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50 Successful improvement in the quality of cleaning and disinfection at a
specialized tertiary care hospital in riyadh, saudi arabia
Conference Paper in BMJ Open Quality · April 2019
DOI: 10.1136/bmjoq-2019-PSF.50
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Abstracts
BMJ Open Qual: first published as 10.1136/bmjoq-2019-PSF.50 on 25 October 2019. Downloaded from http://bmjopenquality.bmj.com/ on December 19, 2020 by guest. Protected by
(10%) patients had HAS-BLED scores of more than 3 (high aspects including nursing skills and procedures. With the cur-
risk). Bleeding (cerebral, gastrointestinal, or hemoglobin <100 rent increase in medicolegal cases, we can conclude that simu-
g/L) occurred in 32 (12.3%) patients; 12 (37.5%) of these lation is both a safer and economically viable way of training
patients had a HAS-BLED score of more than 3 (p=0.0001). nurses. Increased confidence and knowledge using simulation
TTR was not different between patients with or without during orientation has been shown to reduce stress levels in
bleeding (64.1+19.4% versus 66.3+16.1%). On the other clinical areas.
hand, mean HAS-BLED and ATRIA scores were significantly
higher in patients who had bleeding. Using multivariate analy-
sis, ATRIA score followed by HAS- BLED score was the best
predictor of bleeding. Age, sex, and TTR as a measure of 49 PRESCRIBER BEHAVIORS THAT COULD BE TARGETED
INR variability did not show a significant difference between FOR CHANGE: AN ANALYSIS OF BEHAVIORS
the two groups. DEMONSTRATED DURING THE PRESCRIBING PROCESS
Conclusion Similar to previous reports of patients with atrial Mohammed Aseeri, Douha F Bannan, Aeshah AlAzmi, Mary P Tully. Pharmacy, King
fibrillation, ATRIA and HAS-BLED scores were the best pre- Abdulaziz Medical City
dictors of bleeding in our cohort of patients with mechanical
heart valves, with no independent contribution of TTR to 10.1136/bmjoq-2019-PSF.49
estimation of bleeding risk.
Background The prescribing process for children with cancer
is complex, and errors can occur at any step. As a result,
many interventions have been used to reduce errors. However,
few of them have been designed based on an understanding
48 USING SIMULATION TO ASSESS COMPETENCY IN NEW of the prescriber behavior that can lead to errors. In order to
NURSES design effective behavior change interventions, it is first impor-
Mohamed Noor Osman, Sami Alyateem. Nursing, Prince Mohammed Bin Abdulaziz Hospital tant to understand the prescribing process and identify pre-
Madinah scriber behaviors that could be targeted for change.
Methods This study used two sequential phases. First, the pre-
10.1136/bmjoq-2019-PSF.48
scribing process was observed and then described using the
hierarchical task analysis (HTA) method. Second, prescriber
Background Measuring competencies in nursing is critical to
tasks were analyzed using the behavior change wheel (BCW)
ensure safe and effective care of patients. Usually, new nurses
approach to identify promising behaviors for change. These
struggle to cope with the demands of new roles and face dif-
copyright.
identified behaviors were prioritized based on information col-
ficulties in completing the required competencies on time.
lected from focus groups with prescribers and chart review of
Being a clinical resource nurse based in the clinical areas and
errors made in the ward. The hospital’s Institutional Review
responsible for new nurses, I have observed that there is a
Board approval has been granted.
gap in this area which may impact on patient safety. I work
Results The HTA results showed that the prescribing process
as a clinical resource nurse in Prince Mohammed Bin Abdula-
was complex and involved multiple tasks performed in varying
ziz Hospital in Madinah (PMBAH), Kingdom of Saudi Arabia.
orders. Applying the BCW identified 32 candidate behaviors
The focus of this paper is to assess the knowledge and confi-
for potentially reducing prescribing errors. However, after pri-
dence of newly hired nurses in PMBAH. Currently, new
oritizing these behaviors, only two emerged as promising can-
nurses are given 5 days of orientation in class and are then
didate behaviors for intervention: writing drug indications at
sent to clinical areas to start working under a senior nurse.
the time of prescription and using a predefined order sentence
The aim of this study was to assess the confidence and
when ordering medications.
knowledge of new nurses hired by PMBAH.
Conclusion Applying the HTA and BCW methods was helpful
Methods Simulation methodology was used to train new
in identifying potential behaviors for change. Having identified
nurses in PMBAH. A 2-day training schedule was arranged
promising behaviors, future work could explore what needs to
with 2 hours for each competency session, with eight sessions
change with respect to individuals and their work environ-
in total. Each session included a short briefing about the sce-
ments to achieve the desired change in these identified
nario and introductory video followed by a demonstration by
behaviors.
the simulation facilitator. The new nurse was then allowed to
run the scenario with no interruption, followed by individual
briefing directly to consolidate and transform the nurse’s expe-
rience. Nurses were allowed to express their feelings in their 50 SUCCESSFUL IMPROVEMENT IN THE QUALITY OF
own words. Pre and post self-assessment of participants’ CLEANING AND DISINFECTION AT A SPECIALIZED
knowledge and confidence were later assessed. TERTIARY CARE HOSPITAL IN RIYADH, SAUDI ARABIA
Results There was a big difference in the pre- and post-assess-
ment results; the majority of the nurses have shown increased Kassem Abou Yassine, Majid Alshamrani, Ayham Al Badawi, Nada Alrasheed,
Mustafa Alhawtan, Basma Alaidan, Yahya Al Bakheet, Kholoud Alameer, Angela Caswell,
knowledge and confidence after going through simulation
Majid Malki, Aiman El-Saed. Infection Prevention and Control King Abdulaziz Medical City
sessions.
Conclusion We have identified that simulation positively 10.1136/bmjoq-2019-PSF.50
impacts nurses’ learning experiences by replicating the bedside
setting in a mistake-free environment. Therefore, simulation Background Environmental cleaning is critical for reducing the
sessions for new nurses are very helpful to raise knowledge, burden of healthcare-associated infections and multidrug-resist-
confidence, and the ultimate safe delivery of patient care. We ant organisms. The objective of the current study was to
can claim that simulation is an up-to-date and innovative improve the quality of cleaning and disinfection done by
learning strategy, especially when addressing direct patient care housekeepers.
BMJ Open Quality 2019;8(Suppl 1):A1–A33 A21
Abstracts
BMJ Open Qual: first published as 10.1136/bmjoq-2019-PSF.50 on 25 October 2019. Downloaded from http://bmjopenquality.bmj.com/ on December 19, 2020 by guest. Protected by
Methods An interventional study was done between October Methods This was a retrospective study of data collected
2018 and February 2019. The intervention included training over the past 5 years (2013–2017) at KAUH, Jeddah, in
of 130 housekeeping staff; redefining cleaning and disinfection which the quality indicators for certain parameters were ana-
responsibilities between housekeeping and nursing; adding a lyzed and benchmarks were set for blood donor adverse
checklist for surfaces to be cleaned or disinfected; and empha- reactions, transfusion reactions, fresh frozen plasma (FFP) in-
sizing the inspector’s auditing role. The intervention engaged date wastage, and cross match to transfusion (CT) ratio.
relevant staff partners from infection control, housekeeping, Data were forwarded to the Hospital Transfusion Committee
nursing, and environmental services. The study outcome was (HTC) for review. Deviations were identified and corrective
the frequency of effective cleaning done by housekeepers. It actions were taken. The outcomes were used to plan for
was assessed by comparing the photos taken from specified improvement.
room sites (pre-prepared by fluorescent gel) using black light Results Among a total of 60,631 blood donors, 282 donor
before and after cleaning. Six highly touched areas in patient reactions were reported, resulting in a rate of 0.46%, mostly
rooms were chosen. The study was divided into three phases: in the form of mild dizziness. 285 adverse transfusion reac-
pre-intervention assessment (October 2018), intervention tions were reported among 99,564 total blood transfusions,
(November 2018 through January 2019), and post-intervention resulting in a rate of 0.28%; most were allergic and febrile
reassessment (February 2019). reactions. Monitoring of the adverse donor reactions showed
Results A total of 27 rooms with 162 opportunities were a decreased incidence; however, the adverse transfusion reac-
assessed during the pre-intervention phase. The findings tions were under-reported. The FFP in-date wastage was 2205
showed that only 39 (24.1%) of the 162 opportunities were among 22,590 requested FFP units, resulting in a high rate of
effectively cleaned. The frequencies of effective cleaning in 9.76%. The CT ratio was 1.24. Safety improvements were
different sites were: light switches 11.1%, door knobs implemented by a multidisciplinary quality improvement team
25.9%, water faucets 37%, telephones 25.9%, bed rails to determine the critical control points and to address the fac-
14.8%, and patient tables 29.6%. A total of 33 rooms with tors contributing to high FFP wastage.
198 opportunities were assessed during the post-intervention Conclusion The use of quality indicators as a tool for imple-
phase. The findings showed that 116 (58.6%) of the 198 menting a hemovigilance system can provide a better under-
opportunities were effectively cleaned. The frequencies of standing of areas for improvement in the quality of the work
effective cleaning in different areas were: light switches and safety of patients. Establishing guidelines for appropriate
42.4%, door knobs 84.8%, water faucets 75.7%, telephones clinical use of blood and proper communication between clini-
60.6%, bed rails 54.5%, and patient tables 63.6%. The cal transfusion staff and practitioners is expected to enhance
overall improvement in effective cleaning in different sites these features along the blood transfusion chain. The use of a
copyright.
was 34.5% (p<0.001), being highest for door knobs similar model in other institutions will facilitate the local
(58.9%, p<0.001) and lowest for light switches (31.3%, benchmarking between hospitals, which is a feasible method
p=0.014). to lower transfusion risk and cost and to improve quality
Conclusion A multidisciplinary intervention including training outcomes.
and auditing of housekeepers was successful in significantly
improving cleaning and disinfection at different sites in the
patients’ rooms. Frequent assessment and feedback may need 52 LAB QUALITY IMPROVEMENT PROJECT (MONITORING
to be continued until reaching an optimal level. Further stud- SEROLOGY REJECTION)
ies are needed to evaluate the impact of improved cleaning
Sarah Alharbi, Kaneez Zamir, Omar Qassas, Abdulaziz Johani, Abdulrahman Aboud.
on infection rates.
Department of Pathology and Laboratory Medicine, Prince Mohammed Bin Abdul Aziz
Hospital – Al Madinah
10.1136/bmjoq-2019-PSF.52
51 MONITORING THE QUALITY INDICATORS OF BLOOD
TRANSFUSION SERVICES AS A METHOD TO IMPROVE Background This project was initiated because of the observa-
PATIENT SAFETY AT KING ABDULAZIZ UNIVERSITY tion that serology rejection rates were increasing incrementally.
HOSPITAL The quality indicator displayed this; therefore, an intervention
was necessary to reduce the amount of wastage of samples,
Salwa Hindawi, Tarek Elgemmezi, Seraj Alweail. Faculty of Medicine/Hematology and Blood
patient recalls, supplies, and manpower. The aim of this proj-
Transfusion King Abdulaziz University – Jeddah – Saudi Arabia
ect was to reduce the number of rejected samples, reduce
10.1136/bmjoq-2019-PSF.51 recalls of patients and redraw of the samples, and to provide
the best service to our customers.
Background A quality indicator is measurable information Methods
gathered at the critical control points in a process or proce- . Using the quality indicators for the statistical measuring of
dure for monitoring, assessment, and improvement. Quality the amount of serology samples rejected.
monitoring is an important tool used to review blood transfu- . PDCA (plan–do–check–act) cycle.
sion practice and provide feedback on transfusion trends in . Quality indicator:
blood transfusion services. Quality indicators can improve Numerator is serology rejected tests (lithium heparin and
quality standards and support patient safety through setting SST);
priorities and process improvement. The aim of this study was Denominator is serology total tests done (lithium heparin
to report 5 years’ experience of monitoring the quality indica- and SST);
tors at KAUH and to measure its impact on the blood trans- International benchmark value 0.56%;
fusion practice as a tool in hemovigilance system Baseline quality indicator was measured and then
implementation for patient safety. monitoring was done after implementation of interventions.
A22 BMJ Open Quality 2019;8(Suppl 1):A1–A33
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