Re: Bed charts and contact precautions

13/08/2019 at 2:30 pm #75708 Quote

Thomson, Rachel EA (THS)

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Author:
Thomson, Rachel EA (THS)

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Hi there,

We have discussed this quite actively on a number of occasions in our organisation. On regular wards we require the bedside charts to be outside the patient room when the patient is under TBP. Increasingly many wards are placing the bedside charts in a folder outside the patient room regardless of the requirement for TBP or not. In ICU, however, we have made provision for the bedside charts to be included in the bedspace. A summary of our advice is below.

* Management of patient charts and patient notes (DCCM)
* After discussion it was agreed that the most appropriate risk management strategy for the RHH DCCM is to retain the patient charts and notes within the patient cubicle/room on the approved trolley with a focus on the following:
* appropriate hand hygiene including consideration for the appropriate handling of notes and charts (all patients)
* reinforcing the use of PPE when entering the patient cubicle/room (for those patients under transmission based precautions)
* We accept that the retention of patient charts and notes within the patient cubicle/room, particularly for those patients managed under transmission based precautions, is not consistent with the NHMRC Australian Guidelines for the Prevention and Control of Healthcare but the key considerations involved in making this decision were as follows:
* low acquisition rate of MROs (including Clostridium difficile infection) within the RHH DCCM whilst adhering to the abovementioned protocol over many years
* risk management principles relating to minimising environmental contamination such as the risk of staff exiting the cubicle/room wearing contaminated PPE versus the risk of retaining notes in the cubicle/room

Interestingly, if you look at the HH Australia training videos this approach is also supported in the video of the nurse in DCCM where the nurse touches a drain having left the bedside charts and no Moment 1 is required as the charts are considered to be in the patient care zone.
https://www.hha.org.au/images/hha/videos/videoclips/selfEducation/028_SelfEducation.wmv

Kind regards
Rachel
..
Rachel Thomson
Nurse Unit Manager

Infection Prevention & Control Unit
Royal Hobart Hospital
Tasmanian Health Organisation-South

: 03 6166 7882/ 6166 8658

Mobile: 0400 718 574
Email: rachel.thomson@ths.tas.gov.au

Level 4, H Block
48 Liverpool Street
Hobart, 7000

From: ACIPC Infexion Connexion On Behalf Of Michael Wishart
Sent: Tuesday, 13 August 2019 1:06 PM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Bed charts and contact precautions

Thanks Helen

We cant place lockers outside the rooms, as it creates traffic issues in our corridors. We had to move away from trolleys in the corridors for this reason (we use door hangers for PPE now).

The other thing to consider is at least some of our NUMs claim there is a clinical risk of not having the actual order at the bedside when administering the medication, and so they require their staff to take the medication chart into the room. Wouldnt matter where we dispensed it then, the chart would still need to go into the room.

In my mind this is a bit of a MY risk is bigger that YOUR risk situation, and I have to say as long as we reinforce good hand hygiene and cleaning of items removed from the room, they are possibly correct.

Has anyone faced this argument previously? How did you overcome it?

Thanks
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

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From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Helen Roberts
Sent: Tuesday, 13 August 2019 9:26 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: Re: [ACIPC_Infexion_Connexion] Bed charts and contact precautions

Hi Michael,

We place a infection control locker outside the precaution room. (They used to be the patients bedside lockers but we upgrade and kept the old ones for infection control)
It has 5 drawers in it.
We place all the PPE in the bottom drawers and medication are locked inside the top two drawer.
Medications are placed in medication cup outside room.
Nurse places a patient identification label on her blue gown so that she can still do her medication checks on entry into patients room.
Nurse carries the key.
This help solve the issues that you have outlined below.

Hope this helps,
Kind regards,
Helen

Helen Roberts
Infection Control
P:
07 4646 3106
|
F:
07 4633 7602
E:
robertsh@sath.org.au
|
W:
http://www.sath.org.au
Post:
PO Box 263, Toowoomba, QLD 4350
Address:
280 North St, Toowoomba, QLD 4350
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From: ACIPC Infexion Connexion <ACIPCLIST@ACIPC.ORG.AU> On Behalf Of Michael Wishart
Sent: Tuesday, 13 August 2019 8:56 AM
To: ACIPCLIST@ACIPC.ORG.AU
Subject: [ACIPC_Infexion_Connexion] Bed charts and contact precautions

Hi all

How do you manage bed charts under contact precautions?

Looking for some advice, as this has been an ongoing issue here for many years, and the recommendation in the guidelines has not changed in the latest version (2019), viz:

Other points relevant to patient placement include the following:

keep patient notes outside the room

keep patient bedside charts outside the room

disinfect hands upon leaving room and after writing in the chart

The issue is that many of our nurse unit managers (NUMs) require the medication and observation records to be at the bedside when medications are given or observations are taken. I know in some hospitals this will involve a second staff member standing at the door recording or verifying medication orders, but in reality in the private sector this is not resourced, so is not possible. The NUMs argue that there is a higher clinical risk of medication or documentation error than there is from infection transmission risk.

Has this been identified in other facilities, and if so, how do you manage this? We have been allowing nursing staff to take the bed chart into the room for medications and observations, then wipe it over on taking it back out of the room. Obviously the paper charts themselves cannot be wiped over. Generally we try to keep the bed charts outside of the rooms outside of these activities.

Any help or advice would be gratefully accepted.

Cheers
Michael

Michael Wishart | Infection Control Coordinator, CICP-E

St Vincents Private Hospital Northside | 627 Rode Road CHERMSIDE QLD 4032
T +61 7 3326 3068 | F +61 7 3607 2226
E michael.wishart@svha.org.au |
W https://www.svphn.org.au

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