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Workbook for Designing, Implementing, and Evaluating a Sharps Injury Prevention Program |
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OPERATIONAL PROCESSESThe following section describes five operational processes that are viewed as essential elements of any sharps injury prevention program. Toolkit resources to assess, implement, or evaluate these processes are included in the appendices. Institutionalize a Culture of Safety
in the Work Environment
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KEY POINTS |
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Safety culture is also relevant to patient care and safety. According to an Institute of Medicine (IOM) report, To Err is Human (109), medical errors represent one of the nation's leading causes of death and injury. The report estimates that 44,000 to 98,000 deaths occur in U.S. hospitals each year. Although the report acknowledges that causes of medical error are multifaceted, the authors repeatedly emphasize the pivotal role of safety culture. Thus, whereas the focus of this workbook is on healthcare personnel safety, strategies related to safety culture also have important implications for the health and welfare of patients.
To create a culture of safety, organizations must address those factors known to influence employees' attitudes and behavior. Organizations must also direct measures to reduce hazards in the environment. Although many factors influence a culture of safety, this workbook emphasizes those that are believed to be the major determinants of a safety culture.
Ensure Organizational Commitment. Organizations can use three important strategies to communicate their involvement in and commitment to safety:
Management can also communicate a commitment to safety indirectly by modeling safe attitudes and practices. Healthcare professionals in positions of leadership send important messages to subordinates when they:
Similarly, managers should address sharps hazards in a non-punitive manner as soon as they are observed and discuss safety concerns with their staff on a regular basis. This will positively reflect the organization's commitment to safety and build safety awareness among staff.
Involve Personnel in the Planning and Implementation of Activities That Promote a Safe Healthcare Environment. Involving personnel from various areas and disciplines while planning and implementing activities improves the culture of safety and is essential to the success of such an initiative. Those personnel who participate on committees or teams created to institutionalize safety serve as conduits of information from and to their various work sites. They also legitimize the importance of the initiative in the eyes of their peers.
Encourage Reportingand Removal of Sharps Injury Hazards. Another strategy for institutionalizing a culture of safety is to create a blame-free environment for reporting sharps injuries and injury hazards. Healthcare personnel who know that management will discuss problems in an open and blame-free manner are more likely to report hazards. Healthcare organizations can also actively look for sharps injury hazards by performing observational rounds and encouraging staff to report near misses and observed hazards in the work place. (See Implement Procedures for Reporting Sharps Injuries and Injury Hazards.) Once identified, hazards should be investigated as soon as possible to determine the contributing factors, and actions should be taken to remove or prevent the hazard from occurring in the future.
Develop Feedback Systemsto Increase Safety Awareness. A number of communication strategies can provide timely information and feedback on the status of sharps injury prevention in the organization. One strategy incorporates findings from hazard investigations, ongoing problems with sharps injuries, and prevention improvements into articles in the organization's newsletter, staff memoranda, and/or electronic communication tools. It is important to communicate the value of safety by providing feedback when the problem is first observed and commending improvements. Another strategy is to create brochures and posters that enhance safety awareness. Such materials can reinforce prevention messages and highlight management's commitment to safety.
Promote Individual Accountability. Promoting individual accountability for safety communicates a strong message about the organization's commitment to a safe healthcare environment. In order for accountability to be an effective tool, all levels in the organization must comply. An organization can promote individual accountability for safe practices in general-and sharps injury prevention in particular-in many ways. One way is to incorporate an assessment of safety compliance practices in annual performance evaluations; for managers and supervisors, this might include evaluating methods used to communicate safety concerns to their subordinates. Organizations might also consider having staff sign a pledge to promote a safe healthcare environment. This could be incorporated into hiring procedures and/or as part of an organization-wide safety campaign.
Data from four possible sources can measure how improvements in safety culture affect sharps injury prevention:
Each of the above tools can demonstrate changes over time that serve to indicate improvements in the safety culture. For example, decreased frequency of selected items on a blood exposure report form can reflect an increased safety consciousness (e.g., improperly discarded sharps, collisions between personnel that result in a sharps injury). Also, periodic (e.g., every few years) personnel surveys on perceptions of safety and exposure reporting are likely to reflect positive changes in the organization's commitment to safety. Hazards will also decrease as problems are addressed and corrected. If no improvements are detected, the sharps injury prevention leadership team should reassess its strategies and revise the performance improvement action plan.
Additional information on implementing a culture of safety is available at the following Websites: