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The guiding light: Know, respect your limitations
Let bedside pros own their part of IP
By Patti Grant, RN, BSN, MS, CIC
If you have not encountered bewilderment surrounding responsibility lines with the implementation of new guidelines, regulations, or corporate-driven initiatives concerning infection prevention, you will.
An excellent example are the Institute for Healthcare Improvement (IHI) "bundles" that are solidly packaged and based on decades of Centers for Disease Control and Prevention guidelines and peer-reviewed publications. An exciting challenge presents when initiatives have nursing and medical-driven components wrapped into one effort: therein the black-and-white responsibility line can turn gray.
The blended hardwiring of infection prevention efforts to the bedside can feel like a benign, uphill journey only to find a large whirlpool at the top with a thin edge of solid ground. So, how do you make the most of that solid ground, avoid the whirlpool, and not topple back down the hill during planning for triumph over infection? The key is to champion others' expertise while sharing yours within their implementation teams. Infection preventionists (IPs) can no longer be the sole owners of multidisciplinary initiatives because they are not at the bedside where the action takes place. IPs cannot easily possess the continuous, intimate bedside know-how that makes or breaks the information required to develop a streamlined "point-of-service" operational plan.
Although this may sound ominous or negative, the message to be gleaned is safe and positive. What you might sense as a veiled setup for failure really is a shift in philosophy from those writing the guidelines and standards. For example, a program for reimbursement by the Centers for Medicare & Medicaid Services (CMS) involves "present-on-admission" criteria and is an example of a system designed to "force" health care professional collaboration, so that no one faction can be 100% responsible for completion strategies that affect outcomes.
The Joint Commission 2009 National Patient Safety Goals related to infection prevention include process measures and patient education, in addition to the traditional outcome surveillance. IPs are not the frontline caregivers to patients and their significant others, and the education regarding infection prevention related to central lines, surgery, and multidrug-resistant organisms (MDROs) are the domain of the bedside staff to implement and document. IPs verify that science messaging is correct and provide consultative support while others troubleshoot and pilot various approaches for success. The actual doing — the responsibility line within those programs — is a "treatment," just like administering complex medication, performing dressing changes, or explaining procedures: It is a bedside occurrence involving the primary caregiver.
Regardless of origin, I've kept myself on track when the responsibility line starts to blur with a new infection prevention endeavor, by reminding myself that IP's are "transmission-driven" rather than "treatment-driven." While the two concepts are not mutually exclusive, most IPs do not prescribe drugs, order/give treatments, or perform surgery; therefore, the IP should not be the solitary driving force behind the treatment-driven compliance apparatus of infection prevention endeavors beyond interpretation. Respect your limitations to uphold patient safety while bedside professionals, who provide the hands-on care, can create and own their successes. Let your guiding light for implementation of infection prevention strategies that involve shared bedside responsibility lines be to: