From Best Evidence to Best Practice – Implementation of a Hand Washing Campaign in the Accident and Emergency Department of the Georgetown Public Hospital Corporation

Objective:Hand washing compliance amongst emergency healthcare providers is complicated by limited supplies, patient volume, mal-positioning of hygiene materials, and lack of education on the importance of hand hygiene. Designand Methods:A survey was distributedto A&E healthcare staff to determine baseline knowledge about the importance of hand hygiene. Participants were asked to identify departmental obstacles to the practice of proper hand hygiene. Using World Health Organization teaching materials, a hand hygiene clinical observation tool was implemented to determine compliance prior to delivery of tailored education. Education was done utilizing posters, flyers, and powerpoint presentation. Hand sanitizer stations were installed to improve compliance. Finally, the clinical observation tool was implemented following the education initiative to determine impact on provider compliance. A post-implementation survey was distributed to determine if increased education and supplies impacted baseline knowledge and compliance.Results:Only 88% of surveyed providers recognized that the A&E has a current hand hygiene policy with 64% noting GPHC does not stress hand hygiene enough. Providers reported they utilize hand hygiene 75% yet all participants acknowledged that proper hand washing greatly reduces the spread of infection. 53% of providers surveyed felt comfortable encouraging their peers to wash their hands.Conclusions:Initial provider hand hygiene within the A&E was abysmal. Though identified as a predominant barrier, supplies were readily available throughout the observation window. Educational materials placed throughout the department improved both the perception and compliance of hand hygiene. The importance of provider hand hygiene must be continually stressedin order to maintain optimal compliance

Promoting Safer and More Efficient Medication Administration within the Accident and Emergency Department at Georgetown Public Hospital Corporation

Objective:The Emergency Department is a complex environment in which healthcare providers are confronted with uncontrolled and unpredictable critical patient workload. This necessitates multitasking, organization, critical thinking and clear communication. Safe practices during dispensing and administration of medications vastly reduces the potential for patient harm and decreases medication errors (Institute for Healthcare Improvement, 2008). Design/Methods:An eight-question survey was developed to determine nurses’ perceptions of the current medication storage system. Participants were asked to identify ways in which this system could be improved and medications organized in a safer, more systematic way. Following initial data collection, all medications were rearranged to improve medication organization and retrieval. The participants were then surveyed following the intervention to ascertain feedback.Results:68% of participants noted that they perceived the current system to be chaotic. When asked if organizational changes might improve patient care delivery and safety, 96% responded in the affirmative. Labeling medication with both generic/ brand names and organizing them by class and alphabetically thereafter were all identified as potential options for reorganization. Following the intervention, a post-survey demonstrated that 100% of respondents remained enthusiastic about the new system approximately 9 months after implementation.Conclusions:The previous medication storage system was fractured and chaotic. Systematic organization of medications by name/class improved nurses’ perceptions of medication safety and delivery while inadvertently reducing the waste of expired medications. Greater measures are neededto truly minimize the risk for a medication administration errors including targeted continuing education and implementation of an electronic medication administration system