The main purpose of this project is to improve safety practices in medical institutions. Needle sticks appear to be a major threat for both the nurse practitioners and the patients (Eden, 2008).This can only be prevented by the healthcare workers through the implementation of a safe environment in the workplace. Therefore, the medical institution has an obligation of achieving this by ensuring that safe needle devices are used and effective training programs are implemented (Kennamer & Kennamer, 2006). Moreover, the chances of encountering needle stick injuries depend on the type of needle used by the medical practitioners (Feyer & Williamson, 2001). Thus, it is necessary to develop strategies that can reduce the risk of such injury. In order to achieve a successful implementation of the program, the high participation of the healthcare workers should be involved.
One successful intervention is the use of Lewin’s change model, which has three categories namely:
- Unfreezing, which calls for the need for change and greatly emphasises the need for innovation by providing substantial evidence for change, and in this case for needle stick prevention policies (Thomas, Lemmon & Zuckerman, 2005). The need for change can be considered after carrying out a surveillance of the diseases that result from the needle prick injuries.
- Change, which in this case is the replacing of the dangerous needles with safer needles
- Refreezing, where the awareness of the implementation of the new change occurs in this case the safety rules and principles of safe behavioural practices regarding needle stick injury is adopted (Thomas, Lemmon & Zuckerman, 2005)
Identification of the Problem and the Rationale for the Need for the Innovation
Needle stick injuries are major hazards in the health care settings. A number of studies prove that the use of needles is associated with diverse risks at various stages of their use (Centre for Disease Control and Prevention, 2004). This result from the nature of the needles such as their shape, disposal practices of the needles, level of education that the medical practitioners hold, and working conditions for the medical practitioners, among others. The needle stick injuries pose a major threat for the health care workers since it exposes them to blood borne diseases such as the hepatitis B, C and HIV AIDS (Centre for Disease Control and Prevention, 2004). Various methods can be used to influence organizational change in order to improve the safety practices in a clinical setting. The methods constitute a number of features such as motivation and the elimination of obstacles (Eden, 2008). Consequently, several techniques can be designed to lessen the risk of needle stick injuries. However, the application of these techniques have not yet been practical enough since healthcare workers must be informed on the importance of following the healthcare the proposed guidelines (William, & Wilkins, 2007). This makes the healthcare compliance program a challenge. Therefore, unsafe practices may result from attitudes towards the safety standards and management of needle stick injuries, lack of proper knowledge and adequate skills of handling the needles, and the implementation of unsafe practices by the health workers (Dyro, 2004).
Adequate time should be set in place that will serve to increase the reporting of the non-compliance of the safe work practices (Charney, 2009). However, various studies show that a certain degree of collaboration between the healthcare practitioners and the patients is required in order to define the underlying factors that lead to needle stick injuries (Feyer & Williamson, 2001). In addition, a positive attitude is essential since it facilitates the implementation of new policies.
Despite the fact that there is a presence of adequate knowledge among the health workers for preventing blood borne viruses, there is still a high presence of needle stick injuries in the healthcare setting. The needle stick injuries continue to happen despite the fact that the medical practitioners attend accident prevention courses. However, these nurses do not adhere to the knowledge of the practice acquired from training sessions as only a few of them manage to practise the knowledge acquired from the training sessions, such as safe ways of handling the sharp objects and the appropriate measures to be taken in case of a needle stick injury happens (Kennamer, & Kennamer, 2006). This therefore calls for additional intervention, apart from the training sessions for the medical practitioners (Feyer & Williamson, 2001).
Despite the misuse of the safety practices by the medical practitioners, Ginter, Swayne & Duncan (2002) point out that increasing safety in a healthcare setting starts from creating safety awareness in the medical practitioners, is utilizing the new devices present in the healthcare setting, and creating a positive attitude towards the innovation process. This however lies with the medical practitioners rather than the patients, since 385,000 cases of injuries reported each year in the United States result from inadequate use of safety measures on the part of the healthcare workers (Centre for Disease Control and Prevention, 2004). In addition, Harrison and Daly (2006) contend that the data for the sharp injuries amounts to 1,000 each day on average in United States health care settings. However, due to an intervention for the safety measures in 2003, the sharp injuries rate dropped from 30 incidents per a bed capacity of 100 in 1995 to a considerable level of 23.8 percent in 2003 (Perry, 2003).
The Aim of the Innovation
The innovation should aim at improving the awareness and knowledge level of preventing the needle stick injuries. The goal should be directed towards devising a management plan that will serve to prevent the needle stick injuries. This can be successfully achieved by implementing a compliance policy program for all the healthcare practitioners (Tweedy, 2005). The policy should focus on creating rules that govern the way nurse practitioners walk around with the sharp instruments, how they dispose of the sharp objects, how the needles are removed from the syringes, and how they handle the cap of the needles, among others (Beyers & Dudas, 2008).
Proper implementation of rules will serve to enhance the progress of the innovation that will facilitate safety measure requirements and the management of needle stick injuries (Ginter, Swayne & Duncan, 2002). These rules will include the implementation of essential practices that will in turn prevent the needle stick related diseases, such as washing the injured area with the appropriate antiseptic and using all the proper management practices of the needle stick injuries (Price, John & Hicks, 2004).
Supporting Evidence for the Change
A number of management practices can be implemented in order to prevent the blood borne diseases that may result from the needle stick injuries. These management practices involve the use of a plastic syringe barrel, which facilitates the safe disposal of the syringes. Since the wide spread of the blood borne diseases has led to the innovation of protective devices, they need to be incorporated with mandatory requirements in the healthcare institutions. The mandatory rules maintain that the healthcare workers have the responsibility for assessing the clinical setting in areas where blood is involved by checking whether blood-drawing devices are installed with safety measures, such as the self-blunting needles that are used for vacuum tube phlebotomy, butterfly needles, blood gas syringes (Charney, 2009). A checklist should is also used to verify whether there is an elimination of unnecessary needles, which include sharp needles that are used for the drawing blood intravenously and those that can be replaced by blunt ones. Further uses of the checklist are to assess whether:
- the health facility uses the automatically retracting finger instead of manual lancets
- there is any advice given to the blood drawing personnel on never to remove needles from blood drawing device;
- the use of exposed needles has been fully eliminated while injecting blood through a stopper into a vacuum tube (Wessner, 2009);
- the hinged cap, sliding sleeves and retracting needles have been converted to a needle less system
- the clinical staff has a checklist that informs the risk of using syringes in drawing venous blood (Beyers & Dudas, 2008);
- Retracting scalpel blades are used, and whether all the unnecessary sharp equipments are being used (Kennamer & Kennamer, 2006).
Description of the Change
In order to come up with a proper implementation of the innovation, it is of utmost importance to have a description of how this change will be managed. It is also vital to consider the policies, review the procedures and implement the best practice methods.
Innovation is based on the prevention of needle stick injuries as well as needle stick injuries management programs. The management practice is geared towards eliminating and providing adequate information that relates to the control of injuries in the healthcare setting. Before implementing the needle stick prevention program, the management team will be involved in a number of practices, which include:
- Assessing the effects of removing the sharp needles and replacing them with the blunt ones (Finkbeiner, Ursell & Davis, 2009), and
- Assessing the best way of implementing a checklist that will informs the health workers the risks involved while using sharp syringes in drawing venous blood (Beyers & Dudas, 2008).
A proper reporting system within the healthcare institution will be properly implemented as this serves to give feedback on whether the innovation has played a role in managing and eradicating the needle stick related injuries (Kavaler & Spiegel, 2003). In addition, this data collection helps to create surveillance for the blood borne diseases in the healthcare institution.
The management team will also aim at a target, which will be used in order to assess and know whether the goal of reducing the rate of needle stick injuries has been achieved. The target can be to reduce the number of needle stick injuries for the healthcare workers to less than 1%. Likewise, the management will also state a measurable goal of reducing the numbers of injuries for the patients to below 1%. Therefore, a good system of data collection must be implemented, as this will help with the data analysis (Christoffel & Gallagher, 2006). In addition, the areas of weakness will be properly identified through the analysis of the data.
The change will be geared towards transforming the healthcare work practices, such as demonstrating how the needles or sharp objects should be handled , placed and disposed in a the disposal areas (William & Wilkins, 2007 ). Advice from experts will encourage the nurse practitioners to use safer methods of carrying out their tasks since they will realise the benefits that result from the use of the innovation. The implementation of new devices is focused towards minimising the risks for the nurse partitioners during the therapy injections as well as getting injuries from the disposal units. The use of new devices will also help in carrying out various clinical operations such as safe collection of blood, providing for subcutaneous medication, providing for intravenous medications, and providing for intramuscular medication, among others (Burkitt, Quick & Reed , 2007 ).
An annual program that reviews the work practices with an aim of exposing nurses to the risk of needle stick injuries should be formulated. An evaluation should be done for assessing the effectiveness of carrying out prevention efforts and a good feedback mechanism should be formulated (Beyers & Dudas, 2008). In carrying out a review for the safety of sharp object devices, the managers have the responsibility of carrying out several steps that help them to protect the clinical officers from needle stick injuries. These include:
- Helping the nurses in making a selection and evaluating the devices that have safety features;
- Implementing the use of devices that have safety features that are recommended by the managers;
- Refraining from duplicating needles (Beyers & Dudas, 2008);
- Helping in carrying out safe disposal practices;
- Informing the nurses about the hazards related to the needles that have been observed by the management; and
- Making a good reporting system of the needle stick related incidents in order to ensure that the incidents are followed up (Miyazaki & Une, 2004).
Needle Stick Injury Prevention and Management Committee
A business plan for the needle stick prevention management can only be successful if a high degree of collaboration is affected between the committee members ( Swansburg, 2005). The committee members should include planners, evaluators and innovation coordinators. The member team will consist of the medical practitioners who are directly involved with the handling of sharp objects. The cost will be rationally discussed by the committee in relation to cost benefits that result from the implementation of the innovation. This will help the healthcare professionals to know the kinds of instruments that they will budget for. In addition, the committee has the overall responsibility of approving the innovation and informing the healthcare workers of the positive effects of implementing the innovation. A review of the innovation also needs to be carried out in order to assess it success. This will serve to motivate the employees after realising the benefits that have resulted from the innovation (Rosow & Zager 2002).
The management has the overall plan of reducing the rate of accidents that happen in the health care setting. Reducing of accidents can only be achieved by coming up with a good strategy that will help the management to monitor its progress. This can be achieved by including the safety guidance and precaution in the strategic plan of the health care setting (Swansburg, 2005). Through the use of strategic planning, the reviewing of available data that relates to the injuries from sharp objects can be successfully evaluated. In addition, the success or failure that resulted from the innovation can also be evaluated. Strategic planning therefore helps to define the strengths and the limitations of the implemented innovation, and this in turn helps to further educate and train the medical practitioners on the safe ways of handling the sharp objects. In addition, the medical practitioners will be able to modify and reform the work practices that aggravate the risk of injury, as they attempt to make them safer by establishing other policies for handling the needle stick injuries, evaluating other efforts, and providing a feedback mechanism (Swansburg, 2005).
It is of utmost importance to note that every innovation is associated with a certain degree of risk (Roussel, Swanburg, & Swanburg, 2006). Therefore, the implementation of this innovation is expected to be associated with a level of risk because a successful use of the implementation can only be recommended after the programs goes through an analysis that expresses the success of the innovation. This innovation should be efficient in terms of time management, cost and should have the capacity of providing quality care for the patients (Charney, 2009). Because the innovation has not undergone a considerable test of time, the management should be ready to take this risk for a considerable amount of time under which it will use for assessing the effectiveness of the innovation.
Innovation should focus on the medical practitioners that are concerned with the change. This is important since when introducing innovation in a heath care setting, the innovation committee should note that workers are motivated differently (Rosow & Zager 2002).This might lead to each medical practitioner to have different behaviour towards the implementation of this innovation. Therefore, the management should note that when change is imposed on workers it could lead to adverse effects towards its implementation since the medical workers might feel that they do not own the change. Therefore, the control mechanism for the innovation should include enabling change rather than imposing change (Kavaler & Spiegel, 2003).
The transitional arrangement needs to be properly defined since the rate at which change is achieved can produce positive or negative results. The transition should be carried out in a manner that facilitates proper management of information (Rosow & Zager 2002). This information will inturn help the innovation committee to assess whether the objective of the innovation has been achieved. The strategy of the innovation should address all the disciplines in the healthcare institution. Each head of department will be entitled to communicate the transition plan of the innovation. The communication will be enhanced by printed papers as well as through the healthcare setting’s website.
The elements of the resources for the innovation may include human resources as well as non-human resource. The non human resources are the equipment that will lead to a reduction of injuries caused by sharp object. These include implementation of the blunt objects in the health care system. In order to achieve quality service for the team, the management committee should note that this calls for more resources for the clinical setting. It is therefore worthy to note that the health care worker are tensed by running short of the health care resources (Ginter, Swayne & Duncan, 2002).Therefore, the innovation committee should try to identify the resources that will effectively address and promote the adoption of the innovation.
Cost and Budget
The cost of implementation will mostly focus on the training programs for the medical practitioners. An amount of money will be set aside that will successfully complete the training process. This budget will be carried out until the management team realizes a considerable change. The management therefore needs to keep proper records of the surveillance of the diseases that result from the needle stick injuries, in order to assess the need for further budgeting. If the prevalence rate is below 1% per annum, the innovation committee will know that it has achieved its objective. After this realisation, the management will reduce the cost of training for the adoption of the innovation.
The innovation committee should note that a cost benefit arises when the health care setting commits itself to invest its resources in one way (Kavaler & Spiegel, 2003).In this case, the one way is the way to innovation. In cases where the budget increases for the innovation, the innovation committee will ask themselves how best these resources can be spent. In cases where the budget decreases, the less productive areas of the innovation will be substantially reduced.
An evaluation will be carried out to help determine the proficiency of the healthcare workers in the implementation of the needle stick management program. This can be done by evaluating how conversant the nurse practitioners are concerning the innovation (Roussel, Swanburg, & Swanburg, 2006) as well as assessing the level of change from the disease surveillance. For a successful implementation of the program, the competence of the healthcare professionals in implementing the needle stick injury management and prevention program will be evaluated before the program is adopted. A successful evaluation calls for more timely detection of the effects that will facilitate clear translations of the results. This will aid in making plans that are logical and can enhance the innovation.
Although the innovation is a good plan for eliminating and managing the needle stick injuries, it is a requirement for the healthcare personnel to comply with the new practices. The implementation program is faced with challenges of training the medical practitioners. The challenge of training presents itself when the medical staff is not open to innovation, and especially the workers who are satisfied with their work. However, this happens only on the initial stages of training, since the medical staff has not experienced the change (Institute of Medicine, 2001).
The needle stick injuries continue to happen despite the fact that the medical practitioners attend accident prevention courses. However, these nurses do not adhere to the knowledge of the practice acquired from training sessions as only a few of them manage to practise the knowledge acquired from the training sessions, such as safe ways of handling the sharp objects and the appropriate measures to in case of a needle stick injury happens (Kennamer, & Kennamer, 2006).
Therefore, it is of utmost importance to develop strategies that can reduce the risk of such injuries. In order to achieve a successful implementation of the program, the high participation of the healthcare workers should be involved in the process. The strategies should involve adoption of Lewins model, which includes unfreezing, Change Refreezing.
Before implementing the needle stick prevention program, the management team will be involved in a number of practices, which include assessing the effects of removing the sharp needles and replacing them with the blunt ones. Therefore, needle stick injuries in a healthcare setting should be given much consideration for its implementation at the same time with an evaluating whether the program has achieved what it was meant to achieve. This is because injuries that result from needle stick injuries leads to higher healthcare costs for the health workers (Balaji, 2007). In addition, a reduction of workforce has resulted from the blood borne diseases that result from the needle stick injuries. Therefore, an innovation program serves to protect the medical practitioners by creating awareness of the safe use of the sharp devices.
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