Nurses resist sharps program if not consulted
Most risk managers have attempted to reduce needlesticks and the associated costs, and there is no shortage of strategies and devices to aid in the effort. But commonly, the risk manager reviews the data after six months or a year and sees no significant improvement.
So what went wrong with a plan that looked so good on paper?
The answer, say those who have studied how sharps safety programs actually go over in the workplace, is that nurses and other clinicians often do not embrace a sharps program that was developed without their input. Their resistance is sometimes justified, the experts say, if the proposed solutions are not realistic in the day-to-day work environment.
In response to a rise in the number of needlestick injuries in its operating rooms, Hartford (CT) Hospital conducted a study to better understand why staff members sometimes resisted efforts to reduce sharps injuries. The study focused on the perceived barriers to safety, and the study leaders discovered that communication problems with physicians and feelings of powerlessness among nursing staff were lead factors, says Andrea Hagstrom, perioperative services nurse educator, who led the study. In the past year, the results of the study prompted the formation of a staff-led safety committee, made up of nurses and some technicians, and a physician-led initiative to gain practice change buy-in. (See box below for more on how Hagstrom worked with physicians.)
Surgeon buy-in can be hard for needlestick effort Surgeons don't want to be surprised, and buy-in from their leaders is essential to any needlestick prevent effort, says Andrea Hagstrom, perioperative services nurse educator at Hartford (CT) Hospital. Hagstrom has targeted physicians' resistance to practice change with quantitative and qualitative reports to the hospital's largest physician group. Hagstrom notes that she did not gain much support when she first went to the group with needlestick injury data 1½ years ago; however, she persisted in bringing the compliance issue to the forefront of the physicians' agenda. Once Hagstrom brought the results of her own research and an extensive literature search — including information from the Occupational Safety and Health Administration — the physicians heeded her call for change. The physicians group has since started needlestick safety education projects of its own, stressing the topic in mass communication to physicians and inviting Hagstrom to present more information almost quarterly. Because these efforts were generated within their community, surgeons have increased compliance with safety procedures, Hagstrom says. "It's a double-win, because not only do you get better compliance from the physicians and that reduces injuries, but then other staff [members] see that and take a cue that they should comply also," Hagstrom says. "Just like with other staff, maybe more so, physicians want to feel like they're doing something they had a role in deciding, rather than something they're just ordered to do." |
The efforts have empowered nurses to enforce the new safety practices and improved the hospital's needlestick injury rates, Hagstrom says. Specific data on the number of needlesticks are not yet available, she says, but she already can tell the data will show a substantial decrease.
Staff members cite powerlessness as deterrent
Immediately following the passage of the Needlestick Safety and Prevention Act of 2000, Hartford Hospital updated its needlestick safety procedures and experienced a decrease in related injuries. However, needlestick injury rates began to worsen after the initial safety blitz, especially in the operating rooms, where 33% of hospital-wide needlestick injuries occurred in the first quarter of 2004, compared with 25% in 2002, Hagstrom says. In a continued effort to reduce needlestick injuries, Hartford in 2004 implemented a hospitalwide campaign to promote a newer type of safety needle, including inservices on how to use it.
"However, physician compliance with the new policy was lower in the OR than in other areas of the hospital, and nurses felt that surgeons were not aware that we were trying to implement a new practice," Hagstrom says.
As a result, Hagstrom decided to study staff perceptions to pinpoint the reasons for the problem. Hagstrom gathered a group of five perioperative nurses and seven certified surgical technologists to participate in focus group discussions.1 During four one-hour sessions, Hagstrom asked participants to describe their risk of exposure to needlestick injuries in the OR, their power to implement practice changes to prevent needlestick injuries, and their perceived barriers to successful practice changes. These are the barriers cited by the group:
- inadequate horizontal and vertical communication;
- powerlessness;
- resistance to change;
- intimidation;
- inconsistencies in practice;
- negative attitudes;
- inexperience of medical and nursing staff members;
- time constraints.
Investigate current culture first
Assessing the culture and how the staff members perceive their working environment is key to successfully reducing needlesticks, Hagstrom says.
"You can buy the latest toys and gadgets to reduce injuries, but if you don't assess the climate and how people work, you're just shooting in the dark," she says. "It can be hard for people who are enthusiastic about an initiative to understand why others aren't embracing it. The answer usually gets back to how you rolled in and started telling them how great this is without first asking them for their opinion."
Using what she learned from the study, Hagstrom recently had a smooth introduction of a strategy called the "neutral zone," which involves keeping an area free of hands-passing equipment. Building on the feedback about how staff sometimes felt toward a policy introduced without warning or their input, she started by first consulting them for their opinions and then introducing the idea itself to the staff in general.
"We started off with little information sessions and posters. Sending e-mails and hard copies doesn't work, so we had our print shop make posters that we plastered all over the place," she says. "When we actually had the inservice for the staff, it was a smooth implementation because they were ready for it."
Have staff test new devices
A risk manager with experience in needlestick prevention says Hagstrom's work is a valuable reminder about how the success of a safety program depends not just on the strategy itself but also how it is introduced. Patricia Tydell, MSN, BSN, MPH, accreditation facilitator and formerly the risk manager with North Chicago Veterans Administration (VA) Medical Center, has studied needlestick prevention for the VA from a risk management perspective.
"You can have the best program in the world, but people can be resistant to change," Tydell says. "We have a policy here at the VA that before we choose any device to prevent needlesticks, we have to have frontline input. They have to actually use the product for a certain amount of time and give us feedback."
Doing that kind of work up front yields less resistance when you make a decision later and introduce the new product or policy to the staff. You still may have to say the new procedure is mandatory, but you can note that most of the staff liked it in the test run or that the feedback was mostly positive, she says.
"All of this may be heightened when you're talking about surgery," Tydell notes. "They run a tight ship in the operating room, and nobody likes surprises; so if they open a pack and it has a device that is unfamiliar, people are going to be unhappy. You have to avoid giving the impression that you're walking on to their turf and telling them what to do, but that's easy to avoid if you solicit feedback."
Reference
1. Hagstrom AM. Perceived barriers to implementation of a successful sharps safety program. AORN J 2006; 83:391-397.
Sources
For more information on reducing needlesticks, contact:
- Andrea Hagstrom, Perioperative Services Nurse Educator, Hartford Hospital, 80 Seymour St., Hartford, CT 06102. Telephone: (860) 545-3997. E-mail: [email protected].
- Patricia Tydell, MSN, BSN, MPH, Accreditation Coordinator, North Chicago Veterans Administra-tion Medical Center, 3001 Green Bay Road, North Chicago, IL 60064. Telephone: (847) 688-1900.
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