Impact of a Flow Chart To Determine Appropriate Placement of Patients with Resistant Organisms and/or Clostridium difficile at Time of Identification and Readmission

ISSUE: Due to various circumstances over a very short time period, all the full time nursing supervisors in an 180 bed acute care hospital, left their positions. The staff temporarily covering these positions was unfamiliar with the nuances of assigning beds to patients requiring isolation. Immediate action to ensure appropriate placement of patients was indicated. PROJECT: All the possible scenarios encountered at time of identification of a patient with a resistant organism, when Clostridium difficile (C diff) is suspected or confirmed, or when patients previously identified with these conditons are readmitted, were identified and described. Based on the policies and procedures of the facility, two colorful flow sheets, with step by step instructions for patient placement and screening in each of the the patient scenarios identified, was initiated. One flow sheet was dedicated to Methicillin-Resistant Staphyloccus aureus, Vancomycin-Resistant Enterococcus and other resistant organisms; the second flow sheet was dedicated to C diff. The flow sheets were placed back to back and laminated. Individual education of the flow sheets, for all staff covering the nursing supervisor position, was performed. Copies of the flow sheets were posted on the nursing units at the time of unit to unit inservicing of nursing staff. RESULTS: Following inservices, appropriate placement of patients on readmission returned to 98% (49/50 patients), from a low of 92% (54/59).Only patients meeting the policy definition for initiation of isolation, are placed on isolation. Precautions, for patients no longer requiring isolation, are discontinued on a more timely basis. Nursing supervisors, as well as the managers and staff on the nursing units are more familiar and compliant with the isolation policies as noted by the implementation of precautions and search for an appropriate bed, as soon as a positive lab result is called to the nursing units. Screening tests at readmission are initiated by the nursing staff more frequently. Round the clock calls to the Infection Control Practitioner re: patient placement have decreased from multiple calls daily, to a once in a while consultation. LESSONS LEARNED: Visual aids can decrease the disconnect between written policies and real world practices. Although a need for immediate education was identified, the time taken to provide a colorful flow chart for future reference, greatly enhanced the comprehension of policies. Increased policy compliance and patient safety have been documented.