Joint HQIC 4-Part Series: Workplace Violence Prevention

Prepared by the HQIC collaborative group (IPRO, Alliant, Compass, and Telligen)

Defined as “violent acts, including physical assaults and threats of assault, directed toward persons at work or on duty,” workplace violence (WPV) is a growing concern.1 An April 2020 Bureau of Labor Statistics Fact Sheet revealed that healthcare workers accounted for 73% of all nonfatal workplace injuries and illnesses due to violence in 2018. This number has been steadily growing since tracking these specific events began in 2011.2

Now, it is time to act!
Why Now? According to OSHA (2016)3, workplace violence rates among healthcare workers between 1993 and 2009 were 20% higher than that for other industries. The COVID-19 pandemic increased the factors leading to workplace violence, such as staffing shortages leading to a decrease in the amount of staffed (available) beds, a high workload causing stressed staff, and frustrated patients and families who feel as though their needs are not being met. A memo to State Survey Agency Directors dated November 28, 2022, states CMS’ continued enforcement of regulatory expectations that patients and staff have an environment that prioritizes their safety while effectively delivering healthcare.2 To effectively maintain a safe environment for healthcare delivery, hospitals can develop policies and procedures to mitigate the risk of workplace violence.


The HQIC collaborative group consisting of Alliant, Compass, IPRO and Telligen appreciates your interest in the Workplace Violence Prevention series. Access event materials here:

Part 1:  Workplace Violence Prevention (WPV): Best Practices for Safer Care

  • WPV is defined as an act or threat occurring at the workplace from physical and verbal assaults.
  • 2020 Bureau of Labor Fact Sheet found that health care workers accounted for 73% of all nonfatal workplace injuries and illness due to violence in 2018.
  • WPV prevention takes more than security.  Requires commitment from organizational leadership, interdisciplinary, collaboration and allocation of resources.
  • It is an investment in our workforce not a cost.

SLIDES.

Part 2:   Key Components of an Effective Workplace Violence Prevention Program: Leadership Engagement and Communication

  • Workplace violence is more than a written Policy, it is a series of action steps that serve as a foundational guide for educating staff and acting quickly in an emergency.
  • Communication is critical. WPV prevention policies must be communicated to patients and families in a way that is non-threatening, clear, concise and at the appropriate reading level.   
  • The way an organization addresses WPV AFTER an event (debriefing, counseling, performance improvement action plan) is just as important as how your organization responds during the event.
  • Leadership is a partnership. At the heart of all good policies, procedure, and programs is good two-way communication. Find what’s missing by including all perspectives.

SLIDES.

Part 3:   Uncovering Unconscious Bias for Safer Healthcare Interactions

  • Unconscious bias affects healthcare interactions and can lead to poor, inequitable outcomes.
  • Self-reflection is crucial for bias identification and improvement.
  • De-escalation must be a priority to promote safe, healing environments.
  • Organizations must implement training, diversity initiatives, reporting mechanisms, and community engagement to address and mitigate bias in healthcare.

SLIDES.

Collection:  Antibiotic Stewardship Guidelines and Algorithms Compendium

Compiled by IPRO HQIC

Urinary Tract InfectionGuidelines

Guidelines for Treatment of Urinary Tract Infections Michigan Hospital Medicine Safety (HMS) Consortium

Urinary Tract Infection and Asymptomatic Bacteriuria Guidance Nebraska Medicine

URINARY TRACT INFECTIONS IN ADULTS Michigan Medicine, University of Michigan

Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections NIH

UTI References

International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update. Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases 

Topic: Urinary Tract Infection (UTI) AHRQ

UTI Toolkit

Toolkit for Reducing CAUTI in Hospitals AHRQ

Appendix K. Infographic Poster on CAUTI Prevention (ahrq.gov)

UTI Clinical Pearls

Single-Dose Aminoglycoside for Cystitis: An Oldie but Goodie – KY Antimicrobial Stewardship Innovation Consortium

Staphylococcus aureus in a urine culture – KY Antimicrobial Stewardship Innovation Consortium

Aminopenicillins for Enterococcal Cystitis: Teaching an Old Dog New Tricks – KY Antimicrobial Stewardship Innovation Consortium

Skin and Soft Tissue Infection

Cellulitis: A Review (JAMA)

Cellulitis: A Review (NIH)

Cellulitis: Information for Clinicians (CDC)

IDSA Skin & Soft Tissue guidelines 2014

Skin and Soft Tissue Infections: Treatment Guidance Jasmine R Marcelin MD, Trevor Van Schooneveld MD, Scott Bergman PharmD Reviewed by: Mark E Rupp MD, M. Salman Ashraf MBBS

AAFP patient education materials

UCSF Medical Center Guideline for the Management of Suspected Skin and Soft Tissue Infections in Adults Original Author(s): Jennifer S. Mulliken, MD and Sarah M. Doernberg, MD, MAS

SHC Clinical Guideline: Outpatient Management of Skin and Soft Tissue Infections

Prophylaxis/SSI

Strategies to prevent surgical site infections in acute-care hospitals: 2022 Update with essential practices. 

Additional guidelines (all adapted from consensus guidelines):

ASHP Clinical Practice Guidelines for Prophylaxis in Surgery.

Stanford Health Care- Surgical Prophylaxis Guidelines

University of Michigan- Surgical Prophylaxis Guidelines

University of California San Francisco- Surgical Prophylaxis Guidelines

ICHE Compendium 2022- Updated Surgical Site Infection Prevention Compendium

IV to PO Conversion

Article – Intravenous-to-Oral Switch Therapy: Overview, Antibiotics, Antidepressants (medscape.com)

Article – (2023) – Switching patients from IV to oral antimicrobials – The Pharmaceutical Journal (pharmaceutical-journal.com) (from the UK)

Guidelines

Galway Antimicrobial Prescribing Policy / Guidelines (GAPP) – Galway: GAPP (megsupporttools.com)

 (2018) Intravenous to Oral Conversion for Antimicrobials (northernhealth.ca)

SHC-IV-to-PO-Interchange-Protocol.pdf (stanford.edu)

A Resource To Help With Changing From IV To PO Antibiotics (idstewardship.com)

Public Health Ontario: https://www.publichealthontario.ca/-/media/documents/A/2016/asp-iv-oral-conversion.pdf

Community Acquired Pneumonia- Updated Recommendations ATS and IDSA 2020

ATS/IDSA Guidelines for Diagnosis and Treatment of Adults with Community Acquired Pneumonia 2019

C. difficile

Clinical-Pearl-CDI-Risk-2.8.23.pdf (kymdro.org)

CDI Prevention Strategies- https://www.cdc.gov/cdiff/clinicians/cdi-prevention-strategies.html

MN Department of Health C difficile guidelines  https://www.health.state.mn.us/diseases/cdiff/hcp/guidelines.html

UC Davis Guidelines 2021  https://health.ucdavis.edu/antibiotic-stewardship/pdfs/cdi_tx_ucd.pdf

University of Nebraska  2021 https://www.unmc.edu/intmed/_documents/id/asp/clinicpath-cdi_final.pdf

UNC Medical Center 2022  https://www.med.unc.edu/pediatrics/cccp/wp-content/uploads/sites/1156/gravity_forms/1-c06e424ddddee8826f29e1bc5926a251/2022/11/CASP-UNCMC-CDI-Guideline_FINAL.pdf

AHRQ  Best Practices in the Diagnosis and Treatment of C difficile 2019  

Management of C difficile in adults: review and comparison of IDSA/SHEA, ESCMID and ASID guidelines

IDSA C difficile clinical practice guidelines in adults: 2021 Update by SHEA/IDSA

April 18, 2023 LAN Event – Using TAP Strategy for HAI Reduction: CAUTI, CLABSI, C. diff, MRSA

Prepared by IPRO HQIC

Join us for a webinar featuring subject matter experts from the Centers for Disease Control and Prevention (CDC) to learn about a comprehensive strategy to reduce hospital acquired infections (HAI). The Targeted Assessment for Prevention (TAP) Strategy is a CDC-developed framework for quality improvement that uses data to drive interventions that will prevent healthcare-associated infections. The TAP strategy targets healthcare facilities and specific units within facilities that have a disproportionate burden of HAIs so that prevention efforts can be prioritized and implemented where they will have the greatest impact. Our speakers will discuss the latest updates in the strategy and tools, including adaptation for smaller facilities.

March 21, 2023, Joint HQIC LAN – Acute Pain Alternatives: The Impact of Avoiding Opioids on Hospital Delirium

Prepared by IPRO HQIC

Join us for this special presentation featuring real-world strategies for preventing hospital delirium! Delirium affects as many as 50% of hospitalized patients over the age of 65. Furthermore, delirium accounts for increased length of stay, hospital readmissions, emergency department visits and institutionalization of older adults. Delirium is often precipitated by opioid use for pain management. Don’t miss this discussion on alternatives, using an example of a successful hospital project. These initiatives will inspire you to take on delirium prevention at your facility!

Slides

Recording

February 28, 2023 Joint HQIC LAN – I Want to, I Just Don’t Know How: A Practical Guide for Advancing Health Equity

Prepared by IPRO HQIC

This session will highlight best practices and examples for
successfully implementing health equity strategies within hospital
settings. Rosa Abraha, MPH, Alliant HQIC’s health equity lead, will
address frequently asked questions from hospitals and engage in a
discussion with participants.

Slides

Recording

Surgical Site Infection Investigation Tool

Agency for Healthcare Research and Quality (AHRQ)

This tool will help your safety program team understand lapses in infection prevention processes that may have contributed to the surgical site infection case. It can help your team identify patterns and inconsistencies in practice, so you can more easily pinpoint opportunities for intervention.

WHO Global Guidelines for the Prevention of Surgical Site Infection

World Health Organization

The 2016 World Health Organization (WHO) Global guidelines for the prevention of surgical site infection (SSI) are evidence-based and unique in that they are the first global guidelines of this sort, are based on systematic reviews and present additional information in support of actions to improve practice. They were developed by international experts adhering to WHO’s Guideline Development Process and overall aim to achieve standardization.

AORN Comprehensive Surgical Checklist

AORN

The AORN Comprehensive Surgical Checklist can be downloaded and customized to meet a facility’s needs. The checklist includes key safety checks as outlined in the World Health Organization (WHO) Surgical Safety Checklist and The Joint Commission Universal Protocol. It is designed for use in all types of facilities (hospital ORs, ambulatory surgery settings, physician offices).