Communication, vaccinations are among key H1N1 quality concerns
Myths must be exploded; even staff require more education
The good news — if you can call it that — about H1N1 is that it gave us a "sneak peak" this past spring and summer at what it is and how it works, hopefully making it easier to prepare for another, potentially more serious outbreak during this flu season.
The bad news? Quality managers still have a lot of work ahead of them.
"I think what we've learned for the most part is that we weren't really ready," says Katherine West, BSN, MSED, CIC, infection control consultant, Infection Control/Emerging Concepts in Manassas, VA. "Even though we did not have the severity of the disease we feared, it was a good wakeup call to dust off plans and see if they are truly workable."
One of the keys to making your plan succeed, quality managers agree, is communication. "That's one of the lessons we learned; that this had a lot to do with communication," says Rita Stockman, RN, MSA, director, accreditation and quality at William Beaumont Hospital, Royal Oak, MI.
What is required, she found, is more routine communication — as often as possible. "You need to make presentations to administration and to the team — to let them know where you're at with staff call-in rates, or personal protective equipment stack levels — how many we have in stock." That applies to levels of all materials, she emphasizes.
"What I really learned is that we need to run this more like an emergency management situation," she continues. "That became clear as more opinions were expressed. If you plan it out that way, and anticipate the surge, you will have far superior outcomes."
The communication responsibilities of the quality manager become even greater when, as in Stockman's case, he or she plays a lead role in preparing the response. "I think the role we play depends on how much control you have," she says. "I've worked hand in hand to support infection control and our epidemiology team as they made the plan. If I were not a leader, I would not be as involved, but rather playing a supporting role."
In addition, she notes, as data collectors, the quality team gains even greater importance. ""People need to be told what's known on a daily basis," she says. "The doctors will want to know what's going on in the community."
Communication boosts awareness
"When you talk about quality and patient safety, a lot of it comes down to communication awareness," says Anne R. Van Waes, RN, MS, CIC, coordinator of infection control at Anne Arundel Medical Center in Annapolis, MD. Van Waes says she has seen an impressive communications effort by the facility's quality manager, to whom she reports.
"One of the biggest lessons we've learned is that you can never communicate enough about anything," she says. "Communicate on a regular basis, and then move to an 'all points alert' when there has to be an emergency response."
Part of that communications effort, she continues, is to counteract what she calls "media hype." "That becomes a big component — talking with people and trying to keep them from being too alarmed, so they are able to work without fear," she says.
Staff presentations play an important role in H1N1 communications at Anne Arundel. "We did a presentation to the staff the other day on the different components of response — patient surge and how we developed our plan, and an alternate care site within the hospital where patients can be directed for rapid treatment and turnover," Van Waes shares.
"In quality and patient safety, we have a number of specialized personnel like Spanish translators and patient advocates," Van Waes continues. "By being able to talk through with them the different plans under way, they can help us be sure that we cover all the bases. For example, we have had talks about rapid discharge procedures — how to make sure patients are educated appropriately so that they feel safe when they leave the hospital."
Other topics of discussion, she notes, include stockpiling and workforce readiness. "We try to get the message out in as many directions as we can — for example, whether employees should call out sick if a family member is sick and they are not; what kind of staffing patterns we'd have if there were a 30% reduction in the workforce; and alternate job roles," says Van Waes. "We try to encourage them to figure out the jobs they are doing that are absolutely essential for keeping the hospital fully functioning and what types of goals might have to go by the wayside in an event that everyone is needed to help with patient response. For example, an employee doing a desk job might be asked to help pass out linens or water, help with discharge or transportation — do things they are not used to doing but to which they could try to apply their skill level in the best way possible to help deal with a high level of patients."
Handling staff vaccinations
One of the trickiest areas when it comes to preparation, experts agree, is how to handle staff vaccinations. Some states, such as New York, have taken the problem out of the hospitals' hands; all health care workers are now required to receive the seasonal flu vaccination.
But many hospital policies try to find a happy medium. "One hospital in Michigan has made vaccination mandatory, but here, we very strongly recommend it; you have to either accept the vaccination or sign a declination statement stating, 'I know that I am eligible for the flu shot, and I am at risk of acquiring influenza infection. I understand that I may spread influenza to others, even if I have do not have symptoms. I have been given the opportunity to be vaccinated with influenza vaccine at no charge to myself. However, I decline the influenza vaccine at this time,'" says Paula Keller, MS, CIC, technical director epidemiology at William Beaumont. "We also have a respiratory hygiene plan that includes the placing of masks and hand sanitizer, solutions, and tissues at all information desks, registration desks, and in the doctors' offices." As part of the plan, she adds, everyone is expected to wash their hands and to wear a mask or cover their mouths with a tissue when they cough, discard the tissue in the trash, then cleanse their hands. A mask is placed on people who cannot reliably cover their cough.
"We have two methods of surveillance for hand hygiene," says Keller. "Infection control practitioners directly observe; they are on the units nearly every day. We also have 'secret' observers — individuals from the units; we are really serious about this."
Communication is critical here as well. "If someone is not following the proper hygiene practice, we will correct them immediately; I'd say, for example, 'Hi, I'm from infection control, and Paula, I noticed that you didn't wash your hands.'" The same holds true for isolation protection, she notes.
If someone tells her that a physician has not washed his or her hands, for example, she will write a letter to the physician "non-washer" and to his or her supervisor.
Communication also helps improve participation rates, says Keller. "Last year some staff members filed declinations that included their reasons for not taking the flu vaccine, and there were those who said, 'I don't believe it works,'" she shares. "So, we give them scientific data. We give them all the real information — not smoke and mirrors — because we want people to trust us." Participation rates, she says, improve every year.
"The Joint Commission is looking at vaccination as a patient safety issue," adds West, who says that she doesn't think a mandatory policy is the best approach. "We have only 33% of health care workers who participate; you have to do it through education," she asserts.
A lot of facilities, West continues, are taking short-cuts in this area. "You should use an infection preventionist to do face-to-face, one-on-one training," she advises. "This way they can get a feel for the group, learn their concerns, and answer them. If people are using taped and computerized programs, I don't think it will completely help the facility get to the root of the participation issue."
[For more information, contact:
Paula Keller, MS CIC, Technical Director Epidemiology, William Beaumont Hospital, Royal Oak, MI 48073. Phone: (248) 551-4038.
Rita Stockman, RN, MSA, Director, Accreditation and Quality, William Beaumont Hospital, Royal Oak, MI. Phone: (248) 551-3104. E-mail: [email protected].
Katherine West, BSN, MSED, CIC, Infection Control Consultant, Infection Control/Emerging Concepts, Manassas, VA. Phone: (703) 365-8388. E-mail: [email protected].
Anne R. Van Waes, RN, MS, CIC, Coordinator of Infection Control, Anne Arundel Medical Center, Annapolis, MD, Phone: (443) 481-1000.]
The good news if you can call it that about H1N1 is that it gave us a "sneak peak" this past spring and summer at what it is and how it works, hopefully making it easier to prepare for another, potentially more serious outbreak during this flu season.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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