patient safety & quality
By J. Hudson Garrett Jr., PhD, MSN, MPH, MBA, FNP-BC, IP-BC, PLNC, CFER, AS-BC, VA-BC, MSL-BC, CPPS, CPHQ, NREMT,
CADS, FACDONA, FAAPM, FNAP
A Time for Collaboration:
A Needed Paradigm
Shift in Interprofessional
Communication to Reduce
Healthcare-Associated
Infections
COVID-19 has exposed many vulnerabilities in our healthcare
delivery system, most notably issues with availability of
Personal Protective Equipment and compliance with established
core practices in infection prevention and control, but there are
other major opportunities to improve safety. Patients and microbes
really know no formal boundaries, and therefore our efforts as a
healthcare team must be agile and very comprehensive in nature.
Healthcare facilities such as longterm
care facilities and acute-care hospitals
have been dramatically impacted by
Patients and
microbes really
know no formal
boundaries,
and therefore
our efforts as
a healthcare
team must be
agile and very
comprehensive in
nature.
surges of COVID-19 patients, and this
can create communication challenges
even amongst the top-rated healthcare
facilities in the country. These ongoing
challenges require a collaborative,
transparent, and comprehensive
approach to ensuring that all patient
information is handed off during every
patient transfer event.
Now more than ever, healthcare
providers must take the necessary time
to clearly communicate all clinical issues
relevant to the patient’s clinical care.
Clinical patient care may be delivered by
a wide variety of stakeholders such as
registered nurses, providers (physicians,
nurse practitioners, clinical nurse
specialists, and physician assistants),
nursing technicians, and emergency medical services professionals.
Each of these healthcare team members is exposed to
potential infectious disease threats and must be fully integrated
in the clinical care of the patient to optimize the clinical
outcomes of each patient as well as maintain personal safety.
During the COVID-19 pandemic, interfacility transfers,
especially from acute-care hospitals to long-term care facilities
are quite common and require transportation by skilled emergency
medical services (EMS) providers. During these transfers,
EMS providers are often faced with unique infection control
challenges such a small, cramped patient-care environment,
limited ventilation capabilities, and ongoing shortages of
personal protective equipment (PPE). It is important for acutecare
nursing professionals to fully communicate the entire
“clinical picture” of the patient, especially infectious diseases
that might threaten the health and safety of other healthcare
providers as well as patients in the receiving facility.
Here are a few best practices to break down barriers in
patient handoffs to improve safety and reduce the risk for
occupational exposure:
1. Review ALL isolation precautions and rationale for these
precautions with any member of the healthcare team
that will be taking over patient care.
2. Ensure that all necessary PPE is available to ensure compliance
with Centers for Disease Control and Prevention
(CDC) guidelines and recommendations.
3. The sending facility must communicate with the receiving
facility all current infection control and infectious diseases
issues associated with the patient prior to transferring
the patient.
4. If EMS professionals must transport a patient wearing PPE,
then sending hospitals should provide a “clean escort”
for the EMS crew all the way to the transport unit to
minimize potential contamination during the movement
of the patient out of the sending facility.
5. Before transferring a patient, the sending facility must
confirm that the receiving facility has all the necessary
capabilities (e.g. trained staff, PPE, laboratory testing etc.)
to properly care for the patient’s infectious disease (s).
6. If transporting an patient that has an active infectious
disease requiring isolation precautions, carefully follow
all CDC recommendations to minimize exposure to
others and potential occupational transmission to the
healthcare providers transporting the patient.
Pandemics and outbreaks always present healthcare
providers and facilities with difficult challenges, but we have
the capability to stop infection transmission in its tracks if we
focus on adoption of core practices of infection prevention
and control such as hand hygiene, environmental surface
disinfection, and the appropriate use of PPE combined with
enhanced communication regarding patient clinical care and
needs. There are widely available evidence-based communications
tools and programs such as TeamSTEPPS and Just Culture
that can enhance interprofessional healthcare communication
and break down silos. Together, we can significantly reduce
the risk of transmission of infectious diseases and ensure
workplace safety.
J. Hudson Garrett Jr., PhD, MSN, MPH, MBA, FNP-BC,
IP-BC, PLNC, CFER, AS-BC, VA-BC, MSL-BC, CPPS, CPHQ,
NREMT, CADS, FACDONA, FAAPM, FNAP, is the president
and CEO of Community Health Associates, LLC, and also is
an adjunct assistant professor of medicine in the Division of
Infectious Diseases at the University of Louisville School of
Medicine. Garrett is a frequent lecturer globally on patient
safety, infectious diseases, and medical device reprocessing
and safety. He may be reached at: Hudson.garrett@
chaassociates.com
38 august 2020 • www.healthcarehygienemagazine.com