Nursing Notes

October 6, 2010

Hospital bed transfers put thousands of patients at risk of infection

Here is an article I found on Nursing Times that comes from across the ocean.  It seems that our sisters over in the British Isles struggle with many, if not all, of the same issues we struggle with daily.  This particular article caught my attention because it seems that JCAHO or TJC, whichever you are familiar with, is always looking for a new issue to deal with and I think this should be one.

At my facility, patients are moved from one unit to another, from one floor to another, etc. with little concern for what is best for the patient.  I have always felt that we should look at the needs of the patient and place them in the correct unit from the very first minute.  This article is talking about infection control issues in medical hospitals, but in a psych hospital there are many other issues involved as well.  Mixing depressed people with actively psychotic people or bringing active detoxing patients into a unit with 30 or more patients should be contraindicated.  When we transfer patients to the correct units, staff are tied up, patient belongings get lost or left behind, and the patient experiences increased anxiety about the unknown on a new unit.  This cannot be good customer service and I know is detrimental to good patient care.

It was interesting to see that other nurses are also having these worries.  I also worry about the infection control issue of moving my patients around.  In today’s hospital settings, you have to be concerned about this.

Anyway, I hope you enjoy the article.  Won’t you leave me a comment to tell me what you think?

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Hundreds of thousands of hospital patients are being moved from one hospital ward to another with no clinical justification and risking the spread of infection, evidence collected by Nursing Times suggests.

The bed moves often happen because wards are too full and so patients are admitted into inappropriate wards and then moved.  If you are transferring patients lots of times you are moving bugs around the hospital

Patient transfers between wards are a well known cause of infection outbreaks as they reduce the ability of hospitals to contain infections. The transfers can also result in a disruption in patient care as notes are misplaced and observations missed.

Despite the risks only a small number of hospitals monitor their non-clinical patient transfers.

Nursing Times has analysed the data from those hospitals. It suggests that nationally there are around 1.3 million patient bed moves made each year for non-clinical reasons.

The figures suggest nearly one in 10 hospital patients could be affected, although a proportion of patients will have been moved more than once during their hospital stay so the precise number affected is not clear.

Eighty-eight trusts responded to a Nursing Times freedom of information request asking for data about patient transfers. Among the 42 that collected information about the number of patients being transferred from one ward to another, monthly transfers ranged from 9 per cent of inpatients in one trust to 88 per cent in another.

It is impossible to compare the trusts and judge which have the biggest problem as they measure performance in different ways.

Only six trusts were able to distinguish between transfers that were clinically justified – such as when a patient needed to be moved to a lower dependency unit or a different specialty – and those that were not.

Their rates ranged from 0.4 per cent of inpatients transferred without clinical justification at Frimley Park Hospital Foundation Trust to 15 per cent at Imperial College Healthcare Trust in London.

At Southampton for example, an average 5,922 patients were admitted each month between July 2008 and July 2010, and there were 703 non-clinically justified transfers – 12 per cent of admissions.

At Taunton and Somerset Foundation Trust, another which collects detailed information, there were an average of 6,301 inpatients a month and 735 non-clinical transfers in the same period -11.7 per cent of admissions.

Across the six trusts the average monthly rate of non-clinical transfers was 8.8 per cent of total inpatients.

Scaled up across the 13.6 million hospital admissions in England last year, the data suggests there are around 1.3 million clinically unjustified patient transfers each year.

Royal College of Nursing emergency care adviser Alan Dobson told Nursing Times hospitals were struggling to admit patients to the appropriate ward as the bed occupancy rate in hospitals was higher than ever, meaning fewer beds were left vacant to cope with surges in demand.

Mr Dobson said: “Bed occupancy should be about 85 per cent to enable good patient care. Most hospitals are running at about 95 per cent and sometimes it is at over 100 per cent.

“Patients are often moved around the hospital for non-clinical reasons and it’s unacceptable. If you are transferring patients lots of times you are moving bugs around the hospital.”

Frimley Park Hospital Foundation Trust nursing director Mary Dunne said the trust had changed its arrangement of wards to reduce non-clinical transfers.

She told Nursing Times that senior nurses frequently intervened to prevent patients being moved several times.

She said: “We began looking at it as a patient safety issue, but being moved can also be upsetting. Patients like to get to know their team, and just as they are settling they can be moved to another new team.”

However, she said increasing beds and staff would not help because more patients would be admitted to fill them, rather than the flexibility used to reduce transfers. She said: “The more beds you open the more beds are filled. We should be looking to supporting patients back into their own homes.”

Earlier this year a Nursing Times investigation revealed that patients were regularly being placed in areas not designed for care – including wards that were already full, store rooms and mop cupboards – because appropriate wards were full.

The National Audit Office’s report on hospital infection in 2000 highlighted transfers as a risk factor. Accommodating patients in the wrong area – away from the team that is meant to be caring for them – also means they get less attention and are less likely to get the treatment they need, and more likely to deteriorate.

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July 7, 2010

Is 100 percent compliance on hand washing possible?

Here’s an interesting article about handwashing.  It seems like such a silly little thing to be so controversial.  Everyone’s mother harped on you to “wash your hands” until it became habit for you.  Why, now, is this an issue in hospitals?

To answer this, let me give you an example from my own place of employment.  Since I am a psychiatric nurse, my patients are all up walking around the unit.  Frequently I will have patient contact with all eight of my patients in the matter of just a minute or two because they will come up to me with various requests.

To get to a sink to actually wash my hands, I must reach into my pocket and get my keys to unlock the door to the med room or nurses’ station.  Once inside I still have to get through another door with a door handle.  Now, I am able to wash my hands, open the door again with that door knob and proceed through another door to get back out onto the unit to see my patients.  How did washing my hands do any good?  My keys are probably contaminated, my clothes most definitely are contaminated, the door knobs are contaminated, etc.

There are alcohol handwash dispensers scattered through the nursing station, but there are doors in the way there, too.  So, I am not sure how we can get 100% compliance.  Add to the fact that all of our nurses are so busy that we rarely take a break or eat lunch and only get to go to the bathroom when an accident is about to happen.  This senario does not allow for compliance with hand washing, but I know we all want to try to be compliant.

Does anyone else have such barriers to compliance like ours?  I’d love to hear how the other nurses out there are addressing this issue.

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By Sandra Yin

What would it take to move the dial closer to 100 percent compliance on hand washing? And just how realistic is that goal?

“Getting to 100 percent hand hygiene compliance through volunteerism is pretty unlikely,” Dr. William Jarvis, an infection control specialist and president of Jason and Jarvis Associates, a healthcare consulting firm based in Hilton Head, S.C., told FierceHealthcare.

Part of the problem is that most physicians and nurses are not adequately trained in infection control, he said. They may not realize that hand washing is one of the best ways to fight hospital-acquired infections that are behind an estimated 99,000 deaths a year and some $30 billion in excess healthcare spending in the U.S. What’s more, they don’t like to be told what to do. And they don’t understand how easily these pathogens are transmitted. “They just don’t get it,” Jarvis said.

With most hospitals in the 40 to 50 percent adherence range, without a hospital administrator/government mandate or electronic monitoring, it won’t happen, he said. But seatbelt laws and bike helmet laws offer a model to imitate.

A warning for a first violation, a fine the second time, and getting fired the third time would send a clear message, he said. But when the Joint Commission backed off its 90 percent compliance target, hospital administrators stopped caring. If a culture of patient safety were foremost, you wouldn’t see hundreds of doctors or nurses fined, he said, because they would follow the rules.

When asked what it would take to get closer to 100 percent compliance, Vickie Brown, RN, MPH, CIC–a spokesperson for the Association for Professionals in Infection Control and an associate director of hospital epidemiology at the 785-bed UNC Health Care based in Chapel Hill–was cautiously optimistic. “I’m not sure anyone has found the magic bullet,” she told FierceHealthcare. But what took place at UNC was “pretty darn amazing,” she said.

“What happened there holds more promise than anything [else] they’ve tried, short of a miracle.”

People will wash their hands 30 to 40 percent of the time to protect their own health, she said. The challenge is to move people beyond what they learned from their mothers to washing to prevent others from getting infected. Observation, feedback, insuring the right cleaning agents are available, leadership support and role modeling, and encouraging patients to insist that healthcare workers wash their hands can help. But these steps have not pushed the dial to 90 percent compliance. Covert observation can push hand washing to 70 percent, Brown said. But how do you get past that?

At UNC, when 90 nurses became infection control liaisons, ownership of hand hygiene shifted away from Infection Control and became the province of front line providers. They watch each other, provide feedback and correct each other. The liaisons’ work to change the culture of their units helped some reach and sustain 90 percent or greater compliance in hand washing, Brown said.

“To me,” she said, “the key to reducing hospital infections is–whether talking about hand hygiene or ensuring steps are taken to prevent surgical site infections–to ensure the clinicians providing care believe in it and accept infection prevention as a priority.” That’s one way to bring about a complete culture change within an organization. Unlike those infectious bugs, it sounds like it’s worth replicating. – Sandra

From:  The Editor’s Corner; FierceHealthcare.com

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