infection prevention
By Sylvia Garcia-Houchins , MBA , RN , CIC
Tracer Methodology : An Important Infection Control Tool for Identifying Risk
The tracer methodology is the process that Joint
Commission surveyors use to analyze a healthcare organization ’ s systems or processes for delivering safe , high-quality care . It is used to identify real and potential patient safety risks .”
Each infection prevention and control program within healthcare organizations across the nation is unique . All infection prevention programs should share similar foundation and structure , but each individual program is shaped by its healthcare organization ’ s unique culture , physical location ( s ), and staff . Additionally , each program contains various combinations of care treatment , services , supplies , products , and equipment .
It is the uniqueness and ever-evolving nature of each healthcare organization that validates the importance of periodically using The Joint Commission ’ s tracer methodology as a diagnostic tool . The tracer methodology is the process that Joint Commission surveyors use to analyze a healthcare organization ’ s systems or processes for delivering safe , high-quality care . It is used to identify real and potential patient safety risks .
By periodically using tracers , infection preventionists can not only monitor for compliance with set requirements ( checklist approach ) but can also use a broader review to identify and assess variations in processes and practices . Some variations are completely acceptable , while others are potentially dangerous and could put a healthcare organizations , staff , patients , and visitors at risk .
While using tracer methodology Joint Commission surveyors analyze processes by following an individual patient or resident through the healthcare organization ’ s care processes in the sequence experienced by that individual . The tracer methodology process may require visiting just one or multiple care settings to review the care rendered and the systems to support that patient ’ s care . As often witnessed during survey , tracer methodology helps identify varying level of risk – including some that pose an immediate threat to a patient ’ s health or safety and require immediate action to mitigate the risk .
An infection preventionist can use tracers to identify risks that may have resulted in a patient developing a healthcare-associated infection , to proactively identify risks that could result in an infection , or to review a newly implemented risk-reducing healthcare system .
For example , an infection preventionist could trace a patient with a central venous catheter ( central line , trace the care of a patient who developed a central line-related bloodstream infection or trace a system that has been implemented to decrease risk of central line infection .
By tracing the patient ’ s locations beginning with where the initial decision was made to insert a central line , to the location of insertion , to each location where it is used or accessed , infection preventionists can identify risks that could be acted upon to decrease the risk of central line related bloodstream infection for future patients . Important aspects of a good tracer process include :
● Invite variety . Do not follow the same tracer path every time
● Always keep an open mind when collecting tracer data
● Ask open ended questions that lead to a follow-up question or create a “ show me ?” moment
● Collect information that can be further explored – either immediately or when time allows
● Unless someone is at immediate risk , do not immediately begin remedying – the purpose is to collect tracer data
● Do not place blame during tracer processes
To better illustrate the tracer process , consider the basic example of an individual patient tracer utilized to trace a patient with a central line . Tracers can begin anywhere , but for this example scenario we first visit the healthcare facility ’ s oncology floor to identify a patient with a central line .
Then , we review her medical records . Medical records indicate the patient needed a central line for administration of chemotherapy , and subsequently , she had it inserted in the interventional radiology department . ( Patient education is documented by the clinic before the insertion , and by radiology before and after the procedure .) Further tracing shows that the patient ’ s central line has been accessed at the hospital ’ s infusion center emergency department , inpatient oncology unit , and general medicine unit as well as the hospital ’ s off-site infusion center .
Next step , the patient is interviewed . She explains that she was overwhelmed by her diagnosis and depends on her husband to remember what she is supposed to do . She remembers being told that she would need a central line placed for chemotherapy and subsequently had it inserted the next week in Radiology . Placement of a central line was not presented as an option , but as a mandatory step , if a patient is to receive chemotherapy . Staff explained the procedure and directed her not to shower until the insertion site was healed . She was given written instructions at