Cut-rate deal: Focus on sharps safety pays off

Needlestick rate drops by about 50% in 2 years

You can't stop needlesticks just by buying a safety device. Preventing sharps injuries requires a sustained commitment to device selection and training.

That is the lesson learned by St. Joseph Hospital in Bellingham, WA, which renewed its focus on sharps safety when its sharps injury rate slowly began to climb. The hospital brought its rate from 30.5 bloodborne pathogen exposures per 100 occupied beds in 2006 to 12.8 for the first three-quarters of 2008, putting the hospital on track for a reduction of about 50% in just two years.

The key to success? "Persistence, patience and commitment to reducing injury," says Lori Wilkinson, RN, BSN, COHN-S/CM, occupational health manager.

St. Joseph had been monitoring its sharps injury rate by comparing annual data to EPINet, a reporting network of the International Health care Worker Safety Center at the University of Virginia in Charlottesville. When its needlestick rate rose, the hospital launched a process improvement effort, including a root-cause analysis of injuries.

A process improvement team was created with staff from the units with the top injury rates - the operating room, medical units, emergency department, cardiovascular unit, and intensive care unit - and included representatives from laboratory services and materials management. "We tried to do some assessment of what was causing the problem," says Monica Grimes, RN, BSN, COHN-S/CM, who served as the process owner for the improvement team. "We were very committed to doing accident analysis on every needlestick that occurred."

The hospital learned that improper use of the safety feature on winged needle blood drawing devices had led to increased injuries. Intravenous starts also were a problem area.

The team invited vendors to present their safety devices and selected devices with passive activation features. Trials with frontline users in the targeted departments were conducted in the fall of 2007.

"The process improvement team was convinced that we needed to really have all of our stakeholders involved," says Lori Wilkinson, RN, BSN, COHN-S/CM, occupational health manager. "They solicited feedback from wide range of units and users."

Training, trials lead to improvement

During the nearly year-long project, the sharps safety process improvement team had a startling discovery: Needlesticks declined by 21% even before the new devices were implemented, a decrease that began during the injury analysis phase of the project.

"Our belief is that the energy and conversations around the process led to better technique," says Wilkinson. "Increasing the focus made a difference."

It also pointed to the need for better training. The team drafted a new sharps safety policy and, with the support of hospital leadership, developed a mandatory training program. Every user of sharps devices needed to complete training and show mastery of competencies on all sharps devices.

Previously, vendors would visit units to demonstrate new devices. But with its more comprehensive focus, the clinical nurse educators provided multiple scheduled training opportunities. Each 30-minute training was conducted off the unit, in small groups of five employees and one educator. Employees could ask questions and demonstrated competency to use each device safely. The training was concentrated over a three-week period in January 2008.

With the training completed, the hospital implemented the BD SafetyGlide syringe, BD Nexiva Closed IV Catheter System and the BD Vacutainer Winged Safety Push Button Blood Collection device. "This was the biggest device change we've made in quite some years," says Wilkinson.

Not everything went smoothly, however. The process improvement team sought input from all stakeholders, but some groups did not adequately trial the devices. After the new IV system was implemented, some anesthesiologists were concerned about the flow rates. "Anesthesia did not feel part of this decision," concedes Wilkinson, "and they wanted to ensure best practice for patient safety."

The anesthesia and injury reduction team met with the vendor, discussed issues, and again trialed the devices along with another safe IV needle that anesthesiologists were interested in using for higher flow rates. Ultimately, both devices were adopted. Meanwhile, clinical nurse educators continued to make rounds on the nursing units to identify any barriers, assist with process changes, and provide coaching on technique.

A key lesson learned is that future process improvement efforts will not move forward until all stakeholders are fully engaged. The bottom line is you've got to get skilled users to use and assess thoroughly before they will commit to that product." she says.

Annual review required

The Bloodborne Pathogen Standard of the U.S. Occupational Safety and Health Administration requires annual review of sharps safety devices. At St. Joseph, that review regularly occurred. "However, the increase in needlestick injuries spurred us to not only evaluate our devices, but to look at our safety culture around the devices, and that is where we were able to make a difference," says Wilkinson.

"It was also important to navigate the process changes after implementation - during the initial use period, there were valid questions and barriers identified. Clinical educators closely partnered with materials management, occupational health, and our vendor to problem-solve any issues.

"We continue to look for opportunity for injury reduction, and look at our data around all injuries monthly," says Wilkinson.

She also collaborates with colleagues at other hospitals to learn about their experiences with safety devices. And, within the hospital, she feels a momentum that can be used to target other safety issues.

"Because we worked together to problem-solve [through the process improvement effort], we really built some strong relationships that have assisted us in safe patient handling and other safety efforts," Wilkinson says.