ORGANIZATIONAL STEPS
This section describes a series of organizational steps that are designed
to ensure that a sharps injury prevention program:
- Is integrated into existing safety programs,
- Reflects the current status of an institution's prevention activities,
and
- Targets appropriate areas for performance improvement.
Processes Performance Improvement
Although the program focuses on preventing sharps injuries, it is based
on principles that can be applied to the prevention of all types of blood
exposures.
Step 1. Develop Organizational
Capacity
The proposed model is an institution-wide program (i.e., encompassing all
aspects of an organization, whether a small private practice or a complex
medical center) in which responsibility is held jointly by members of a
multidisciplinary leadership team that is focused on eliminating sharps
injuries to healthcare personnel. Representation of staff from across disciplines
ensures that needed resources, expertise, and perspectives are involved.
The responsibility and authority for program coordination should be assigned
to an individual with appropriate organizational and leadership skills.
Representation from senior-level management is important to provide visible
leadership and demonstrate the administration's commitment to the program.
The team should also include persons from clinical and laboratory services
who use sharp devices, as well as staff with expertise in infection control,
occupational health/industrial hygiene, inservice training or staff development,
environmental services, central service, materials management, and quality/risk
management, as available. Regardless of the type or size of the organization,
a multidisciplinary approach is essential to identify health and safety
issues, analyze trends, implement interventions, evaluate outcomes, and
make recommendations to other organizational components.
KEY POINTS
Designing Action Plans |
- Establish an action plan for reducing injuries
- Set targets for injury reduction
- Specify which interventions will be used
- Identify indicators of performance improvement
- Establish time lines and define responsibility
- Establish an action plan for performance improvement
- List priorities for improvement, as identified in the baseline
assessment
- Specify which interventions will be used
- Identify performance improvement measures
- Establish time lines and define responsibilities
|
Model for a Leadership Team
Staff Representation |
Contributions/Strengths |
Administration/Senior Management |
Communicate the organization's commitment to worker
safety; and Allocate personnel and fiscal resources to meet program
goals. |
Infection Control/Healthcare Epidemiology |
Apply epidemiologic skills to the collection and
analysis of data on injuries and healthcare-associated infections;
Identify priorities for intervention based on disease transmission
risks; and Assess infection control implications of engineered sharps
injury prevention devices. |
Occupational Health and Safety/Industrial Hygiene1 |
Collect detailed information on reported injuries;
Assist in surveying healthcare personnel on underreporting; and Assess
environmental and ergonomic factors contributing to sharps injuries
and propose solutions. |
Risk Control/Quality Management1 |
Provide an institutional perspective and approach
to quality improvement; and Help design processes related to the
sharps injury prevention program. |
Inservice Training/Staff Development |
Provide information on current education and training
practices; and Identify training needs, and discuss the organizational
implications of proposed educational interventions. |
Environmental Services |
Provide insight on environmental injury risks not
captured through percutaneous injury reporting; and Assess the environmental
implications of proposed interventions. |
Central Service |
Provide insight into unique injury risks associated
with reprocessing of sharp devices; and Identify logistical issues
involved in implementing devices with engineered sharps prevention
features. |
Materials Management |
Help identify products and manufacturers of devices
with engineered sharps prevention features; and Provide cost data
for making informed decisions. |
Labor |
Promote injury reporting, safe work habits, and the
implementation of prevention priorities among members. |
Front-line Clinical and Laboratory Staff |
Provide insight into injury risk factors and the
implications of proposed interventions; Actively participate in the
evaluation of prevention interventions. |
Although the leadership team should include a small core group of clinical
staff, other staff from areas such as radiology, anesthesiology, respiratory
therapy, surgery, hemodialysis, intensive care, pediatrics, and other
units might be invited to participate in a particular discussion or as
part of an ad hoc subcommittee.
In this first step, the leadership team should outline how it plans
to achieve the goal of injury reduction or elimination. The team should
determine which of the facility's standing committees will contribute
to the process and how these committee's will exchange information. Committees
might include:
- Infection Control
- Quality Improvement
- Occupational Health and Safety
- Value Analysis
- Materials Management/Product Evaluation
In some organizations, one of these committees might be charged with
oversight of the sharps injury prevention program. However, each committee
should become involved in designing the sharps injury prevention program.
For example, the Occupational Safety and Health or Infection Control
committees might provide monthly reports on sharps injuries. In turn,
the leadership team might work with the Occupational Safety and Health
or Infection Control committees to improve the quality of information
collected to better meet performance improvement goals.
Step 2. Assess Program Operation
Processes
The proposed program model includes five operational processes, each
of which is discussed in detail in subsequent sections of the workbook.
These include:
- Institutionalize a culture of safety in the work environment,
- Implement procedures for reporting and examining sharps injuries
and injury hazards,
- Analyze sharps injury data for prevention planning and measuring
performance improvement,
- Selection of sharps injury prevention devices (e.g., devices with
safety features), and
- Education and training of healthcare personnel on sharps injury prevention.
The team should conduct a baseline assessment of each of these processes
to determine where improvements are needed.
KEY POINTS
Program Operation Processes |
- Five processes support a sharps injury prevention program
- A baseline assessment of these processes is necessary for effective
program planning
- Areas for review include:
- Assessment of the Culture of Safety
- Procedures for sharps injury reporting
- Analysis and use of sharps injury data
- Systems for selecting, evaluating and implementing safety
devices
- Programs for the education and training of healthcare personnel
on sharps injury prevention
|
Toolkit Resource for This Activity:
Baseline Program Assessment Worksheet (see Appendix
A-1)
Assessing the Culture of
Safety
This assessment determines how safety, particularly sharps injury prevention,
is valued in the organization and what processes are in place to promote
a safe work environment for the protection of patients and healthcare
personnel. Key elements of an organizational safety culture and suggestions
for improving safety awareness are discussed in Operational Processes,
Institutionalize a Culture of Safety in the Work Environment. As
part of a baseline assessment, the team should assess the following:
- Organization leadership's commitment to safety;
- Strategies used to report injuries and to identify and remove injury
hazards;
- Feedback systems to improve safety awareness; and
- Methods to promote individual accountability for safety.
The team should also explore the data sources (e.g., written or observational
surveys, incident reports) that are used or could be used to measure
safety culture performance improvement. As part of the baseline assessment
and as a possible mechanism for measuring performance improvement, the
team might consider using the following tool to survey staff about
their perceptions of a safety culture in the organization.
Toolkit Resource for This Activity:
Survey to Measure Healthcare Personnel's Perceptions of a Culture of
Safety (see Appendix A-2)
Assessing Procedures for Sharps Injury
Reporting
Most healthcare organizations have procedures for reporting and documenting
employee needlesticks and other percutaneous injuries. The team should
assess whether these procedures are adequate for data collection and
analysis and determine the data sources that can be used to assess improvements
in injury reporting.
As part of the baseline assessment, the team should consider using
the following tool to assess the completeness of sharps injury reporting.
(Although postexposure management is not included in the model for
a sharps injury prevention program, the survey tool does include questions
that can be used to assess worker satisfaction with the postexposure
management process.) Periodic repeat surveys (e.g., every few years)
can be used to measure improvements in reporting compliance.
Toolkit Resource for This Activity:
Survey of Healthcare Personnel on Occupational Exposure to Blood and Body
Fluids (see Appendix A-3)
Assessing Methods for the
Analysis and Use of Sharps Injury Data
Data on sharps injuries need to be analyzed and interpreted so it will
be meaningful for prevention planning. This part of the assessment determines
how these data are compiled and used in the organization. See Operational
Processes, Analyze Sharps Injury Data, for a discussion of how to
perform simple data analysis.
Assessing the Process for
Identifying, Selecting, and Implementing Engineered Sharps Injury Prevention
Devices
Because an important goal of this workbook is to provide information
and guidance on the implementation of devices with engineered sharps
injury prevention features, a model approach for the evaluation of these
devices is included in Operational Processes, Selection of Sharps
Injury Prevention Devices. This baseline assessment considers who
is involved and how decisions are made. As with other program functions,
it is important to determine the data sources (e.g., product evaluation
committee reports, lists of manufacturers contacted, device lists) that
can be used to measure process improvement. A similar process assessment
of methods for identifying and implementing other prevention interventions
(e.g., changes in work practices, policies, and procedures) also could
be included in this baseline assessment.
Assessing Programs for the
Education and Training of Healthcare Personnel on Sharps Injury Prevention
Most healthcare institutions have a plan for providing employee education
and training on bloodborne pathogen prevention at the time of hire, as
well as on an annual basis. The implementation of a sharps injury prevention
program is an opportune time to reassess the quality of these efforts
and to identify other education and training opportunities. As
with other processes, it is necessary to identify the data (e.g., staff
development reports, curriculum changes, training) that can be used to
assess improvements in educating and training healthcare personnel.
Step 3. Prepare a Baseline Profile
of Sharps Injuries and Prevention Activities
After assessing program operations, the next step is to develop a baseline
profile of injury risks in the institution. This information, along with
the information gleaned from the baseline assessment, will be used to
develop an intervention action plan.
Toolkit Resource for This Activity:
Baseline Institutional Injury Profile Worksheet (see Appendix
A-4)
Toolkit Resource for This Activity:
Baseline Injury Prevention Activities Worksheet (see Appendix
A-5)
Using data currently available in the organization and the tools provided
in this workbook, develop a profile of how injuries are occurring
and a list of current prevention strategies. The following questions
may help guide the development of this profile, but other questions may
be added.
- What occupational groups most frequently sustain sharps injuries?
- Where do sharps injuries most frequently occur?
- What devices are most commonly involved in sharps injuries?
- What circumstances or procedures contribute to sharps injuries?
- What sharps injuries pose an increased risk for bloodborne virus
transmission?
- Has the organization taken steps to limit the unnecessary use of
needles by healthcare personnel? If so, how has this been done?
- What devices with engineered sharps injury prevention features have
been implemented?
- Is there a list of recommended work practices to prevent sharps
injuries?
- What communication tools have been used to promote safe sharps handling
techniques?
- Is there a policy/procedure for determining the appropriate location
of sharps containers?
- Who is responsible for removing/replacing sharps containers?
Step 4. Determine
Intervention Priorities
Not all problems can be addressed at once, so healthcare organizations
must decide which sharps injury problems should receive priority attention.
Baseline information on sharps injuries, along with the weaknesses identified
in the assessment of program operation processes, should be used to determine
priority areas.
Sharps Injury Prevention Priorities
The following approaches can be used alone or in combination to create
a list of initial priorities for intervention:
- Determine priorities based on injuries that pose the greatest
risk for bloodborne virus transmission (e.g., focus initially
on preventing injuries associated with vascular access)
- Determine priorities based on the frequency of injury with
a particular device (e.g., focus on injuries associated with hypodermic
or suture needles)
- Determine priorities based on a specific problem contributing
to a high frequency of injuries (e.g., focus on sharps handling
and/or disposal)
Toolkit Resource for This Activity:
Same as for Step 3
Program Process Improvement
Priorities
Leadership teams might consider selecting one problem in each of the
processes or focus only on one of the processes for performance improvement.
Give priority to those areas that will have the greatest impact on improving
the overall operation of the program.
Step 5. Develop and Implement
Action Plans
An intervention action plan provides a road map for charting the course,
monitoring progress, and measuring performance improvements in a sharps
injury prevention program. Two intervention action plans are proposed:
- The first focuses on implementing and measuring interventions to
reduce specific types of injuries.
- The second measures improvements that are the result of the program
processes.
Action Plan to Reduce Injuries
Set Targets for Injury Reduction. Based on the list of priorities,
set targets for reducing specific types of injuries over a designated
period (e.g., six months, one year). These targets should provide reasonable
expectations based on the interventions available and the degree to which
they are likely to be successful.
KEY POINTS
Designing Action Plans |
- Establish an action plan for reducing injuries
- Set targets for injury reduction
- Specify which interventions will be used
- Identify indicators of performance improvement
- Establish time lines and define responsibility
- Establish an action plan for performance improvement
- List priorities for improvement, as identified in the baseline
assessment
- Specify which interventions will be used
- Identify performance improvement measures
- Establish time lines and define responsibilities
|
Specify Interventions. For each problem targeted for intervention,
apply one or more of the following strategies:
- Substitute a non-sharp alternative for performing a procedure
- Implement a device with an engineered sharps injury prevention feature
- Recommend a change in work practice
- Change a policy or procedure
- Provide targeted education of healthcare personnel
The intervention action plan should reflect each strategy used and
describe the steps, time line, and responsibility for implementation.
Identify Indicators of Performance Improvement. Indicators are
tools for measuring progress; they tell when a goal is reached. The following
can be used to measure the impact of an intervention on injuries:
- Changes in the frequency of certain types of injuries
- Frequency of compliance with the use of a newly implemented engineering
control
- Changes in injury rates, e.g., device-specific or occupational
Once the indicators are identified, the team will need to decide:
- How frequently indicators will be monitored (e.g., monthly, quarterly,
semiannually, annually), and
- How and by whom they will be reported.
Toolkit Resource for This Activity:
Sharps Injury Prevention Program Action Plan Forms (see
Appendix A-6)
Action Plan to Measure Program Performance Improvement
The baseline profile will identify the strengths and weaknesses of
the organization's sharps injury prevention activities. With this information,
the team can create a list of priorities for performance improvement
and then decide how to accomplish the necessary tasks. When writing this
part of the action plan, the team should be sure that the areas for process
improvement are clear and measurable. To increase the likelihood of success,
only a few improvements should be taken on at a time.
Step 6. Monitor Program Performance
KEY POINTS
Designing Action Plans |
- Develop a checklist of activities
- Create and monitor a time line for implementation
- Schedule periodic reviews for assessing performance improvements
|
The one questions asked repeatedly during the assessment of operational
processes is: What data can be used to measure performance improvement
for each process? Once identified, data from each of these processes
should be used to monitor overall program performance. In addition, as
with any planning function, a checklist of activities and a timeline
for implementation should be developed to monitor progress. The team
should consider developing a monthly or quarterly schedule for reviewing
performance improvement. Not all areas targeted for improvement need
to be reviewed at each team meeting. By spreading these over the year,
the team can spend more time on each issue. If the desired objectives
are not being met, the team should redesign the plan accordingly.
The process of designing, implementing, and evaluating a sharps injury
prevention program is continuous. At least once a year, the team should
reassess the processes for avoiding injuries.
|