What Works to Improve Staff Compliance With Multi-Drug-Resistant Organism (MDRO) Screening

2.50
Hdl Handle:
http://hdl.handle.net/10755/621586
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
What Works to Improve Staff Compliance With Multi-Drug-Resistant Organism (MDRO) Screening
Other Titles:
Global Perspectives on Multi-Drug-Resistant Infections
Author(s):
Gesmundo, Monina
Lead Author STTI Affiliation:
Pi Iota
Author Details:
Monina Gesmundo, MN (Hons), PGDip HSc, PGCertTertiaryTch, BSN, RN, RM, CNS, Professional Experience: October,16 (current) - Lecturer, School of Nursing, Massey University August, 2012-September 2016 - Clinical Nurse Specialist in infection prevention and control at Middlemore Hospital, Auckland, New Zealand 2010 - July,2012 Proficient high-risk postpartum nurse at Middlemore Hospital, Auckland, New Zealand 2006 - September, 2009 Lecturer/Reviewer for the Philippine Nurse Licensure Examination, various review centers, Philippines October 1999 - 2007 Teaching Associate/ Clinical Instructor/Lecturer/ Senior Lecturer for the University of the Philippines Manila College of Nursing (Manila, Philippines) Author Summary: Monina Hernandez Gesmundo is a nurse-midwife who currently works as a lecturer at the School of Nursing, Massey University. Monina was working as a clinical nurse specialist for infection prevention and control in Auckland, New Zealand when she submitted this abstract. Her extensive experience in community health and teaching in the Philippines motivated her to pursue research relevant to disease prevention. Her current research interests include infectious diseases and enhanced patient safety.
Abstract:

Purpose of the presentation: To present the evaluation of multi-modal interventions on the staff MDRO admission screening compliance rate in various departments of a secondary public hospital in New Zealand 

Target Audience: The target audience of this presentation are staff nurses, nurse educators, nurse managers, quality improvement advisers and infection control practitioners who are keen to identify interventions that work in improving staff compliance to MDRO admission screening

Objective: To evaluate the effect of multi-modal interventions on the staff MDRO admission screening compliance rate in various departments of a secondary public hospital

Research question: What is the effect of multi-modal infection prevention and control interventions on the staff MDRO admission screening compliance rate in various departments of a secondary public hospital?

Design: A retrospective review of monthly MDRO admission screening audits was done to compare the compliance rate before and after multi-modal interventions were implemented. The audit was conducted in the care of older people and elective surgical department of a public secondary hospital in Auckland, New Zealand from December 2010 to November 2014.

Setting: Two departments of a public secondary hospital in Auckland, New Zealand

Methods: Monthly MDRO admission screen audits were done in a representative ward of each department for the purpose of quality improvement. Audits were conducted by generating a monthly list of patients who were eligible to be screened for MDRO on admission to the ward. Twenty patients were randomly selected from the monhtly list for a specified period of time to evaluate whether nurses screened them for MDRO within 24 hours of admission. Eligibility to be screened is based on the criteria published in the organisational policy for MDRO management. Nursing staff compliance rate with the MDRO admission screen policy was computed using frequency and percentage.

Multi-modal interventions focusing on the nursing staff were implemented by the infection control practitioner. Interventions include: monthly MDRO admission screen compliance audits, regular reporting of audit result, feedback with regard to missed screens, regular education sessions with the nursing staff and staff encouragement from both the infection control practitioner and nurse manager.

Compliance rates were reported to the charge nurse managers on a monthly basis through an e-mail. Compliance rates of greater than 90% were celebrated and reinforced, whereas a drop in the compliance rate or a compliance rate of < 90% was followed up with the nurse manager. Regular 10-15 minute-education sessions during staff handovers were done by the infection control practitioner to present the audit results, to provide input, to answer queries and to encourage the staff to do better. Nurse managers also encourage staff to improve screening compliance rate.

Data analysis utilized Microsoft Excel Software in quantitative data collation and encoding. MDRO admission screen audits were presented using descriptive statistics such as frequency, percentage, mean, median and mode. Standard deviation was used to show data variability. T-test was utilized to test for a significant difference in the overall compliance rate before and after the multi-modal interventions were introduced. T-test is a parametric procedure of testing the difference in group means. The level of significance was set at P < 0.05 to identify a significant difference in the compliance rate.

Results: Results show that the MDRO admission screen compliance rate in the two departments were variable. The average compliance rate from October, 2012 to November, 2014 in the elective surgical department is 85.75% compared to 75.91% from December, 2010 to September, 2012 (Table 1).

Table 1.MDRO admission screen compliance at the elective surgical department

Surgical Department

Before*

After**

Mean

75.90909091

 Mean

85.75

Number of patient records audited

1670

 Number of patient records audited

2058

Number of monthly audits completed

22

 Number of monthly audits completed

24

*Period coverage is from December, 2010 to September, 2012

**Period coverage is from October, 2012 to November, 2014

In the care of older people department, results show that the MDRO admission screen compliance was also variable. The average MDRO admission screen compliance rate from August, 2013 to October, 2014 is 96.80% compared to 83.84% from December, 2010 to July 2013 (Table 2).

Variability in the compliance may be due to patient acuity, staff mix, thorough history-taking of the patient, review of previous admissions, completeness of handover, staff knowledge of the organisational policy, staff motivation to adhere to organisational policy and availability of staff support.

Table 2.MDRO admission screen compliance at the health of older people department

Health of Older People

Before***

After****

Mean

83.83870968

Mean

96.8

Number of patient records audited

2599

Number of patient records audited

1452

Number of monthly audits completed

31

Number of monthly audits completed

15

 

*** Period coverage is from December, 2010 to July 2013

****Period coverage is from August, 2013 to October, 2014

Statistical analysis of the overall MDRO admission screening compliance rate before and after the interventions showed a significant difference (P < 0.05) in the compliance rate in both departments. A two-sample T-test with unequal variance was utilized in the statistical analysis given the variability in the screening rate and count. Table 3 provides a summary of the statistical testing done. The last column shows that there is a significant difference in the compliance rate in the surgical department (P < 0.009) and the care of older people department (P < 0.00003)

 Table 3.Descriptive summary of statistical testing of the MDRO admission screen compliance rate before and after the interventions

Departments

Before

After

T-Test

 (< 0.05)

Number of Audits

Mean Compliance Rate

Number of Audits

Mean Compliance Rate

Surgical Department

22

75.91

24

85.75

0.009324379

Care of Older People

31

83.84

15

96.80

0.000036141

Conclusion: The multi-modal interventions addressed to nurses had a significant impact on the MDRO admission screening compliance rate in various departments of a tertiary public hospital. While various factors may affect the staff MDRO admission screening compliance rate, the rate could be kept at a high level through regular audits, regular reporting of audit result, regular education sessions and consistent staff encouragement.

Keywords:
MDRO Admission Screen; Multi-modal Interventions; Nursing Staff Screening Compliance
Repository Posting Date:
22-Jun-2017
Date of Publication:
22-Jun-2017
Other Identifiers:
INRC17L10
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleWhat Works to Improve Staff Compliance With Multi-Drug-Resistant Organism (MDRO) Screeningen_US
dc.title.alternativeGlobal Perspectives on Multi-Drug-Resistant Infectionsen
dc.contributor.authorGesmundo, Moninaen
dc.contributor.departmentPi Iotaen
dc.author.detailsMonina Gesmundo, MN (Hons), PGDip HSc, PGCertTertiaryTch, BSN, RN, RM, CNS, Professional Experience: October,16 (current) - Lecturer, School of Nursing, Massey University August, 2012-September 2016 - Clinical Nurse Specialist in infection prevention and control at Middlemore Hospital, Auckland, New Zealand 2010 - July,2012 Proficient high-risk postpartum nurse at Middlemore Hospital, Auckland, New Zealand 2006 - September, 2009 Lecturer/Reviewer for the Philippine Nurse Licensure Examination, various review centers, Philippines October 1999 - 2007 Teaching Associate/ Clinical Instructor/Lecturer/ Senior Lecturer for the University of the Philippines Manila College of Nursing (Manila, Philippines) Author Summary: Monina Hernandez Gesmundo is a nurse-midwife who currently works as a lecturer at the School of Nursing, Massey University. Monina was working as a clinical nurse specialist for infection prevention and control in Auckland, New Zealand when she submitted this abstract. Her extensive experience in community health and teaching in the Philippines motivated her to pursue research relevant to disease prevention. Her current research interests include infectious diseases and enhanced patient safety.en
dc.identifier.urihttp://hdl.handle.net/10755/621586-
dc.description.abstract<p><strong>Purpose of the presentation: </strong><span>To present the evaluation of multi-modal interventions on the staff MDRO admission screening compliance rate in various departments of a secondary public hospital in New Zealand</span><strong> </strong></p> <p><strong>Target Audience: </strong>The target audience of this presentation are staff nurses, nurse educators, nurse managers, quality improvement advisers and infection control practitioners who are keen to identify interventions that work in improving staff compliance to MDRO admission screening</p> <p><strong>Objective: </strong>To evaluate the effect of multi-modal interventions on the staff MDRO admission screening compliance rate in various departments of a secondary public hospital</p> <p><strong>Research question: </strong>What is the effect of multi-modal infection prevention and control interventions on the staff MDRO admission screening compliance rate in various departments of a secondary public hospital?</p> <p><strong>Design: </strong>A retrospective review of monthly MDRO admission screening audits was done to compare the compliance rate before and after multi-modal interventions were implemented. The audit was conducted in the care of older people and elective surgical department of a public secondary hospital in Auckland, New Zealand from December 2010 to November 2014.</p> <p><strong>Setting: </strong>Two departments of a public secondary hospital in Auckland, New Zealand</p> <p><strong>Methods: </strong>Monthly MDRO admission screen audits were done in a representative ward of each department for the purpose of quality improvement. Audits were conducted by generating a monthly list of patients who were eligible to be screened for MDRO on admission to the ward. Twenty patients were randomly selected from the monhtly list for a specified period of time to evaluate whether nurses screened them for MDRO within 24 hours of admission. Eligibility to be screened is based on the criteria published in the organisational policy for MDRO management. Nursing staff compliance rate with the MDRO admission screen policy was computed using frequency and percentage.</p> <p>Multi-modal interventions focusing on the nursing staff were implemented by the infection control practitioner. Interventions include: monthly MDRO admission screen compliance audits, regular reporting of audit result, feedback with regard to missed screens, regular education sessions with the nursing staff and staff encouragement from both the infection control practitioner and nurse manager.</p> <p>Compliance rates were reported to the charge nurse managers on a monthly basis through an e-mail. Compliance rates of greater than 90% were celebrated and reinforced, whereas a drop in the compliance rate or a compliance rate of < 90% was followed up with the nurse manager. Regular 10-15 minute-education sessions during staff handovers were done by the infection control practitioner to present the audit results, to provide input, to answer queries and to encourage the staff to do better. Nurse managers also encourage staff to improve screening compliance rate.</p> <p>Data analysis utilized Microsoft Excel Software in quantitative data collation and encoding. MDRO admission screen audits were presented using descriptive statistics such as frequency, percentage, mean, median and mode. Standard deviation was used to show data variability. T-test was utilized to test for a significant difference in the overall compliance rate before and after the multi-modal interventions were introduced. <em>T</em>-test is a parametric procedure of testing the difference in group means. The level of significance was set at <em>P < 0.05 </em>to identify a significant difference in the compliance rate.</p> <p><strong>Results: </strong>Results show that the MDRO admission screen compliance rate in the two departments were variable. The average compliance rate from October, 2012 to November, 2014 in the elective surgical department is 85.75% compared to 75.91% from December, 2010 to September, 2012 (Table 1).</p> <p><strong>Table 1.</strong>MDRO admission screen compliance at the elective surgical department</p> <div align="center"> <table border="0" cellspacing="0" cellpadding="0"> <tbody> <tr> <td colspan="4" valign="bottom" nowrap="nowrap" width="596"> <p align="center"><strong>Surgical Department</strong></p> </td> </tr> <tr> <td colspan="2" valign="bottom" nowrap="nowrap" width="271"> <p align="center">Before<sup>*</sup></p> </td> <td colspan="2" valign="bottom" nowrap="nowrap" width="325"> <p align="center">After<sup>**</sup></p> </td> </tr> <tr> <td valign="bottom" nowrap="nowrap" width="196"> <p>Mean</p> </td> <td valign="bottom" nowrap="nowrap" width="76"> <p align="right">75.90909091</p> </td> <td valign="bottom" nowrap="nowrap" width="227"> <p> Mean</p> </td> <td valign="bottom" nowrap="nowrap" width="98"> <p align="right">85.75</p> </td> </tr> <tr> <td valign="bottom" nowrap="nowrap" width="196"> <p>Number of patient records audited</p> </td> <td valign="bottom" nowrap="nowrap" width="76"> <p align="right">1670</p> </td> <td valign="bottom" nowrap="nowrap" width="227"> <p> Number of patient records audited</p> </td> <td valign="bottom" nowrap="nowrap" width="98"> <p align="right">2058</p> </td> </tr> <tr> <td valign="bottom" nowrap="nowrap" width="196"> <p>Number of monthly audits completed</p> </td> <td valign="bottom" nowrap="nowrap" width="76"> <p align="right">22</p> </td> <td valign="bottom" nowrap="nowrap" width="227"> <p> Number of monthly audits completed</p> </td> <td valign="bottom" nowrap="nowrap" width="98"> <p align="right">24</p> </td> </tr> </tbody> </table> </div> <p><sup>*</sup>Period coverage is from December, 2010 to September, 2012</p> <p><sup>**</sup>Period coverage is from October, 2012 to November, 2014</p> <p>In the care of older people department, results show that the MDRO admission screen compliance was also variable. The average MDRO admission screen compliance rate from August, 2013 to October, 2014 is 96.80% compared to 83.84% from December, 2010 to July 2013 (Table 2).</p> <p>Variability in the compliance may be due to patient acuity, staff mix, thorough history-taking of the patient, review of previous admissions, completeness of handover, staff knowledge of the organisational policy, staff motivation to adhere to organisational policy and availability of staff support.</p> <p><strong>Table 2.</strong>MDRO admission screen compliance at the health of older people department</p> <div align="center"> <table border="0" cellspacing="0" cellpadding="0"> <tbody> <tr> <td colspan="4" valign="bottom" nowrap="nowrap" width="603"> <p align="center"><strong>Health of Older People</strong></p> </td> </tr> <tr> <td colspan="2" valign="bottom" nowrap="nowrap" width="273"> <p align="center">Before<sup>***</sup></p> </td> <td colspan="2" valign="bottom" nowrap="nowrap" width="329"> <p align="center">After<sup>****</sup></p> </td> </tr> <tr> <td valign="bottom" nowrap="nowrap" width="203"> <p>Mean</p> </td> <td valign="bottom" nowrap="nowrap" width="70"> <p align="right">83.83870968</p> </td> <td valign="bottom" nowrap="nowrap" width="234"> <p>Mean</p> </td> <td valign="bottom" nowrap="nowrap" width="95"> <p align="right">96.8</p> </td> </tr> <tr> <td valign="bottom" nowrap="nowrap" width="203"> <p>Number of patient records audited</p> </td> <td valign="bottom" nowrap="nowrap" width="70"> <p align="right">2599</p> </td> <td valign="bottom" nowrap="nowrap" width="234"> <p>Number of patient records audited</p> </td> <td valign="bottom" nowrap="nowrap" width="95"> <p align="right">1452</p> </td> </tr> <tr> <td valign="bottom" nowrap="nowrap" width="203"> <p>Number of monthly audits completed</p> </td> <td valign="bottom" nowrap="nowrap" width="70"> <p align="right">31</p> </td> <td valign="bottom" nowrap="nowrap" width="234"> <p>Number of monthly audits completed</p> </td> <td valign="bottom" nowrap="nowrap" width="95"> <p align="right">15</p> </td> </tr> </tbody> </table> </div> <p><sup> </sup></p> <p><sup>*** </sup>Period coverage is from December, 2010 to July 2013</p> <p><sup>****</sup>Period coverage is from August, 2013 to October, 2014</p> <p>Statistical analysis of the overall MDRO admission screening compliance rate before and after the interventions showed a significant difference (<em>P < 0.05) </em>in the compliance rate in both departments.<em> </em>A two-sample T-test with unequal variance was utilized in the statistical analysis given the variability in the screening rate and count. Table 3 provides a summary of the statistical testing done. The last column shows that there is a significant difference in the compliance rate in the surgical department (P < 0.009) and the care of older people department (P < 0.00003)</p> <p> <strong>Table 3.</strong>Descriptive summary of statistical testing of the MDRO admission screen compliance rate before and after the interventions</p> <table border="1" cellspacing="0" cellpadding="0"> <tbody> <tr> <td rowspan="2" valign="top" width="151"> <p align="center"><strong>Departments</strong></p> </td> <td colspan="2" valign="top" width="180"> <p align="center"><strong>Before</strong></p> </td> <td colspan="2" valign="top" width="172"> <p align="center"><strong>After</strong></p> </td> <td rowspan="2" valign="top" width="98"> <p align="center"><strong>T-Test</strong></p> <p align="center"> (<em>P </em>< 0.05)</p> </td> </tr> <tr> <td valign="top" width="81"> <p align="center">Number of Audits</p> </td> <td valign="top" width="98"> <p align="center">Mean Compliance Rate</p> </td> <td valign="top" width="80"> <p align="center">Number of Audits</p> </td> <td valign="top" width="92"> <p align="center">Mean Compliance Rate</p> </td> </tr> <tr> <td valign="top" width="151"> <p>Surgical Department</p> </td> <td valign="top" width="81"> <p align="center">22</p> </td> <td valign="top" width="98"> <p align="center">75.91</p> </td> <td valign="top" width="80"> <p align="center">24</p> </td> <td valign="top" width="92"> <p align="center">85.75</p> </td> <td valign="top" width="98"> <p align="center">0.009324379</p> </td> </tr> <tr> <td valign="top" width="151"> <p>Care of Older People</p> </td> <td valign="top" width="81"> <p align="center">31</p> </td> <td valign="top" width="98"> <p align="center">83.84</p> </td> <td valign="top" width="80"> <p align="center">15</p> </td> <td valign="top" width="92"> <p align="center">96.80</p> </td> <td valign="top" width="98"> <p align="center">0.000036141</p> </td> </tr> </tbody> </table> <p><strong>Conclusion: </strong>The multi-modal interventions addressed to nurses had a significant impact on the MDRO admission screening compliance rate in various departments of a tertiary public hospital. While various factors may affect the staff MDRO admission screening compliance rate, the rate could be kept at a high level through regular audits, regular reporting of audit result, regular education sessions and consistent staff encouragement.</p>en
dc.subjectMDRO Admission Screenen
dc.subjectMulti-modal Interventionsen
dc.subjectNursing Staff Screening Complianceen
dc.date.available2017-06-22T20:40:15Z-
dc.date.issued2017-06-22-
dc.date.accessioned2017-06-22T20:40:15Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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