Patient Safety Policy Paper
Metropolitan State University
NURS-605-50
Spring 2012

Introduction
Patient safety is a primary goal for all health care workers, especially Registered Nurses who are the primary care givers for many patients. To promote safety and well-being it is important to provide the best possible care to all patients without spreading hospital acquired infections to patients that were previously free from certain diseases. Clostridium difficile infections (CDI) are a common occurrence within health care settings and can cause many complications, increasing length of stay, and could even cause death.
The goal of this paper is to provide a policy to make changes to the Intensive Care Unit (ICU) at Mercy Hospital in Coon Rapids, Minnesota. The ICU has struggled with preventing and eliminating the spread of CDI from patient to patient. The unit has implemented many changes to increase hand hygiene, improve cleaning techniques of equipment, and increase staff knowledge and awareness without improvement of the CDI rates.
By reviewing policies provided by the Agency for Healthcare Research and Quality (AHRQ) there can be changes made to improve the CDI rates at Mercy Hospital. Policy changes can be implemented and staff can be educated on proper hygiene techniques and other policies that the AHRQ will provide. The ultimate goal is to eliminate hospital acquired CDI’s and with the policy changes this can be a possibility.
Policy Implementation The main focus area for this patient safety policy change will be focused on the Intensive Care Unit (ICU) at Mercy Hospital. Mercy Hospital is part of the Allina Health organization which serves the northeastern suburbs located in Coon Rapids, Minnesota. Mercy is a level II trauma hospital with an estimated 255 inpatient beds. The ICU has 19 beds that serve a multitude of patient ranging from medical/surgical to neurological, septic to cardiovascular. The unit cares for all aspects of health care with the exception of level I trauma, burns, and pediatrics. The focus area for this policy change and implementation will be patients admitted to the ICU that may be susceptible for Clostridium Difficile Infection (CDI). Clostridium difficile is the most common cause of infectious health-care associated diarrhea (Eiland, 2011). The infection is spread through human contact with an emphasis in transmission from fecal to oral route. It is extremely important to promote and perform hand hygiene to all patients and staff. Evidence-based policy is an extension or extrapolation of the tenets of evidence-based practice to decisions about resource allocation and regulation by various government and regulatory bodies (Chaffee, Leavitt, & Mason, 2012). Policy implementation and change is a never ending occurrence within the health care setting. With evidence based practices and research there are opportunities for improvements in many areas to provide the best possible care possible for each and every patient. The AHRQ has conducted many studies and investigations into the prevention and education of CDI. Through evidence-based research and randomized testing there have been many research studies conducted with results showing that if policy and practice changes are made there can be a significant decrease in CDI’s. The AHRQ has come up with special approaches for the prevention of CDI. By following these approaches the studies have been successful and outcomes have been achieved. An approach to minimize clostridium difficile transmission by health care workers involves the following ("Strategies to prevent," 2012):
1. Intensify the assessment of compliance with process measures.
2. Perform hand hygiene with soap and water as the preferred method before exiting the room of a patient with CDI.
3. Place patients with diarrhea under contact precautions while C. difficile test results are pending.
4. Prolong the duration of contact precautions after the patient becomes asymptomatic until hospital discharge.
With proper implementation these strategies can help reduce infections, bioburden, and promote cleanliness within the patient’s hospital stay. These actions are crucial to implement due to patient harm and cost of infection. Each year, an estimated 215,000 cases of hospital-acquired C. difficile occur in the USA, along with 263,000 in nursing homes. The hospital-acquired infections cost $1.6 billion a year to treat and result in 9,000 deaths, says the Centers for Disease Control and Prevention (Elizabeth, date unknown). With changes in reimbursements the Centers for Medicare and Medicaid Services (CMS) will be monitoring outcomes related to patient hospitalizations and length of stay. A CDI can increase patient length of stay causing more costs to the patient, which are covered by the hospital, and cause the CMS to not provide reimbursements.
Plan
To implement this policy and procedure change will require extra efforts from the education department and patient care managers on the inpatient units within Mercy Hospital. All managers have to be involved with training purposes as each unit has different styles of learning. Within the ICU the Patient Care Supervisor is the main educator that will facilitate the changes. With help from the education department we will create as electronic learning (e-learning) in which staff will have to view and sign an attestation that they have viewed it and understand the content. Each quarter the unit receives multiple e-learning’s and this will be added to the 2nd quarter learning’s for 2012. The learning will provide explanation of the disease, stress the importance of hand hygiene, and alert the staff to send a stool sample with the first liquid stool or change in stool consistency. There will an additional entry that will explain the need to keep the CDI patient in isolation until they are transferred out of the ICU even if the infection is cured. This will decrease confusion of when to take patients out of isolation and decrease the amount of fear in relation to equipment not being cleaned properly between patient uses. Follow-up will be made by the manager and PCS of the ICU to determine if the e-learning was effective and to see if the staff has any questions or concerns. This follow-up will be beneficial for those that did not view all of the learning or that continue to struggle with policy changes. This follow-up will be completed at scheduled “huddles” before and after each shift. The “huddles” consist of educational and informational opportunities for staff to learn and express viewpoints on certain topics. The “huddles” only last 5-10 minutes in which a single topic is covered, in this case it will be to stress the importance of the CDI e-learning.
Conclusion
With the research provided by the AHRQ there is a plan a process for policy changes within the ICU at Mercy Hospital. To help promote patient safety and well-being the focus area on the policy change will be to decrease the chance of CDI’s. As this problem has become a bigger issue throughout the nation it is important to get a policy in place to prevent any more a harm spread to the patient within the ICU.
As reimbursement rates are changing and will focus on patient satisfaction this is a big issue that needs to be addressed. Patient safety is a main concern for patients, staff, and families and is a guiding principle within the ICU at Mercy. To promote well-being and the best care possible it is necessary to implement these changes. With promoting these changes the ICU will be successful in eliminating this devastating disease and move forward into promotion of patient care.

References
Chaffee, M., Leavitt, J., & Mason, D. (2012). Policy & politics in nursing and health care. St. Louis: Elsevier Saunders.
Eiland, I. H. (2011). Activities of a Clostridium difficile infection reduction team. American Journal Of Health-System Pharmacy, 68(14), 1298-1301. doi:10.2146/ajhp100664
Elizabeth, W. (date unknown). Lesser-known bug hits hospitals in S.E. USA Today.
Strategies to prevent clostridium difficile infections in acute care hospitals.. (2012). Retrieved from: http://www.guidelines.gov/content.aspx?id=13398&search=clostridium difficile