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Sometimes first solutions prove to be learning opportunities that reveal the real problems and suggest appropriate fixes — but only to those astute enough to catch the clues. Such is the interdisciplinary Group Against Sharp Injuries (GASI) project at the 400-bed Rockford, IL-based SwedishAmerican Health System.
"We saw a gradual rise in injuries, especially from needles, as the nurses were working harder and faster," says Henry Anderson, MD, chief quality officer. In 1996, there were 56 injuries. "We’ve tried things, but we still have to make a big decrease in needlesticks," says Kathy Howell, RN, MBA, director of Women’s & Children’s Services.
Phase 1. Solutions uncover the real problems.
• New products with safety features were introduced throughout the system.
• Inservice education on new product use and review of hepatitis and HIV risks. Those solutions yielded a 7% injury reduction.
"There are still user issues," Howell admits. "It’s like convincing people of the need to wear latex gloves a few years ago. It’s a mindset thing." Some safety products are cumbersome and incident reports reveal that caregivers don’t always activate them. Persistent trouble spots: (1) phlebotomy needle disposal; (2) butterflies, ultra-fine needles for pediatrics, and frail patient veins.
Phase 2. Shift from supervisory instruction to peer reminders.
Ideas under consideration:
• instructional video and skills verification;
• GASI progress newsletter;
• testimonials from clinicians who confess they chose not to use safety devices, their accounts of personal health consequences, and time spent for ongoing disease monitoring.
Projections for Phase 2 solutions.
Goal: 70% decrease in needlesticks. "We feel we have a handle on the problem and I’m predicting that, in a few months, when we see our data, we will see the 70% decrease," Howell says. Based on Phase 2 outcomes, GASI will collaborate with vendors on improved needle designs.
Kathy Howell, SwedishAmerican Health System. Telephone: (815) 489-4687.