Date of Award

Spring 6-2021

Scholarly Projects

Projects: SPU Access Only

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

Faculty Chair

Dr. Lena Hristova

Faculty Reader

Dr. Carol McFarland

Executive Summary

Body Fluid Exposure Management: Improving Provider Adherence to Clinical Practice Guidelines

EXECUTIVE SUMMARY

Background and Significance

About 385,000 people are exposed to blood or body fluids through percutaneous injuries in the United States each year (CDC, 2013). Healthcare and community workers with blood or body fluid exposures (BFE) require sensitive and timely care to prevent the possible transmission of bloodborne pathogens. Nonadherence to clinical practice guidelines (CPGs) by healthcare providers can lead to important missed steps that are time-sensitive, such as failing to start patients on prophylactic treatment within 72 hours of exposure, missed baseline labs and follow up care.

Problem and Purpose Statement

Adherence to CPGs diminishes when providers lack awareness, knowledge, resources, or structural support (Fisher et. al, 2016). Successfully implementing CPGs into practice involves finding strategies to overcome existing barriers. At a large acute care hospital, emergency department (ED) providers had varying levels of unfamiliarity and exposure to BFE guidelines. Tailored interventions catering to ED providers (e.g. physicians, residents, and advanced practitioners) were needed to help them correctly implement BFE procedures and reduce fallouts.

The purpose of this DNP project was to increase provider adherence to BFE guidelines by 1) revising the BFE procedures to a more accessible, user-friendly version and by 2) providing education sessions to raise awareness.

Methods

Part 1: Create a BFE clinical pathway (time: four months)

  • Participants: ED lead clinician, quality assurance nurse, ten ED providers
  • Process Measures: 15-min informal interview for revision feedback with a pre- and post-revision survey

Part 2: Raise awareness of the BFE clinical pathway (time: one day)

  • Participants: All ED providers
  • Dissemination Methods: flyers, launch email, zoom presentations for residents and faculty
  • Process Measures: number of a) emails sent and responses received, b) zoom attendees, c) pre-and post-presentation surveys completed

Outcome Measure: Percentage of BFE fallouts (# fallouts/total # BFE cases)

  • Fallout rate was compared between four weeks before and four weeks after Part 2 intervention

Results

Although the outcome measure did not demonstrate reduced fallouts, creating a BFE clinical pathway was an important step in process improvement. Developing a simple resource that was clearly presented, well organized, and easy to understand was met with positive feedback from providers. After review of the two post-intervention fallouts, the project lead identified the need to sustain efforts to raise knowledge and awareness regarding the BFE clinical pathway, and that education should be extended to all staff involved in any part of BFE management.

Sustainability

Previously, no structured communication or sustainable strategy existed around disseminating BFE guidelines and procedures. This DNP project delivered a training session to raise provider awareness and to educate providers on the BFE clinical pathway. However, a one-time training session was not enough to effect long-term change in provider adherence. The success of this DNP project lies in sustaining BFE education and dissemination. The DNP project deliverables were the creation of electronically accessible BFE clinical pathways and a PowerPoint presentation for future new hire and resident orientation sessions.

Implications for Nursing

Healthcare staff and community workers exposed to potentially infectious body fluids arrive to the ED in a state of high stress and anxiety. Such a moment is not a suitable time for providers to figure out how they should manage BFEs. Even if a resource is available, providers cannot adhere to that which they are unaware. Focusing on making ongoing efforts to increase provider awareness of BFE guidelines is important so that providers will know what is and where to access the resource they need at the point of care. By utilizing the BFE clinical pathways, providers can approach BFE cases in a standardized way to avoid missing important patient care procedures. In doing so, providers will be able to deliver better quality of care for exposed healthcare and community workers seeking medical attention.

References

Centers for Disease Control and Prevention. (2013). Blood/body fluid exposure option. Retrieved from https://www.cdc.gov/nhsn/pdfs/hps-manual/exposure/3-hps-exposure-options.pdf

Fischer, F., Lange, K., Klose, K., Greiner, W., & Kraemer, A. (2016). Barriers and strategies in guideline implementation--A scoping review. Healthcare (Basel, Switzerland), 4(3), 36. doi:10.3390/healthcare4030036

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