Year: 2014
Type: dissertation
Abstract: Clostridium difficile (C.difficile) infection (CDI) has the potential to be a severe or fatal \ninfection, occurring predominantly in the elderly and other vulnerable patients (NHS England, \n2014, a). Since 2010, the Infection Prevention and Control Team in association with staff \nacross an acute Trust have undertaken a collaborative daily checklist review which later \nbecame known as the daily review checklist process (DRCP) for all CDI patients. This review \nincluded feedback at ward and organisational levels. The DRCP incorporated completion of \na checklist through contemporaneous clinical patient assessment and ward level \nexamination of infection prevention and control practices. \nA grounded theory approach was used to explore the influence of the DRCP on the care and \nmanagement of patients with CDI. The study consisted of two distinct phases. Phase 1 \nincluded a retrospective documentary analysis that examined all checklists (n=928) \ncompleted between July 2010 and December 2011. Phase 2 explored the perceptions of \ndifferent groups of staff (Infection prevention and control practitioners [IPCPs], matrons, \nward based staff and senior managers) concerning the influence the DRCP had on the care \nand management of patients with CDI. \nThe findings from Phase 1 highlighted that the DRCP was used as a form of real time \nmonitoring, providing organisational surveillance to assure safe and effective infection \nprevention and control practice for inpatients and appropriate and timely responses when \ncare or standards of infection prevention and control may have been suboptimal. \nPhase 2 findings indicated that staff perceived that the DRCP had been influential in the care \nand management of patients with CDI. Three main themes were developed: education and \nlearning, developing and sustaining relationships and leadership and change management \nthat offer an explanatory framework for understanding the interactive processes that may \nhave contributed to the care and management of patients with CDI. In terms of education \nand learning, ward staff valued the situated nature of learning provided by the review \nprocess. The DRCP also appeared to conceptualise CDI as an illness suggesting \nembodiment. Traits such as approachability and helpfulness of the key players involved in \nthe DRCP (IPCPs and matrons) appeared to be fundamental to the DRCP and were \nparticularly significant for developing and sustaining relationships and team work between \nstaff. Finally the DRCP illustrated clinical leadership in practice with the IPCP and matron \nproviding leadership and assistance in the care and management of patients with CDI. \nThe DRCP evolved from a checklist serving as an instrument of surveillance and monitoring \nto an interactive educative facilitative process assisting staff in the care and management of \npatients with CDI and in compliance with general infection prevention and control practice. \nWhat emerged during the evolution of the DRCP was the influence of a human factors \napproach and the impact that communication, teamwork, situated learning and leadership \nhad on the process. \nThe key implication that emerged from this study included the contribution of human factors \ntheory to behavioural change and improved patient outcomes. Incorporated within this was \nthe influence situated learning can make to effecting change in knowledge and compliance \nand the impact relationship development can have on infection prevention and control \npractices and potentially processes that require different professionals to work together to \nimprove patient outcomes.
Author: Elizabeth Andrea Denton
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W83522913