e22 ANNUAL ASPAN CONFERENCE ABSTRACTS

‘‘CHANGING THE SAFETY CULTURE THROUGH HANDWASHING’’Laura Owen, BSN, RN, CPAN, Laurel Stocks, MSN, RN,

Dina Krenzischeck, PhD, RN, MAS, CPAN

The Johns Hopkins Hospital, Baltimore, Maryland

The Centers for Disease Control (CDC) Prevention cited that hand wash-

ing is the single most effective way to prevent the transmission of dis-

ease. Despite the proven health benefits of hand washing, many

people have poor hygiene practice including PACU staff. The goal of

this safety project was to improve hand washing adherence through ac-

cess and staff education. The objectives were to assess baseline hand

washing compliance, implement strategies, monitor, report findings

and recognize staff. The process included: baseline data, staff education,

training of observers, Purell bottles at each bedside and around the unit,

weekly random audit, feedback, and recognition. It was a successful

practice because staff positively accepted the challenge and influenced

providers to follow. Pride was seen among recognized staff while others

continue to improve. Change in safety culture evolved and data showed

positive outcome. Baseline compliance rate increased from 28% to 90-

100% post two months of interventions and has been maintained at

high level. In October 2008, the PACU received a hospital recognition

certificate for the ‘‘Most Improved Unit’’ in hand washing. The implica-

tion of teamwork and commitment among perianesthesia nurses led to

successful change in safe practice not only in the unit but throughout

the hospital.

ASPAN SAFETY ENVIRONMENT RESOURCE: ‘‘2009 SAFETYTOOL KIT’’Dina A. Krenzischek, PhD, MAS, RN, CPAN,

Pam Windle, MS, RN, CNA, BC, CPAN, CAPA and ASPAN Safety

Committee

Johns Hopkins Hospital

The purpose of the ASPAN Safety Committee is to promote a culture of

safety for perianesthesia nursing practices. ASPAN is viewed as the mem-

bers’ indispensable resource for perianesthesia education and knowl-

edge. Currently, there is a no Resource for Safety Tool Kit for

perianesthesia nurses and leaders. The objective is to provide a safety re-

source and support for perianesthesia nurses. A survey was conducted

among the ASPAN Safety Committee members and solicited information

from other members and some leaders. Information was collated and

served as a starting point for the safety resource. An outline was devel-

oped to meet objectives and main categories served as framework.

Through this project, some ‘‘up and comers’’ were invited to write arti-

cles for professional development. Opportunities to contribute to the re-

source were provided to members who were doing it for the first time.

There was a collaborative engagement between mentors and mentees in

developing the safety resource. Topics were related to practice, educa-

tion, research, leadership, regulatory information. Through teamwork,

perianesthesia nurses developed a ‘‘hands on’’ tool for perianesthesia

bedside nurses and leaders.

‘‘BLOOD PRESSURE (BP) CUFFS: ALTERNATIVEAPPROACHES TO SAFE PRACTICE’’Dina A. Krenzischek, PhD, RN, MAS, CPAN, Julie Kubiak, MSN, RN,

Polly Ristaino, MS, Anne Castor-Gaa, MSN, RN, MPH, Colleen Cusick, RN,

Thomas Galloway, RN, Laurel Stocks, MSN, RN,

& Eugenia Heitmiller, MD

Hand washing and disinfection of BP cuff alone will not eliminate micro-

bial life of potentially lethal pathogens, such as Clostridium difficile espe-

cially when the cuff goes from one patient to another. A survey indicated

that multiple uses of one disposable BP cuff on several patients was more

common than either ‘‘single use’’ or standardized cleaning practices

which were inconsistent. The objective was to assess the use and clean-

ing of BP cuff practices within the hospital. A Hospital BP Cuff Task Force

was created; reviewed articles, met with experts, conducted surveys; an-

alyzed cost; piloted recommended practice; and recommended change

in protocol.

Addressing the practice of providing one BP cuff per patient/visit or in-

stituting a cleaning and disinfection protocol were successfully imple-

mented. Multiple use of BP cuff on different patients was eliminated

and staff members were satisfied that there was less risk of transmitting

deadly pathogens among their patients. The perianesthesia nurses

changed their practices from multiple use of BP cuffs to single use.

The BP cuff traveled with the patient from admission to the OR,

PACU, inpatient until discharge. Upon discharge from the inpatient

unit, the BP cuff would be discarded or cleaned and re-used in accor-

dance with the hospital protocol.

‘‘BALANCING PACU OVERFLOW AND PATIENT FLOW’’Dina A. Krenzischek, PhD, RN, MAS, CPAN, Elizabeth Martinez, MD, MHS

Johns Hopkins Hospital

ASPAN recognized the concerns about staffing and PACU overflow re-

lated to lack of bed availability in the ICU and/or inpatient units. The di-

lemma was the increasing pressure to maximize the PACU beds because

of OR backup. The goal was to improve patient flow using a standard

communication protocol. The objectives were to assess: scope of the

problem, contributing factors, delineate competing demands, and de-

velop potential interventions. It started with problem identification, as-

sessment of department/unit needs, and collaborative development of

communication protocol. The approved protocol was successfully im-

plemented with the guidance from the core group of nurses and pro-

viders engaged in the team work process. Communication process

was improved which included group briefings and debriefings through-

out the day. The implementation of ‘‘unstaffed beds’’ was used when

there were no available staffed beds. The anesthesia providers managed

the patients in the unstaffed beds until a PACU nurse became available.

This additional capacity has reduced backup in the OR. The implication

among perianesthesia nurses was the increased positive collaborations

between nurses and providers. The proactive planning improved effi-

ciency in the patient flow and reduced the frequency of ‘‘PACU Hold.’’

This initiative reduced frustrations and aggravations which undermined

the positive teamwork.