CA hospital sees 100% rise in reporting with new log
Needlestick info helps focus prevention efforts
Armed with a mandate to collect detailed information on each needlestick, California hospitals are gathering unprecedented information on these injuries. For Santa Clara Valley Medical Center in San Jose, CA, that has meant an increase of more than 100% in reported sharps injuries — and a new way to evaluate injury prevention.
"If you have a device that’s supposed to be a safety device and you see an increase in injuries among workers using it, it may be that the device is not as good as it was intended to be," says Donna Haiduven, RN, PhD, CIC, infection control supervisor at the medical center. "It’s a two-way monitor, both for your [work] practice and for the new devices you bring in."
Haiduven and her colleagues revised the employee injury log three times to make sure it complied with state law. (See sample log on p. 102.) It is used in conjunction with the Supervisor’s Report of Injury, enabling information to be collected from both employees and supervisors.
In addition to obtaining basic facts such as when and where the injury occurred, California hospitals are required to note the brand name of the device. They also record whether the device had engineered sharps injury protection and whether the safety mechanism was activated or was in the process of activation.
Yet capturing that information isn’t always a simple process. A review of employee injury logs at Santa Clara Valley Medical Center showed that 93% lacked the brand identification.
"Many times, the employee doesn’t know the brand name of the device they used," explains Kathleen Scott, NP, MS, COHN, employee health nurse practitioner. "To help the employee, we have a board that has the different devices so the employee can point to the device they were using."
Santa Clara Valley is also trying to standardize devices as much as possible, so the brand identification will be clear just from the type of the device used, says Sue Chen, RN, MPH, CIC, infection control nurse.
Make reporting as easy as possible
Failure to report needlesticks is a problem nationwide. According to some estimates, only about half of all needlesticks are reported.
"It’s important to make reporting as simple and accessible as possible," says Scott. "We attempt to do this by having blood exposure packets’ of the standardized forms and protocols available on all the hospital units."
For example, the hospital previously captured needlesticks on the supervisor’s Report of Injury form, which is completed by a supervisor. Because physicians aren’t employees, they often didn’t fill out those forms. With the standard employee injury log, physician reporting increased by more than 400%. The supervisor’s Report of Injury form is included in the packet that health care workers receive either in the employee health department or the emergency department when a needlestick occurs. Employee health personnel follow up with the injured worker, interviewing him or her and filling out the employee injury log.
Because of the new law, employee health professionals now ask employees how they think the needlestick could have been prevented and why they think the injury occurred. Although 91% of employee injury log forms lacked employee opinions about prevention, the questions provide a valuable opportunity for opening discussion about needlesticks, says Chen.
"One of the things the law does mandate is [that] we ask the employee their opinion," says Chen. "That’s empowering to the employee. Most of them want to be listened to."
Look beyond data for cause of injury
So far, the employee injury log has highlighted some areas of possible concern. For example, one device was implicated in 13 needlesticks, and one particular type of syringe was identified six times.
However, the numbers alone are not enough to tell whether the device needs to be replaced. Haiduven and her colleagues are examining other issues, such as education and training. They also consider whether the safety mechanism was activated or if the needlestick occurred while it was being activated.
"[The number of needlesticks] could be a red flag, but at this point we still need more information," says Chen.
While gathering complete information is always a challenge, employees increasingly understand the importance of reporting, says Scott.
"The process has been very positive," Chen says. "It gives us data that we haven’t had before, so we can be more effective with our interventions."
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