The purpose of this paper is to help student nurses to learn and understand new polices and procedures. It will familiarize student nurses on the multitude of standardized nursing polices, standards of care, and evidenced based researches that will influence and provide guidance as new graduate nurses. The nursing policy that was chosen is Contact Isolation for Clostridium defficile, and focuses on the difficulty of finding the evidence based policies, dissemination of policy guidance to staff, rationale for the occurrence of deviation on unit, and discussion of unsafe practice, which affect the patients and the hospital.
The unit that was observed has many patients that are on isolation, either contact or droplet isolation precaution. An increased in unsafe actions, such as failure to wearing the appropriate isolation attire, will most likely increase. The policy for contact isolation was required to provide guidance. However, it was difficult to locate on the hospital website search engine. The preceptor also had hard time finding the document. It was eventually located after more than fifteen minutes.
It was observed that the difficulty in searching for the document was mainly due to the clunky algorithm of the search engine. It was not smart enough and hence required multiple keywords for it to effectively locate the right document. The evidenced-based policy/procedure was originally disseminated through yearly computer based learning to staff that are in contact and care of such patients. Although they have yearly computer based training, it was still observed that there were deviations from the policy.
It was also observed that often preceptor and other nurses enter patient’s room to shut the button off on the IV monitor wearing only gloves, without the necessary gowns. These actions caught my attention as according to the hospitals policy for personal protective equipment (PPE) requirements, “Gloves and Gown for every entry into patient room”. While they did follow the protocol, which includes sanitizing hands before entering the rooms and identifying self, they chose to not take the additional step of putting a gown on. This was puzzling.
The preceptor response to the inquiry was that she had just walked out of that patient’s room after making providing the necessary care and ensuring the patient was comfortable, and during those times she was properly gowned and gloved. However as soon the preceptor left, the alarm sounded off. Since she knew patient was okay, and that it was only one button to touch to silence noise, she decided to wore only gloves to enter the contact isolation room. After exiting the room, appropriate hand hygiene for C-diff contact isolation was performed by washing hand using soap and water.
The CDC recommended the use of soap and water, rather than alcohol-based handrubs, to mechanically removal of spores from hands. There are some consequences for not following the policy even though it might not affect the patient at that time. The reason for gowns to be worn by personnel during the care of patients infected with epidemiologically important microorganisms is to mitigate the risk of transmission of pathogens from patients or items in their environment to other patients or environments; when gowns are worn for this purpose, they are removed before leaving the patient’s environment, and hands are washed according to CDC.
Clinical and laboratory coats worn over personal clothing for purpose of identity are not considered PPE. So not only the nurses are culprits for short cuts, but also doctors and pharmacists. This work around creates some short-term risk, which could result in transmission of microorganism from your own clothing to another patient, environmental surfaces etc. Long-term consequence such as extending patients time in staying in hospital could result in financial strain for both patient and hospital.
Not only do I see these incidences on the unit I am on, but also in other hospitals that I had worked at. This is a mistake that is common amongst doctors, pharmacist and others, including myself. As a corrective action, I will ensure that I will take all necessary precaution to provide safety for that patient as the priority of role is about the well being of my patients. I will ensure gowns and gloves are stocked, remind patients health care team that the patient is contact isolation and ensuring that they wear the necessary PPE.
Summary As we get more experienced in working in the healthcare field, we often come up with work around that may streamline process and not thinking about the short and long-term consequences for the patients and hospitals finances. As a new grad nurse entering the professional field, we need to recognize the reason why the policy and procedure is written and why we need to follow it to ensure the highest quality of patient care.