Change model helps create latex-safe environment
Task force formed to implement changes
When the incidence of allergic reactions to latex gloves among patients and staff began to increase at Milton (MA) Hospital, a non-teaching facility with about 900 employees, the employee health nurse and the medical director quickly instituted a plan to create a latex-safe environment. They began by assembling a latex task force and implementing a strategic change model.
"The medical director and the employee health nurse took people from different areas," says Susan Manual, MS, BSN, RN, assistant vice president of patient care services at Milton. The core representatives included the employee health nurse herself, the nurse manager, a staff nurse from the emergency department, the nurse manager of the post-anesthesia care unit, a staff nurse from the operating room, the director of materials management, the assistant vice president of patient care services, and the staff educator, Manual recalls. "They collected information on how other facilities addressed the same problem and found out what products they were using. Then they delegated the workload. Some task force members dealt with patient care, and others dealt with employee health policies," she continues.
Manual notes that the medical director brought an urgency to his task based on an episode that had occurred the previous year when he worked at a Midwestern hospital: A physician and a nurse had experienced "full blown" anaphylaxis after working with latex.
Of the several change models considered, the task force opted to emulate a 10-stage organizational development change model first described in 1983.1 Manual writes that "this approach to the change process is based on systematically collecting information and implementing the change based on that information."2
Manual summarizes the 10 stages of the change model applied at Milton Hospital as follows:
1. Initiation. Obtain preliminary information about a need for change. The medical director outlined the scope of the problem and his plans for change. The interdisciplinary task force, chaired by the medical director, was established early in 1995. Top administrators at the hospital assured him they would fully support all efforts to make the hospital latex-safe.
2. Clarification. Answer additional questions about the need for change. At this stage, Manual and the medical director outlined the committee’s preliminary and subsequent goals. The initial goals, according to Manual, were to develop policies for the management of latex-sensitive patients and staff, and to determine plans and programs to educate physicians and the health care staff about latex sensitivity.
3. Specification/agreement. Agree on the need, preliminary objectives, and resources. At this stage, the medical director educated the task force about the effects of latex allergy on patients and staff. "The diversity of the task force enabled the members to address the many issues in the care of those impacted by latex sensitivity," Manual says, "such as administering medication, performing procedures, and monitoring vital signs in caring for latex-sensitive individuals." The specific duties of the task force were allocated.
4. Diagnosis. Evaluate where the organization is at the present time. The task force gathered large amounts of information on latex sensitivity and its ramifications, as well as documentation about how other facilities had addressed the problem. Research turned up several prior seminal events related to latex use at Milton Hospital: One patient had experienced anaphylactic shock during a colonoscopy, and a nurse had suffered two asthmatic episodes requiring emergency treatment. Manual says "the committee members were astonished at the information previously unknown to them." This lack of knowledge highlighted the lack of knowledge about latex-related allergies among the staff.
5. Goal setting/action planning. Determine what will be done, by whom, and when. The task force set its initial goals.
6. System intervention. Implementation of the change plan is initiated. The task force was expanded to include the director of pharmacy and an anesthesiologist. Staff worked to develop latex-safe patient care carts. The project ran into its first significant opposition during this phase, according to Manual. "Changing from latex gloves to synthetic alternatives had the greatest impact on the development of the latex-safe environment. It also had the greatest repercussions. Although resistance was expected, the intensity of the resistance was not. The reaction of individual staff was directly related to the level of knowledge about latex sensitivity."
Manual told Hospital Employee Health that identifying "key resistors" in a given hospital department and working to persuade them to join the cause became an effective strategy. Among those most resistant to the move away from latex gloves was the laboratory manager, because the new synthetic gloves offered decreased tactile sensitivity and made routine laboratory tasks more difficult. During this phase, Manual says the task force printed draft policies for the care of latex-sensitive patients and distributed them to the staff for feedback and ultimately hospitalwide approval.
Also during this phase, the staff educator produced a latex allergy education plan to educate nurses and allied health professionals, a review of latex policies for new employee orientation, and a mandatory annual review of latex policies, which included a short exam.
7. Evaluation. Assessing the progress of the plan. Manual strongly emphasizes the need for continuous education on the topic of latex allergy to sustain "buy in" from physicians and other health professionals on staff.
8. Alteration. Modify the change plan as necessary.
9. Continuation/maintenance. Monitor and maintain the plan. Constant monitoring of the plan is essential for its success, notes Manual. "You can’t consider the job done once you have policy in place," she says. "You have to conduct regular updates. You have to consider staff turnover and monitoring the care of patients who come in with latex allergies. You also have the huge task of updating the policy as new equipment comes in. You need a built-in monitoring system." This, she adds, is perhaps the most challenging step of all.
10. Termination. Change is entrenched in the institution; the change agent is no longer needed. At this point, the task force was dissolved, having met its goals.
"We certainly haven’t gone to a totally latex-free environment, but we have made some changes and put in a standard of care for how to deal with a patient who comes through the door with a latex allergy," Manual explains.
Most of the reduction in latex use has taken place with exam gloves. The operating room was included in the process, but so far has not changed the type of sterile gloves it has been using. "We concentrated on the exam gloves that people use in the day-to-day care of patients," says Manual, adding the task force felt that any decisions regarding gloves used in the OR should be made independently by the OR committee.
References
1. White D. Action in Organization. Boston: Allyn and Bacon; 1983.
2. Manual S, Donahue J. Implementing a latex safe environment in a hospital setting. Am Assoc Occup Health Nurse J 1999; 47:206-212.
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