Assessment and Educational Tools. Marilyn Weinmaster RN BScN CIC CHICA-SASKPIC September 20,2013

Transcription

1 Assessment and Educational Tools Marilyn Weinmaster RN BScN CIC CHICA-SASKPIC September 20,2013

2 Present Context Describe Assessment and Educational Tools Demonstrate Point of Care Risk Assessment Introduce two RPAP Tools

3 System of infection prevention and control practices to control the transmission of microorganisms and protect patients, healthcare workers(hcw) and others Used by all HCWs, for all patients, all the time in all settings All blood, body fluids, secretions, excretions, drainage, tissues of all patients potentially infective

4 Hand Hygiene PPE Source control Patient placement/ accommodation Patient flow/activity Cleaning and disinfection of patient equipment Cleaning of environment Handling of waste and linen Management of visitors Aseptic technique Sharps safety Patient Patient=resident=client

5 Airborne Droplet Contact Droplet/ Contact Transmission based Based on mode of transmission and interruption of transmission Extra measures when RP alone not interrupt transmission Always in addition to RP Initiated both on syndrome and on diagnosis Identify symptomatic patients

6 Revised 1999 guidelines Some practice changes Principles sound Updated evidence/literature base

7 ...Need to make Routine Practices routine HCWs need to know the changes HCWs may need help with new emphasis on PCRA Good opportunity to review and reinforce RPAP basics RPAP Educational and Assessment Tools can help

8 Assessment Tools 7 Algorithms 7 Checklists Which Bug/Which AP Table 7 Performance Checklists 10 Cases/Answers and Discussion Points

9 September-November 2009 CHICA and PHAC 6 ICPs,1 educator 6 provinces Acute Care, LTC, urban/rural/small/large centers Sessions: 2 HCWs,1 ICP colleagues ICPs and nursing responsible for deciding which precautions are initiated

10 Three Tools: Elements of RP Summary Point of Care Risk Assessment(PCRA) for RP Algorithm: Appropriate Use of Personal Protective Equipment(PPE) Five case scenarios IV insertion Suctioning Diaper Change Medication Administration Morning Care

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12 Point of Care: Where patient, HCW and environment interact Risk Assessment: Assess risk of exposure likely in an encounter Purpose: Assess risk Determine actions and equipment Interact safely

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14 Short description of patient and healthcare(hcw) interaction 4-7 related questions Suggested answers Discussion points Reflect common care situations, kept simple illustrate decision making process Target group- nurses,lpns and continuing care aids Need to develop for other groups, i.e. paramedics, home care, environmental services, therapies

15 Small groups Select case scenario and answer questions PCRA RP Algorithm Answers and discussion points to promote critical thinking and discussion Not necessary to review all scenarios 2-3,vary depending on target groups and settings

16 Alice, a care aid, is going to change the diaper of a 3 month-old Rose, who has ben admitted for failure to thrive

17 Identify, using Risk Assessment for RP Algorithm, which PPE are required and when hand hygiene should occur Explain your reasoning by stating your decisions at each decision point in the algorithm

18 Diaper Change Gloves, potential contact with body fluids Gown not necessary Minimize contact

19 Discuss situation where soiling of uniform may occur, e.g. Cognitive impairment Uncooperative patient Contracture etc.

20 How would your answer to question 1 differ if: 1. Baby were male 2. Rose admitted with croup 3. Patient were an elderly female 4. HCW going to empty a bedpan of elderly female 5. What microorganisms are of concern, and for whom?

21 Bedpan, elderly female Gloves, potential contact with body fluids Gown, possibly Minimize contact

22 Five Tools: 5 algorithms for syndrome or conditions Outline decision making process related to identifying need to place on AP 5 AP case scenarios Cough Diarrhea Acute Neurological Herpes Zoster Draining Wound

23 Stopping/Changing AP algorithm Outline decision making process 4 AP checklists Contact, Droplet/Airborne/Contact/Droplet Summarize list of key actions taken when patient requires AP : Accommodation and Placement, PPE, Signs, Supplies and Equipment, Handling Waste and Linen, Patient Leaving Room Patient and Visitor Teaching

24 Which Bug/Which AP Table Summary table Quick reference Type and duration of AP More common microorganisms encountered in health care

25 Short description of patient and HCW interaction 7-8 related questions Answers Discussion points Kept simple to illustrate decision making process Choice depends on target group and audience Appropriate for nurses, physicians. Any staff who have responsibility for deciding need for AP Staff with responsibility limited to adhering to AP may find questions in case and AP checklist useful but not algorithm or AP table

26 Small groups to generate discussion Select AP case scenario Work through questions, using: AP Algorithm, Stopping /Changing AP Which Bug Table AP checklist PCRA for RP Algorithm Refer to case scenario answer and discussion points Review and discuss all 5(ideal).2-3 if time limited

27 Mr. Richards, age 75,brought to ER from nursing home with fever and dehydration secondary to diarrhea. He has been incontinent of liquid stool several times in past 24 hours. Erin, triage nurse, begins assessment Question 1 Identify, using Diarrhea algorithm, if Erin should initiate any precautions.

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30 Discuss the difference between applying: RP with an incontinent adult with diarrhea from a non-infectious cause and Contact Precautions when cause suspected to be infectious Discuss how to set up isolation room

31 How would your answers to question 1 change if there were a norovirus outbreak at the Long Term Care Facility? Given Contact Precautions, what PPE are required for Nurse Amy. Changing IV bag If contaminated gloves 48 hours later, Mr. Richards has loose stool but no longer incontinent and C. difficle is ruled out. Do precautions need to be changed

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33 Performance Checklists Hand Hygiene PPE Sample Program and Materials Session Agendas: 30 minute, One hour,1/2 day and full day Adaptations for different groups

34 RP and AP Tools Encouraged to adapt and add to tool set based on local experience, legislation, regulations, OHS, guidelines Modify case scenarios Add new scenarios Add new discussion points Which Microbe/Which AP Table Add microorganisms to reflect commonly encounter in the setting, including microorganism for which only need RP

35 Risk Assessment and Educational Tools can help ICPs and educators review RPAP and translate knowledge into practice