VA teaches a model for sharps safety
August 1, 2005 5 minutes read
VA teaches a model for sharps safety
Sharps injuries drop among residents
"See one; do one; teach one" isn’t an adequate training plan for medical residents when it comes to sharps safety. Reducing needlesticks requires a sustained, comprehensive approach with ongoing opportunities for training, notes Annemarie Leyden, EdD, RN, chief of learning resources at the VA New York Harbor Healthcare (NYH) System, Brooklyn campus.
The VA NYH Brooklyn campus gained the support of chief residents and trained them to be the program champions. They evaluated the tasks that used sharps devices, inventoried the existing devices, and created ongoing and effective training. The result: Only one sharps injury was reported in the past academic year (ending June 30, 2005) among medical residents, a drop from 14 the prior academic year.
The evaluation and education project also benefited hospital staff and other physicians, and provided a model for improving sharps safety.
Leyden and the chief resident received the VISN 3 Safety and Health first place award for Resident Needlestick Prevention Program from the Veterans Health Administration.
Focusing on medical residents is difficult because they rotate among several facilities and may use different devices at each. But creating a culture of safety among them can have a long-lasting impact, Leyden explains. "We had to overcome a certain thinking about the residents that they’re just students," she says. "They’re going to continue throughout their professional life using devices."
Just one sharps injury can ruin the life of a medical resident who hasn’t even begun his or her career. In a well-known case at Yale-New Haven (CT) Medical Center, a resident stuck herself while inserting an arterial line in an AIDS patient. She said she had done the procedure only once before. She developed HIV infection and won $12.2 million in a 1998 lawsuit against the hospital for providing inadequate training and supervision.
More personally, Leyden recalls a case at her own institution in which a medical resident developed HIV infection from a sharps exposure. The woman is divorced and no longer practices medicine. "That gets etched in your memory forever," she notes.
A 1990 survey at Yale found that three-quarters of the residents had sustained a sharps injury from a hollow-bore needle or suture needle, but only 19% of the incidents had been reported. Leyden’s program emphasizes the importance of reporting as well as the focus on safe practices.
"We get the message across to them repeatedly [to think of] safety in everything that you do," she says. "Should you have an incident, you have to take care of yourself."
The VA NYH Brooklyn campus project is based on device evaluation and selection methods developed by the TDICT Project (Training for the Development of Innovative Control Technologies) in San Francisco. The bottom line: Device choices should be based on a task analysis that considers their actual use, and evaluation should include simulated scenarios based on clinical experience.
It’s not enough just to have frontline health care workers sitting at a conference table talking about a device, or punching it into an orange, explains June Fisher, MD, TDICT director and associate clinical professor of medicine at the University of California at San Francisco, who was involved in the design and implementation of the VA project.
Instead, Fisher envisions role-playing in which a "patient" may be rolling around in the bed, or when health care workers face other challenges.
"When you do this, you build in some of the other [aspects] that you know are going to happen — drop it on the floor, hit it against the bedrail. It gives you a better understanding of the actual use in real situations," she says. "By the time you’ve gone through this, you have a pretty good idea of how suitable the device."
The VA NYH Brooklyn campus took an interactive approach when it developed a program that incorporated medical resident training. It began with a multidisciplinary task force, including employee health, infection control, the supervising chief resident, an attending physician, the social work specialist, the chief nurse anesthetist, and the deputy chief of staff.
"We basically train the chief resident to be an expert in safe needle devices — evaluation, selection and use," says Leyden. The residents receive their device training at their advanced cardiac life support training.
Following Fisher’s advice on sharps safety device evaluation, the VA NYH Brooklyn campus used task analysis to determine the needs on a unit.
For a month, residents in the intensive care unit wrote down the procedures they performed, the devices they used, the time of day, and the condition of the patients.
That process helped residents think about work practices that might affect sharps safety — or patient safety and comfort, Leyden says. "It gave them an opportunity to rethink how they would approach these things."
Meanwhile, the task force conducted an inventory to determine what devices actually were in regular use. "Some of the nurses on the med-surg unit showed us two boxes from the same manufacturer. One was a safety device, the other was an unprotected needle," she explains. "The boxes looked almost the same. That in itself was a big hazard."
The hospital eliminated the nonprotected hollow bore needle and also contacted the manufacturer to alert them of the labeling issue.
The task force also discovered that prepackaged kits for inserting central lines do not come with safety-engineered devices. "We found no kits with safety devices," Leyden notes. The hospital contacted the manufacturers and asked them to develop safety-engineered kits.
The hospital also set up a resource room with a sophisticated manikin that allows for simulation of real-life scenarios. For example, the manikin can have a heart attack, forcing residents to insert arterial lines in an emergency situation. The manikin even groans and breathes.
Even with their success, the VA NYH Brooklyn campus continues to seek new ways to improve sharps safety. "There’s a tremendous amount of work to be done on this," Leyden adds.
See one; do one; teach one isnt an adequate training plan for medical residents when it comes to sharps safety. Reducing needlesticks requires a sustained, comprehensive approach with ongoing opportunities for training, notes Annemarie Leyden, EdD, RN, chief of learning resources at the VA New York Harbor Healthcare (NYH) System, Brooklyn campus.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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