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Exploring Infection Control with Participatory Visual Research Methods: A Restorative Approach
BC Patient Safety & Quality Council Quality Forum 2013: Inspiring Improvement
Patricia Marck RN PhD, Professor & Director, School of Nursing
Associate Dean, Faculty of Health & Social Development
University of British Columbia Okanagan Campus
Copyright: ES Higgs PI
University of Victoria
Copyright: PB Marck PI
UBC Okanagan
ACKNOWLEDGMENTS
• RESEARCH TEAM
o P Marck RN PhD (PI)
o S Woolsey RN BScN ICP, Alberta Health Services (C-PI)
o M Joffe MD, FRCP, Senior Medical Director, Infection Prevention & Control, Alberta Health Services & Professor, Faculty of Medicine, University of Alberta (CI)
o M Howell BScN Student (Hons), University of Alberta Faculty of Nursing, CIHR Summer Student (P Marck Supervisor)
o S Lupul BScN, Clinical Nurse Educator, Alberta Health Services (CI)
o G Davis BScN, Patient Care Manager, Alberta Health Services (CI)
• FUNDING o Royal Alexandra Hospital Foundation Nursing Research Fund
o Canadian Nurses Foundation Nursing Care Partnership Fund
o Canadian Institutes of Health Research
HIAs: Our Spreading Problem…
• Healthcare-associated infections continue to cause increased morbidity, longer length of stay and rising costs to health systems across Canada and the world
• We know that many practitioners, patients, and visitors do not consistently follow even the simplest preventive measures (eg. adequate hand hygiene)
• IP&C competes with every other health care problem for sustained attention and sufficient resources
• Health systems exhibit attention deficit syndrome and repeated failures to implement and monitor the outcomes of evidence-based decision-making
• We often ignore good ideas and keep doing things that don’t work
We asked: What Can We Learn From Systems Management in Other Fields?
Ecological restoration is the study and repair of ecosystems that have been degraded, damaged, or destroyed, with specific attention to the health and resilience, integrity, and sustainability of the places we share Society for Ecological Restoration, 2004 http://www.ser.org/
Assessing forest ecology in the Rocky Mountains near Jasper National Park. Culture, Ecology and Restoration in Jasper National Park. ES Higgs PI, Parks Canada 1996 – 1998 ($70,000) & 1996 – 1997 ($20,000)
Restorative Research in Health Systems
PLACE ETHIC: Work with community members to understand and respect the history, culture, practices, and resources of the place they inhabit
CITIZEN SCIENCE: Use photographic research methods, citizen forums, historical research, field observations, and other methods to develop a comprehensive picture of conditions over time
ENGAGED PRACTICE: Use restorative practices like self-monitoring and correction in our daily work to link research, policy & practice together
ADAPTIVE LEARNING: Use what we learn to re-imagine and re-create better ways to treat each other and the places we share
*Talbot Lake,
Jasper National Park, 1915
*Talbot Lake,
Jasper National Park, 1998
*Higgs ES. ( 2003). Nature by Design.
Boston, MA: MIT Press 2003.
#Marck, P.B., Higgs, E.S., Vieira, ER., & Hagedorn, K. (2008). Through the eyes of practitioners: Adapting visual research methods from ecological restoration to integrate the ethics, science, and practice of safety in health care. Health Care Systems Ergonomics & Patient Safety International Conference Papers, 2008. http://www.heps2008.org/abstract/data/PDF/Marck_Patricia.pdf
January
2009
•Develop Preliminary Issues List in Focus Group 1
April 2009
•Practitioner-Led Photo Walkabout with Photo Narration
January 2010
•Photo Elicitation Focus Groups with Unit Staff
February 2011
•Formulate & communicate recommendations for improvements
What We Did
Publish & Plan with Decision-
Makers &
Design & Implement
Interventions
Spring - Fall 2011
Data Analysis
Data Analysis
Data Analysis
What We Found: Clean/Dirty Storage Workarounds
Photo 36: Clean/Contaminatedd
“So there is no system for actually checking off if these things have been cleaned, and who cleaned them and when they were cleaned.”
P3_FG2A_27Jan10
Copyright: PB Marck PI
UBC Okanagan
What We Found: Signage Workarounds
Photo 15/17: Signage
“Okay that’s a problem because they’re using that, and the next thing you know the doctors are putting their dirty gowns right on top of the clean ones”
P3_FG2A_27Jan10
Copyright: PB Marck PI
UBC Okanagan
Copyright: PB Marck PI
UBC Okanagan
What We Found: Isolation Cart Workaround
Photo 18: Isolation Carts
“And they’re full of junk that people don’t use and stuff that shouldn’t be there” P3_FG2A_27Jan2010
Copyright: PB Marck PI
UBC Okanagan
What We Found: Long Arms Syndrome
Photo 50: Equipment/Supplies
“A lot of times the cuffs are so loose on the gowns, that you put on your gloves over top. You reach out to wash a patient or something, the next thing you know your sleeves are up here, and your gloves
are down there, and there’s a big gap.” P3_FG2A_27Jan10
Copyright: PB Marck PI
UBC Okanagan
What We Found: Storage Workaround for Modern Problems
Photo 56: Vernacare Shower Room Storage
“So who knew you had to have 49 boxes full of stuff?” P3_FG2B_24Feb2010
Copyright: PB Marck PI
UBC Okanagan
What We Found: Workaround - Bugs on Call
Photo 59/60: Call System Workaround
“It’s been there a long time. A long, long time.” P3_FG2B_24Feb10
Copyright: PB Marck PI
UBC Okanagan
Copyright: PB Marck PI
UBC Okanagan
What We Found: Making Do - Equipment & Supplies
Photo 72: Computer Chair
“Half of the mattresses on some units look like that.” P3_FG2B_24Feb10
Copyright: PB Marck PI
UBC Okanagan
Doing Better …. *Recommendations & Improvements to Date
• *specific equipment and environmental modifications
• *redesign of several problem processes and practices
• *incorporate regular photo walkabouts with feedback into quarterly workplace safety inspections [BUT ICP has used PWs to document and track priority improvements on 5 units during an outbreak]
• *design larger scale intervention research [ VA grant application under review (A Sales PI) & 2 units piloted at TOH (C. Backman PI) ]
• Spread to places that are ready to adapt
New Sink in Med Room
Post Photo #5
Functional Shower Stall
Copyright: PB Marck PI
UBC Okanagan
Copyright: PB Marck PI
UBC Okanagan
Post Photo #2 Post Photo #3
Wipeable Call Bell Cord
Copyright: PB Marck PI
UBC Okanagan
Post Photo #6
Additional Shelving in Tub Room
Copyright: PB Marck PI
UBC Okanagan
Post Photo #7
Protected Clean Storage
Copyright: PB Marck PI
UBC Okanagan
Post Photo #4
New Chairs with Intact Upholstery
Copyright: PB Marck PI
UBC Okanagan
Post Photo # 10
Wall Repairs & New Paint
Wipeable Corkboard
Copyright: PB Marck PI
UBC Okanagan
Post Photo # 12
Nosocomial MRSA and VRE Cases
Study Unit
Renovation Photo Walkabout
Focus Group
Ca
se
s
• Parke, B., Hunter, K., Strain, L., Marck, PB, & Waugh, E. (in press). Facilitators and Barriers to Safe Emergency Department Transitions for Community Dwelling Older People with Dementia and their Caregivers: A Social Ecological Study. International Journal of Nursing Studies. Alzheimers Society of Canada.
• Hansen-Ketchum, P., Marck, P., Reutter, L., & Halpenny, E. (2011). Strengthening access to restorative places: Findings from a participatory study on engaging with nature in the promotion of health. Health and Place 17 (2): 558 - 571.
• Backman, C., Marck, P.B., Krogman, N., Taylor, G. Sales, A., Roth, V.R. (2011)) Barriers and Bridges to Infection Prevention and Control: Results of a Case Study of a Canadian Surgical Unit. Canadian Journal of Infection Control 26 (4): 233-242.
• Backman, C., Marck, P.B., Krogman, N., Taylor, G., Sales, A.E., Roth, V., Bonten, M.J.M., Gigengack-Baars, A.C.M. (in press; accepted 09 Feb 2012). Barriers and bridges to infection prevention and control on a surgical unit at a Netherlands hospital and a Canadian hospital: A comparative case study analysis. BMJ Open. 2:e000511 doi: 10.1136/bmjopen-2011=00511
• Backman, C, Taylor, G, Sales, A & Marck, PB (2011). An Integrative Review of Infection Prevention and Control Programs for Multidrug-Resistant Organisms in Acute Care Hospitals: A Socio-Ecological Perspective. American Journal of Infection Control 39 (5): 368-78.
• Marck, PB, Lang, A, Macdonald, M, Griffin, M, Easty, A, Corsini-Munt, S (2010). Safety in Home Care: A Research Protocol for Studying Medication Management. Implementation Science 45:3 at http://www.implementationscience.com/content/5/1/43
• Raduenz, AC, Hoffmann, P, Radünz, V, Teresinha M. Dal Sasso, G, Alves Maliska, IC, Marck, PB (2010). Nursing care and patient safety: Visualizing the organization, storage and distribution of medication with photographic research methods. Revista Latino-Americana de Enfermagem/Latin American Journal of Nursing 18 (6).
Some References
• Marck, P.B., Higgs, E.S., Vieira, ER., & Hagedorn, K. (2008). Through the eyes of practitioners: Adapting visual research methods from ecological restoration to integrate the ethics, science, and
practice of safety in health care. Health Care Systems Ergonomics & Patient Safety International Conference Papers, 2008. At http://www.heps2008.org/abstract/data/PDF/Marck_Patricia.pdf
• Marck, PB, Kwan, JA, Preville, B, Reynes, M, Morgan-Eckley, W, Versluys, R, Chivers, L, O’Brien, B, van der zalm, J, Swankhuizen, M & Majumdar, SR. (2006). Building Safer Systems by ecological design: Using restoration science to develop a medication safety intervention. Quality and Safety in Health Care 15: 92-97 .
• Marck, PB. (2006). Discourse – Field notes from research and restoration in the backcountry of modern health care. Canadian Journal of Nursing Research Focus on Safety and Risk 38(2): 11 – 23
• Marck, PB. (2004). Ethics in hard places: The ecology of safer systems in modern health care. Invited article for Health Ethics Today 14(1): 2-5.
• Backman C, Zoutman DE, Marck PB. (2008). An integrative review on the current evidence on the relationship between hand hygiene interventions and the incidence of healthcare associated infections. American Journal of Infection Control 36(5):333-348.
• Marck PB, Higgs, ES, Edwards, N, Molzahn, A (2006). Generating Adaptive Health Systems: An Emerging Framework of Research and Restoration for a Safer World. At http://www.nursing.ualberta.ca/SaferSystems/projects.htm
• Brites, ADS, Cabral, IE & Agular, RCB (2010). Analise imagetica da producao de residuos derivados do uso da insulinoterapia infantile: uma contribuuicao da enfermagem. Revista de Pequisa: Cuidado e Fundamental Online 9/10 (2): 305 – 308.
•
More References
THANK YOU Patricia Marck
250-807-8417
E Higgs (PI) & S Campbell, D Cruden, I MacLaren, J Rhemtulla Rocky Mountain Repeat Photography Project – Jasper research team. Foothills Model Forest, NSERC, SSHRC, Parks Canada & University of Alberta. http://bridgland.sunsite.ualberta.ca/jasper/index.html
