Introduction
The main purpose of the project is to improve safety practices in medical institutions. Every person, who works in this field, has to run various risks but we are going to focus on needle pricks, which appear to be one of the major threats for both practitioners and patients. Health care employers are required to provide the staff with a safe environment in the workplace in order to prevent them from needle prick injuries. Medical institutions are expected to achieve this by ensuring that safe needle devices are used and effective training programs are implemented. This kind of injury can be caused by many types of needle devices, and it can occur in at almost every time (Levy, 2006).
Therefore, this brings about the necessity to develop strategies that can reduce the risk of such injury. It is of the crucial importance to put this policy into practice and more importantly involve medical workers (Conte, 2001). In this paper, I have applied Lewin’s change model to launch needle prick prevention program. It comprises three components
- unfreezing which involves identification of the need for change, stating the aim of the innovation, detailing the support evidence for needle prick prevention changes, and a description of needle prick prevention policies.
- The second step is the very process of transition.
- The final stage of this process is freezing, at which we need to reassert new safety rules and principles of behavior. Yet, this is just a general overview, which needs to be further elaborated.
Identification of the Problem and the Rationale for Need for Innovation
According to Kurt Lewin, organizational change and subsequent improvement can be achieved by various methods, but in the overwhelming majority of cases, they come down to the following aspects:
- stimulation and
- elimination of the obstacles, which prevent the management to carry out necessary reforms (Lewin, 1951).
There exist several applicable techniques designed to diminish the risk of needle prick injury. But there is a different dimension of this question: many people, working in hospitals are not aware of new safe guidelines or they are not willing to follow these instructions. The problem of compliance by health care workers is very acute and it leads to the increase the rate of needle pricks injuries. On the whole, we can single out three reasons for such incidents:
- unsafe work practices and task performances by health workers;
- lack of knowledge and skill;
- inadequate beliefs or attitude towards safety standards and reluctance to meet them.
In order to implement this program, we need to address each of these aspects, otherwise, it is very unlikely that the situation will alleviate.
A great number of surveys indicate that the most frequently reported non-compliance to safe work practices and task performances due to lack of time and interference with performance (Kellen et., 1990). Apart from that, some researchers believe that the interference with the patient and practitioner relationships is one of the underlying causes of needle pricks (Linn et al., 1995). According to the NIOSH study, the workers, who do see all the importance of safety measures are more likely to be injured.(Gershon et al., 1995). Thus, we can presume that proper attitude is necessary condition for the adoption of new policies in such organization as hospital. Many health care workers believe that occupational safety requirements interfere with optimal performance of their jobs.
According to DeJoy et al., (1995), the majority of health care workers have adequate knowledge of occupational safety practices and exposure to blood-borne pathogens. In a national survey, Hersey (1994) revealed that 89% of practitioners and nurses, attending patients, had undergone at least one training session on infection control procedures. Although respondents had necessary training, only 43 per cent of them wore protective gloves always to draw blood, only 55% recapped at least ‘sometimes’ and only 63% ‘always’ washed their hands after removing their gloves (Hersey, et al p 245). It is apparent from this study that knowledge alone is not sufficient to ensure safety in the workplace.
Majority of HCW know blood-borne pathogens present maximum risks to them and their patients. When they are exposed to these blood borne pathogens, they risk contracting lethal infections. Jagger (1996) estimates over 80% of needle prick injuries can be prevented with the use of safe needle facilities and appropriate training of health care employees. Moreover, strict monitoring can reduce the risk of needle prick injuries by 90% (Jagger, 1996). In the 1970s, pioneer designs of safe needles were patented. Food and Drugs Administration (1992) ordered the use of needleless IV System whenever possible to all health care facilities. However, less than 15% of the US medical institutions utilized safety devices and systems despite the alert issued by Food and Drugs Administration (McCormick, 1999).
Findings from National Institute of Occupational Safety and Health (1999) suggest that such devices can substantially decrease needle prick injuries by approximately seventy percent. Nevertheless, even now many hospitals continue to use obsolete technologies. In part, it can be explained by the lack of funding but such behavior can also be attributed to unawareness of the management.. In accordance with the data, published by Dr, Jagger, a leading expert in epidemiology of needle prick injuries, the institutions that have utilized new technologies and safety devices, have lower rate of needle prick injuries, only 17 percent (Jagger et al, 2003)Therefore, we can mark out various dimensions of the problem:
- first it is necessary to increase peoples awareness of safety practices,
- secondly, the management should make full use of new devices, enabling to diminish the risk of such incidents. Finally, medical workers have to change their attitude toward new rules and principles.
According to the Centre for Disease Control and Prevention, 385,000 cases of needle prick and other injuries, reported each year are due to the inefficiency of health care personnel; amounting to 1000 sharps injuries each day on average (Centre for Disease Control and Prevention, n.d). Data from a survey conducted by National Surveillance System for Health care Workers revealed that 59% of all sharps injuries were caused by hollow bore needles with disposal syringes, accounting more than 32% of all sharp injuries (National Surveillance System for Health Care Workers, n.d). The rate of needle prick injuries for health care staff was at its highest in 1995, approximately, 30 incidents per 100 beds were recorded. In 2003, safety initiatives caused a drop of sharps injury rate to 23.87 incidents per 100 beds (Perry, 2003).
Nevertheless, the results are still deplorable mostly due the fact that enhanced syringe technology is not employed throughout the country (Zeichner, 2005). According to Jagger (2003), 1000 patents were granted from 1984 to 1996 alone for safety devices meant to prevent needle sticks. Unfortunately very few of them are used, and this subsequently endangers lives of people, who are involved in the process of health care. Thus, our task is to propose some amendments, which may possible resolve this rather urgent problem.
The Aim of Innovation
The main aim of innovation is to develop methods that would enable us to reduce the risk of needle prick injury in medical organizations. This project includes several tasks: namely
- to introduce safe technologies;
- start training programs which would increase professional skills of health care workers:
- and eventually, it is necessary to change their attitude toward safety standards and new practices.
Furthermore, preventive policy has to encourage them to dispose of used or uncovered syringes as soon as possible. We need to ensure that used sharps are never disposed in ordinary dumping bins, which can be exposed in public places; needles must never be removed from syringes except in cases when a second substance is to be injected using the same needle. Additionally, the cap of the used vacuum tube needle must never be replaced by hand (Gruendemann, 2001: Fuszard, 1995).
The management policy will require mandatory washing of the area injured hot water and antiseptic soap. The injury must be rubbed to encourage bleeding; mandatory reporting of the incident to the supervisor immediately; mandatory extraction of blood specimens to define the risk of infection to the injured staff; and other management measures (Ziady, 2005). Certainly, at first glance, such measures may seem be self-evident or even banal. However, many lethal incidents occur only because some medical workers do not follow these rules.
Support Evidence for the Change
The surging spread of HIV and hepatitis B in the 1980s brought out the necessity for measures preventing accidental spread of blood borne pathogens (Mayhall, 2004). Therefore, the protection of medical workers from accident related needle pricks became absolutely necessary and led to an in-depth research, conducted by inventors and technology developers in order to create protective devices (Mech, 2002). This subsequently set new standards to health care institutions, management and employees, who must make reviews and updates of annual exposure plans; assess the effectiveness of protective devices. (US Department of Labor, 2001).
Moreover, they have to utilize evidence-based practice. The guidelines provided specific annual reviews of exposure plans and the input of health care workers on choosing more effective technologies. The decision on safety equipment depends on the size and type of the organization. This may be influenced by physicians, nurses, infection control staff, or others.
Mason (2002) argues that significant reforms have to be carried out. There are several reasons for such radical steps. Fist, safe needle systems and technologies have developed to the point where many products are clearly showing their effectiveness but they are not used to full extent. Lynda Arnold, a courageous nurse who had contracted HIV several from a needle stick, laid an important foundation and brought attention to the issue; she waged a campaign to encourage health care institutions to commit voluntarily to using safer devices (Satter, 2002:). In 1999, OSHA conducted an exercise of collecting data from health care institutions to assess the overall effectiveness of engineered sharps protection devices in preventing needle pricks injuries (US Department of Labor, 2001: Acello, 2002). In the following section we present our approach this problem, which emerged long ago. Hopefully, it will help to improve and elaborate some practices and create a safe workplace environment in hospital or other medical organizations.
Description of Change
Based on the objectives, revised series of policies, procedures, and operating practices will be implemented. The main purpose of the innovative strategy is to contain the damage of a needle prick injury within the limits of the health care institution itself. Its success will be measure according to various quantitative and qualitative parameters, namely, the number of reported incidents and the support given to it by medical workers(Charney, 2002). The prevention policy will attach primary importance to education and training, incorporation of safer medical device use. It will necessitate medical workers to comply with new safety standards.
The innovative prevention program will assist in evaluating the work practices and medical safety devices such as needles and syringes. The change strategy is aimed at transforming the health care work practices, for instance, by positioning the sharps containers at strategic points of use, in a patient’s room or in an examination’s room.
At the moment it is vital for us to describe the principles of implementation. As it has been noted before, we will use a three-step Lewin model, which consists of such stages as unfreezing, changes, and refreezing. At first, the management, has to attract the attention of medical workers to this problem. They must understand that negligence constantly exposes them to danger, it must be brought home to them that current state of affairs is no longer applicable.
Employees must regard new requirements as a necessary step. Apart from that training course should be given to the practitioners and nurses, they should not take much time because, many medical workers already possess adequate knowledge, we need only to up-date their skills. The second stage is the process of transition. At this point, we need to introduce new technologies, monitor the behavior of the personnel. Yet, monitoring must not turn into supervision. The step is to make new rules habitual for all employees who may run risk of needle prick.
In this respect, we should discuss the leadership style, which would be most appropriate. Many, people give preference to authoritative or imperative management, which means that the decisions of the authorities are simply thrust upon workers. Nonetheless, it seems that there is more optimal solution. Liberal or democratic management is much more effective, because it is based not on compulsion but on persuasion, the employees have to feel that new rules must be established and adhered to. Without this commitment any further action will be of little avail.
Business Plan
First and foremost, the management should establish committee, which will assist in planning, coordinating, communicating, evaluating and implementing of this innovation. The committee will be tasked to discuss the problems or the dangers threatening health care workers. Moreover, it is necessary to ascertain overall costs involved in mitigating the problem in medical institutions. We need to prove to the committee that this innovative strategy is effective in terms of cost-effective.
If the committee approves this strategy, we can conduct a meeting with the heads of departments, practitioners and other officials, who should formally inform members of the staff about the approval of the new strategy and clearly elaborating the benefits of changes.. The announcements and communications about the innovation will also be distributed to all units within the institution. After that, hospitals have to establish trainings programs to ensure that the new principles are not only declared but also practiced.
Strategy
We should adopt the following strategy to assist in the effective implementation and success of this innovative prevention of needle prick injuries. They will include such aspects as;
- Analysis of injuries related to sharps in the working environment
- The review of all available information about risk factors for needle prick injuries and successful intervention efforts
- Educate and train healthcare staff in the safe use and disposal of sharps (Rhinehart, 1999)
- Modification of work practices that pose needle prick injury risk to make them safer
- Establishment of procedures and processes for reporting and timely treatment of these injuries.
- Campaigning for safety awareness in the working environment
- Evaluating the effectiveness of prevention techniques and providing feedback on the performance (Flemming, 2000)
Risks
The expected risks that will pose some drawbacks in the implementation of this strategy may come from health care facilities, government, and major needle manufacturing companies that choose to neglect this stressing questiosn. Currently, they are not making needle prick injury prevention a priority for their own selfish reasons, and, they are not willing to produce safer syringe devices because they are more expensive. This is probably one of the major limitations of this project.
Control Mechanism
To insure that there is no misunderstanding; experts will always be placed on standby to address the concerns and questions of the personnel. There has to be no controversy or ambiguity in the new rules. Furthermore, efficient training mechanisms will save time and costs in terms of providing the health care workers with the necessary skills as conveniently as possible.
Transitional Arrangements
This innovative strategy will be approved by the health institutional committee. The management s should then meet all the heads of departments in order to inform them about the strategy. They need to discuss with them the costs and benefits of the safety strategy. The heads of department will be expected to communicate to all physicians and other health care professionals. The secretary will be mandated to arrange training programs for physicians.
The needle prick management and prevention strategy costs will be clearly and elaborately explained to them. The head nurses will be expected to inform the rest of the nurses about this strategy and make the necessary arrangements for training program to be conducted by the training department to commence. Furthermore, informative internal announcements will be effectively communicated. The transition from the current practices is expected to last approximately for over one month. Therefore, the elaborate preparations are meant to ensure the smooth transition with minimum complications.
Resources
The services of professional experts will be engaged in order to provide current efficient updates on enhanced needle prick injuries management and prevention program. All health care professionals will participate in the successful implementation of the new policies.
Cost and Budget
The execution of this new strategy will not require a staggering amount. Much of the funds required for the project will go to training expenses. The estimated amount needed to carry out this vital project is around $ 60,000 US. This amount will be adequate to actualize all aspects of this program. The money will be solicited from the ministry of health. The expected results after implementation of the strategy will be to prevent and if possible eliminate needle prick injuries and save medical costs.
Evaluation
After implementing the program, evaluation of the action will occur. The program is designed to offer protection to health care workers from needle stick injuries. This program provides a good example of the significance of evaluation in demonstrating that; the program is put into practice and appropriately enforced. We determine the degree to which the risk of needle stick injuries will be reduced. (Cherry, 2005). The competence of health care professionals will be evaluated before the program is adopted. This will be achieved through trial tests to ensure that they are able to operate under various circumstances.
This evaluation method will assist in determining the ability and capacity of the health care professionals in dealing with the new strategy. In addition, efficiency as a result of the program will be determined by the number of incident reports of needle prick injuries. The health care professionals will also be required to provide frequent feedback that will assist in gauging the effectiveness of the new policies. The feedback from these professionals will help to make sure that health care professionals understand and most importantly comply with the new rules.
Dissemination of the Plan to Others
An elaborate report will be published about the new strategy, and distributed to all medical units in the health care institution. The published report will include the description of the new strategy and its benefits. The health institutional committee will also be provided with the detailed account of the new reforms and their efficiency. The information to be disseminated will also include reports about related successful implementations of the program, and how it may be useful to medical institutions. It will seek to establish efficient systems of tracking needle prick injuries and subsequent preventive measures.
Limitation
As it has been mentioned before, one of the major limitations is the reluctance of health care manufactures to produce less dangerous needles, because it is more expensive for them. Yet, there is another drawback, in particular how to design appropriate schedule for medical workers. This is the domain of local authorities, who not be able to do it. But, it should be pointed out that the training courses will not be time consuming and they may take place before or after work.
Conclusion
The costs of needle prick injuries cause much strain to hospital resources. These costs increase especially given the current recorded average rate of 24 injuries per 100 beds. If one considers the fact that every year, health care professionals are infected by blood borne ailments resulting from contaminated needle pricks, the expenses of medical organizations only increase.
The program under discussion protects health workers and makes them aware of the risks posed by needle stick injuries. It promotes safe use of hospital devices, and better work practices such as; using safe and effective alternatives to needles; assisting health care institutions to select and evaluate devices with safety features; ensuring that needles are not recapped; prompt disposal of used syringes in appropriate sharps disposal bins; reporting all needle prick injuries promptly for immediate treatment; and active participation in training. However, there is a limitation; its success completely depends upon the efficiency of local authorities and their willingness to cooperate.
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