SMAH915 Practice Improvement Project (Part A) Assessment Answer

Introduction

The improper sterilisation of reusable surgical instruments within Queensland public hospitals represents a critical patient safety concern, warranting immediate attention and remediation. This issue contravenes the National Safety and Quality Health Service (NSQHS) Standard and the Australian Commission on Safety and Quality in Health Care (ACSQHC) Standard. The significance of this problem is underscored by the potential for adverse patient outcomes, including surgical site infections and the transmission of bloodborne pathogens (Shakoor et al., 2020). Moreover, the financial ramifications of such lapses, in terms of prolonged hospital stays and the associated costs of treating nosocomial infections, are substantial. This project endeavours to comprehensively address this issue by applying a clinical practice improvement methodology guided by NSQHS and ACSQHC standards. By conducting a thorough diagnostic evaluation of the root causes contributing to improper sterilisation and subsequently implementing evidence-based solutions, this initiative aims to enhance patient safety, elevate the quality of care, and align clinical practices with established national standards.

Cause of the process failure

A Queensland public hospital system conducted a retrospective study to evaluate different underlying factors that may have contributed to the improper sterilisation of reusable surgical instruments. The study identified adverse events primarily linked to inadequate cleaning standards which led to an increased risk of infections and other complications for patients undergoing surgeries using these instruments. A thorough examination of patient records and incident reports uncovered a troubling pattern of post-operative complications, notably surgical site infections, prompting concerns regarding the efficiency of the sterilisation procedures. Additional inquiry included interviews with healthcare staff responsible for instrument sterilisation. Their input emphasised a need for uniform training and consistent approaches among team members. (Panta et al., 2022). Moreover, an evaluation of the sterilisation equipment disclosed malfunction and insufficient upkeep. Additionally, the absence of standardised protocols and inconsistent procedures within the hospital setting can be responsible for increasing the risk of errors (Asfaw et al., 2021).

Aim of the project

The project aims to implement a comprehensive staff training program focused on sterilisation protocols and practices, aiming to equip healthcare personnel with the necessary knowledge and skills to ensure proper sterilisation of reusable surgical instruments in the Queensland public hospital. Additionally, the Ishikawa (Fishbone) diagram and Driver diagram will be incorporated as quality improvement tools to facilitate a systematic and holistic approach to enhancing sterilization processes and outcomes.

Impact of process failure

The improper sterilisation of reusable instruments in the hospital has short and long-term consequences. Patients undergoing surgical procedures face an elevated risk of developing surgical site infections due to the compromised sterility of instruments. This can lead to prolonged hospital stays, increased healthcare costs, and potential long-term health consequences for affected patients (Kong et al., 2021). Improperly sterilised instruments may harbor bloodborne pathogens, posing a severe risk of transmission to patients. This can lead to potentially life-threatening infections, requiring additional medical interventions and treatment. This issue pertains to the fundamental principle of patient non-maleficence, where healthcare providers are ethically obliged not to harm. (Varkey, 2021). Inadequate sterilisation directly contravenes this principle, posing a substantial risk of healthcare-associated infections. The increased incidence of post-operative complications, including infections, results in extended hospital stays and additional medical interventions (Calderwood et al., 2023). This burdens the healthcare system and affects patients financially, potentially leading to higher healthcare costs and resource allocation challenges. Substandard sterilisation practices may lead to legal consequences for the hospital, healthcare providers, and administrators. News of improper sterilisation practices can harm the reputation of the hospital and its healthcare professionals.

Overview of Proposed Solutions - Staff Training Program

Implementing a comprehensive staff training program emerges as a pivotal solution to address the issue of improper sterilisation of reusable surgical instruments (Fast et al., 2019). This initiative entails the development and execution of a structured curriculum, encompassing theoretical knowledge and practical training on sterilisation protocols, equipment operation, and quality control measures, thus minimising the risk of healthcare-associated infections (Haque et al., 2020). The staff training program will cater to various healthcare professionals, including sterilisation technicians, nurses, and surgeons. It will incorporate didactic lectures, hands-on training sessions, and periodic assessments to reinforce learning. Additionally, the program will be accompanied by a resource repository consisting of reference materials and procedural guidelines to support participants(Dyann Matson-Koffman et al., 2023). Unlike procedural adjustments or equipment upgrades, which may offer partial solutions, the training program targets the human element, which plays a pivotal role in sterilisation. By empowering healthcare professionals with the necessary expertise, the program ensures sustained adherence to best practices, thus yielding a more robust and enduring improvement. Research supporting the effectiveness of structured training programmes in lowering the incidence of healthcare-associated infections and improving overall patient safety further supports the choice of this solution. (Wang et al., 2023)

Moreover, this approach aligns closely with established healthcare quality improvement models, emphasising the significance of education and training in driving sustainable improvements in clinical practices. Implementing a structured staff training programme perfectly aligns with NSQHS Standard 3: Preventing and Controlling Healthcare-Associated Infections (ACSQHC, 2019b). This standard emphasises the significance of implementing efficient infection prevention and control measures to reduce the risk of infections related to healthcare. Investing in thorough training allows medical staff to follow strict sterilisation guidelines, ultimately lowering the risk of infections caused by insufficient sterilisation (Josephs-Spaulding & Singh, 2021). Additionally, the staff development programme aligns with NSQHS Standard 1: Clinical Governance, emphasising the significance of clinical leadership, accountability, and a culture of continuous improvement (ACSQHC, 2017). The healthcare facility demonstrates its dedication to clinical governance by implementing a training programme, ensuring correct sterilisation practices are upheld through thorough education and oversight. Standard 2: Partnering with Consumers of the Australian Commission on Safety and Quality in Health Care (ACSQHC) emphasises patients' rights to receive high-quality, safe care (ACSQHC, 2019a). Engaging in rigorous staff training directly translates to improved patient safety, as it ensures that healthcare providers are equipped with the necessary skills and knowledge to provide care free from unnecessary risks. This aligns with the ACSQHC standard, demonstrating a commitment to partnering with consumers to pursue better healthcare outcomes.

 Strategy for Implementation

A systematic step-by-step plan will be meticulously followed to implement the chosen solution of a staff training program effectively. Initially, a comprehensive needs assessment will be conducted to identify specific gaps in knowledge and skills among healthcare personnel (Fernandez et al., 2019). This phase will encompass surveys, interviews, and consultations with stakeholders to ensure that the training program is tailored to address the unique requirements of the Queensland public hospital. A dedicated curriculum development phase will be undertaken, creating detailed training materials, including manuals, presentations, and practical exercises (Ayub Khan et al., 2022). These resources will engage participants and enhance their understanding of sterilisation protocols. Subsequently, a pilot training program will be conducted with a select group of staff members to refine the content and delivery methods based on real-world feedback. This iterative process will culminate in the full-scale implementation of the training program for all relevant healthcare personnel, accompanied by ongoing support through periodic refresher sessions.

Allocating resources and responsibilities will be a critical facet of this implementation strategy. Adequate funding will be allocated for program development, encompassing the design of curriculum materials, production of resources, and training facilitators. A designated training coordinator will oversee the program's implementation, manage logistics, schedule sessions, and track participant progress. The task of effectively delivering the training content will be given to experienced trainers or subject matter experts, ensuring that the programme is carried out with accuracy and expertise.

A well-planned execution schedule will govern the implementation process.

Data gathering and presentation will be the cornerstone of the project's ongoing development. A reliable data collection system will be put in place to track participant attendance, understanding, and performance. Participants' feedback will be systematically analysed to pinpoint training programme improvement opportunities. The program's impact on patient safety and the standard of care will be reinforced through regular reporting on its effectiveness. This will prove any observed decline in improper sterilisation incidents and related outcomes.

 Application of Quality Improvement Tools

Implementing quality improvement models and tools is crucial for directing the improvement process. The cause-effect diagram, also referred to as the Ishikawa or fishbone diagram, will be used to pinpoint the primary factors causing incidents involving improper sterilisation (Peters & Eng, 2021) (Figure 1). Potential causes are divided into distinct branches by this visual tool, including personnel, equipment, procedures, and environment. The team can identify root causes and tailor interventions by methodically analysing each category. This methodical approach guarantees a thorough comprehension of the numerous variables affecting sterilisation practices. The driver diagram will also be used to give a visual representation of the main drivers of the project and how they relate to one another (Schubert et al., 2022) (Figure 2). This tool makes it possible to identify both primary drivers, like improved staff training, and secondary drivers, like improved protocol adherence. The cause-and-effect connections between the various parts of the improvement initiative are made clearer by the driver diagram. The team gains a strategic framework to direct the implementation of the staff training programme by outlining these drivers, ensuring a targeted and methodical approach.

Outcome measurement

The Cause-Effect Diagram helps in identifying potential causes and factors contributing to the problem of improper sterilisation. By categorising these causes (People, Process, Equipment, Resource Constraints), it provides a structured approach to understanding the root issues. Once interventions are implemented, the Cause-Effect Diagram serves as a reference point to ensure that the identified causes are effectively addressed (‌Peters & Eng, 2021). This can indirectly influence the expected outcomes. The Driver Diagram also helps set specific, measurable, achievable, relevant, and time-bound (SMART) goals for each driver (Schubert et al., 2022). These goals can serve as indicators for measuring the effectiveness of the interventions and, by extension, the project's outcomes.

The decrease in improper sterilisation incidents, measured through incident reports and audits, will be one particular metric for evaluation (Aseeri et al., 2020). This metric will be a measurable sign of how the programme affects patient safety. The improvement in compliance rates with established sterilisation protocols, as determined by pre-and post-training assessments, will also be a key performance indicator. Another crucial outcome metric will be the decline in healthcare-associated infections (HAIs) (Panta et al., 2019). This can be monitored by keeping a close eye on post-operative patients and comparing infection rates before and after the training programme was put into place.

The program's contribution to better patient outcomes is highlighted by this metric, which also supports the overarching objective of preventing nosocomial infections.

Conclusion

The project addresses the process failure of improper sterilisation of reusable surgical instruments in Queensland public hospitals, which poses a serious risk to patient safety and is in direct violation of NSQHS and ACSQHC standards. The proposed solution focuses on a structured staff training program, aligned with established healthcare quality improvement models and emphasising the importance of education in driving sustainable improvements. The project unfolds in phases, beginning with a needs assessment and curriculum development, followed by a pilot training, full-scale implementation, and ongoing monitoring and support. A carefully constructed timeline guides each step, spanning a total of 18 months. Clear responsibilities and resource allocations are outlined to ensure the program's successful execution. Data collection and analysis play a crucial role in monitoring participant progress, refining the training program, and evaluating its impact. By systematically addressing the root causes contributing to improper sterilisation, this project aims to enhance patient safety, improve the quality of care, and align clinical practices with national standards thus reflecting a commitment to delivering healthcare of the highest quality, prioritising patient well-being and safety above all else.

References

‌‌Aseeri, M., Banasser, G., Baduhduh, O., Baksh, S., & Ghalibi, N. (2020). Evaluation of medication error incident reports at a tertiary care hospital. Pharmacy, 8(2), 69. https://doi.org/10.3390/pharmacy8020069

Asfaw, S. H., Galway, U., Hata, T., Moyle, J., & Gordon, I. O. (2021). Surgery, anesthesia, and pathology: A practical primer on greening the delivery of surgical care. The Journal of Climate Change and Health, 4, 100076. https://doi.org/10.1016/j.joclim.2021.100076

‌‌Australian Commission on Safety and Quality in Health Care (ACSQHC). (2019a). Partnering with consumers standard. https://www.safetyandquality.gov.au/standards/nsqhs-standards/partnering-consumers-standard

Australian Commission on Safety and Quality in Health Care (ACSQHC). (2019b). Preventing and controlling infections standard. https://www.safetyandquality.gov.au/standards/nsqhs-standards/preventing-and-controlling-infections-standard

Australian Commission on Safety and Quality In Health Care (ACSQHC). (2017). Clinical Governance Standard . https://www.safetyandquality.gov.au/standards/nsqhs-standards/clinical-governance/clinical-governance-standard

‌Ayub Khan, M. N., Verstegen, D. M. L., Islam, S., Dolmans, D. H. J. M., & van Mook, W. N. A. (2022). Task-based training to prevent surgical site infection: A formative evaluation. Infection Prevention in Practice, 100235. https://doi.org/10.1016/j.infpip.2022.100235

Calderwood, M. S., Anderson, D. J., Bratzler, D. W., Dellinger, E. P., Garcia-Houchins, S., Maragakis, L. L., Nyquist, A.-C., Perkins, K. M., Preas, M. A., Saiman, L., Schaffzin, J. K., Schweizer, M., Yokoe, D. S., & Kaye, K. S. (2023). Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology, 44(5), 695–720. https://doi.org/10.1017/ice.2023.67 

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‌Fast, O. M., Gebremedhin Teka, H., Alemayehu/Gebreselassie, M., Fast, C. M. D., Fast, D., & Uzoka, F.-M. E. (2019). The impact of a short-term training program on workers’ sterile processing knowledge and practices in 12 Ethiopian hospitals: A mixed methods study. PLOS ONE, 14(5), e0215643. https://doi.org/10.1371/journal.pone.0215643

‌Fernandez, M. E., ten Hoor, G. A., van Lieshout, S., Rodriguez, S. A., Beidas, R. S., Parcel, G., Ruiter, R. A. C., Markham, C. M., & Kok, G. (2019). Implementation mapping: Using intervention mapping to develop implementation strategies. Frontiers in Public Health, 7(158). https://doi.org/10.3389/fpubh.2019.00158

Haque, M., McKimm, J., Sartelli, M., Dhingra, S., Labricciosa, F. M., Islam, S., Jahan, D., Nusrat, T., Chowdhury, T. S., Coccolini, F., Iskandar, K., Catena, F., & Charan, J. (2020). Strategies to prevent Healthcare-Associated Infections: A narrative overview. Risk Management and Healthcare Policy, 13(1), 1765–1780. https://doi.org/10.2147/RMHP.S269315

Josephs-Spaulding, J., & Singh, O. V. (2021). Medical device sterilisation and reprocessing in the era of Multidrug-Resistant (MDR) Bacteria: Issues and regulatory concepts. Frontiers in Medical Technology, 2. https://doi.org/10.3389/fmedt.2020.587352

Kong, X., Zhu, X., Zhang, Y., & Wu, J. (2021). The application of plan, do, check, act(PDCA) quality management in reducing nosocomial infections in endoscopy rooms: it does work. International Journal of Clinical Practice. https://doi.org/10.1111/ijcp.14351

Panta, G., Richardson, A. K., & Shaw, I. C. (2019). Effectiveness of autoclaving in sterilising reusable medical devices in healthcare facilities. The Journal of Infection in Developing Countries, 13(10), 858–864. https://doi.org/10.3855/jidc.11433

Panta, G., Richardson, A. K., Shaw, I. C., & Coope, P. A. (2022). Healthcare workers' knowledge and attitudes towards sterilisation and reuse of medical devices in primary and secondary care public hospitals in Nepal: A multi-centre cross-sectional survey. PLOS ONE, 17(8), e0272248. https://doi.org/10.1371/journal.pone.0272248

‌Peters, H., & Eng, P. (2021). Root Cause Analysis (RCA) for the improvement of healthcare systems and patient safety. CRC Press.

‌Schubert, A., Truxillo, T. M., & Guthrie, R. (2022). The power of the driver diagram: A conceptual approach. Optimising Widely Reported Hospital Quality and Safety Grades, 21–29. https://doi.org/10.1007/978-3-031-04141-9_4

Shakoor, S., Warraich, H. J., & Zaidi, A. K. M. (2020). Infection prevention and control in the tropics. Hunter’s Tropical Medicine and Emerging Infectious Diseases, 159–165. https://doi.org/10.1016/B978-0-323-55512-8.00020-X

‌Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17–28. https://doi.org/10.1159/000509119

Wang, X., Liu, C., Du, Y., Wang, D., & Zhang, X. (2023). Do Knowledge, Attitudes, and Barrier Perception Affect the Prevention and Control of Healthcare-Associated Infections? A Structural Equation Modelling Approach. (16), 3051–3063. https://doi.org/10.2147/idr.s409398

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