of sharps injuries is a work habit and an organizational commitment, and the goal was to have zero sharps injuries.
The team developed a campaign logo and theme titled, The Goal is Zero: Zero-In on Accidental Needlesticks! Campaign for Worker Safety through Sharps Injury Prevention, as well as a communication plan that includes posters, stickers, and an ongoing newsletter called Nix the Sticks!
According to Boyd Wilson, system director of infection control, eliminating sharps injuries is a very difficult goal for a number of reasons.
Needle safety is challenging to address because it requires people to be comfortable with change in behavior and oftentimes clinical practice, he explains. We have tried very hard to include our staff in the decision-making process regarding needle safety, so they could buy into the benefits before we implemented the program.
The HealthEast Needle Safe Committee, co-chaired by Kathy Miller, St. Johns Hospital infection control specialist, and Debbie Hulbert, system director of employee occupational health, has been instrumental in this process.
By 2003, HealthEast experienced a decrease in injury rates in all of the hospitals where the majority of sharps injuries occur and the sharps injury rate was cut nearly in half across the system. In 2004, they have focused on reducing sharps injuries in surgery and have seen some improvement already in the first quarter.
It has taken awhile to see the success in reducing our injuries, Wilson continues. Its a project that requires continual evaluation and openness to change in order to create a shift to create a culture of safety. We applaud the Needle Safe Committee for their work and our staff and physicians for their trust and support of this program.
Rather than using a traditional performance improvement model for this work, the team used an eight-stage change model, described by John P. Kotter in his 1996 book Leading Change, to support the culture transformation. The eight stages are:
- Establishing a sense of urgency
- Creating a guiding coalition
- Developing a vision and strategy
- Communicating the change vision
- Empowering employees for broad-based action
- Generating short-term wins
- Consolidating gains
- Producing more change and anchoring new approaches in the culture
They also implemented communication and education modifications to include a new needle-safety module as a part of the computerized mandatory education, and updated the sharps safety information provided during general orientation and site/department orientation.
Success has been due to the combined approach of implementing safety devices, providing ongoing educational support, and assessing work practices. The group seizes every opportunity to continue to keep a high awareness level regarding preventing sharps injuries. An important part of the culture transformation is that non-safety needles and sharps are being eliminated where clinically feasible. Wherever a safer alternative has been identified, the group used an exemption form process for those departments requesting a non-safety device. Therefore, the purchasing department serves as a stopgap to prevent departments from ordering non-safety products without review and approval of the needle safe committee.
Their culture is continually transforming, and good habits are being nurtured sometimes in unexpected ways. At a recent emergency department infection control in-service, a physician presented a bottle of wine to a nurse who had pointed out to him recently that he did not clean up his sharps after a procedure. He agreed it was his responsibility and said he owed her a bottle of wine and would change his practice. They are celebrating their successes when they come and continue to work toward the goal of zero by transforming the work culture to one where sharps injury prevention and worker safety are becoming a habit. This work was presented as a performance improvement initiative during recent JCAHO surveys and was presented at the 2003 APIC-Minnesota Fall Conference.
Brad Poulos is director of NAPPSI.
2004 Primary Prevention Safety Award Sponsers
A pioneer of safety-inspired advancements, Baxter is your connection to safety. With the introduction of the Interlink System, Baxter became the first medical device manufacturer to offer split septum access ports, greatly reducing the need for traditional steel needles and the potential for accidental needle-stick injuries. Baxter's latest needleless technology, the Clearlink System, offers cannula-free, Luer-activated access. Clearlink also promotes safety through its unique, clear housing. This provides visualization of the fluid path, allowing clinicians to see the results of flushing.
(800) 4 BAXTER or www.baxter.com
The passive Introcan® Safety IV Catheter is designed to minimize accidental needlesticks without requiring user activation. A stainless steel clip is used to shield the needle tip. The passive design eliminates risk of inadvertent activation while offering a short learning curve with minimal inservice training. Compliance is virtually assured since the safety mechanism cannot be bypassed. A syringe can be pre-attached to the Introcan Safety IV Catheter to facilitate aspiration and injection during insertion.
(800) 854-6851 or www.bbraunusa.com
Bio Systems is the expert in providing full service sharps management solutions to hospitals throughout the United States. Through the utilization of our unique re-usable sharps containers and handling process, Bio Systems has been successful in providing safe, environmentally friendly and cost effective sharps management programs to hundreds of major hospitals since 1984.
(888) 776-2288 or www.biosystemsusa.com
Cell Robotics, Inc.
Cell Robotics, Inc. provides the only sharps-free instrument for capillary blood sampling. The new Lasette® P200 laser lancing device is redesigned specifically for clinical screening and point-of-care blood analysis featuring higher blood flow, one-handed operation, and simplified controls. Laser lancing requires no physical penetration of the skin and eliminates the use of medical sharps.
(800) 846-0590 or www.cellrobotics.com
Hospira is a global specialty pharmaceutical and medication delivery company dedicated to Advancing Wellness by developing, manufacturing and marketing products that help improve the safety and efficacy of patient care. Created from the core global hospital products business of Abbott Laboratories, Hospira is a new company with 70 years of service to the hospital industry. The companys portfolio includes the industrys broadest line of acute-care injectables and integrated solutions for medication management and infusion therapy.
(877) 9HOSPIRA or www.hospira.com
Tyco Kendall has demonstrated its commitment to providing top-quality sharps containers, needles and syringes and blood collection products to the healthcare industry, developing and manufacturing the broadest range of products available with the clinician in mind and strict quality control measures in place. The best products for the job, the safest products on the market.
(508) 261-8000 or www.tycohealthcare.com
StatLock safety securement devices replace the outmoded catheter fixation techniques of tape and suture to provide dramatically improved patient safety, healthcare worker protection and cost-benefits. StatLock is fastbecoming the new standard for securement of all medical tubes and catheters. In fact, the CDC has recently acknowledged that StatLock is superior to suture in reducing catheter-related blood stream infection. Similarly, OSHA and the U.S. Congress have recognized StatLock as a needlestick safety device under the law. And, with over 10,000 patients studied, StatLock is indisputably superior to tape for securement of peripheral IV catheters. StatLock the new Standard of Care for vascular access device securement.
(800) 833-3895 or www.statlock.com