844 infection control & hospital epidemiology july 2018, vol. 39, no. 7 table 1. Continued


Adherence to Injection Safety Elements by Clinic Area with Predominant SEIPS Theme Reported During Interviews, Adherent, No./Totalb (%)


9. Needles are not exposed until the moment of use.


Workflow, persons, organization 6/6 (100) 34/34 (100) 13/13 (100)


10. Contaminated needles are not recapped. 11/11 (100) Workflow, persons, organization


Environment, workflow, persons, organization


11. Needles are not passed by hand; instead, a designated tray or location is used for placement and retrieval.


NA


Common themes reported: ∙ Clear daily routine workflow ∙ Prepare for high patient volume and multi-task ∙ Pre-visit and injection planning each day ∙ Staff training and team work ∙ Clear and easy policies to follow 34/34 (100)


Common themes reported: ∙ Clear daily routine workflow ∙ Staff training and teamwork ∙ Clear and easy policies to follow NA


12/12 (100) NA 6/6 (100)


13/13 (100)


7/7 (100) NA 6/6 (100)


NA


Common themes reported: ∙ Condition and adequate size of the medication room ∙ Organize medication room with clear labels and storage ∙ Pre-visit and injection planning for the day ∙ Staff behavior and team work ∙ Adequate supplies and provisions ∙ Clear and easy access to policies ∙ Leadership qualities


Workflow, organization, tools/technology Common themes reported: ∙ Postinjection workflow ∙ Staff education and training ∙ Clear and easy access to policies ∙ Available safety devices


12. When appropriate, all needle safety devices are activated promptly with one hand after use.


13. All needles and syringes are immediately discarded into sharps container after use. Environment, workflow, organization


10/11 (91) 36/36 (100)


Common themes reported: ∙ Condition of medication and patient-care area ∙ Easy access and location of sharp containers ∙ Post-injection workflow protocol and training ∙ Patient behavior that can cause distraction ∙ Adequate staffing and training ∙ Adequate financial means to maintain supplies ∙ Leadership qualities ∙ Clear and easy access to policies


NOTE. SEIPS, System Engineering Initiative for Patient Safety; NA, not applicable. aAdapted from standards from the Centers for Disease Prevention and Control, National Institute for Occupational Health and Safety, and the American Nurses’


Association. bTotal reported number of adherence and nonadherence; does not include not applicable or not observed.


13/13 (100) 20/20 (100) 14/14 (100) 9/9 (100) 11/11 (100) 31/34 (91) 11/11 (100) NA 2/2 (100) NA


10/10


NA


6/6


(4) they did not feel that injection safety was an issue. Of the 21 clinics, 16 participated in both the interviews and observations, 2 participated in observations only, and 3 had interviews only. For 3 clinics, only interviews were performed because no injections were given during the observation period. One staff member and one manager were interviewed in all clinics except for pediatrics where only one staff was available for interview. Participating clinics included 4 adult internal medicine departments, 6 pedia- tric or family medicine departments, 1 provided urgent-care services, 3 adult specialty medicine services (dermatology, allergy, and immunology), 3 ambulatory procedures (digestive health, radiation oncology, and ambulatory surgery), 2 provided imaging


services, and 2 provided outpatient dialysis services (Table 1). Most of the clinics were locatedwithin the city of Madison, and 3 were in outlying communities. In total, 106 injections were observed at the 21 clinics


(average 5 injections per clinic, range, 0–10 injections). Most injections (82.1%) involved SDVs compared to MDVs (17.9%). Of the 13 standards, 5 were followed 100% of the time, including the standard of not using SDVs for >1 dose or >1 patient (Table 1). The standard with the lowest compliance rate was preparing and administering injections using needle- less access devices. Primary care and urgent care clinics were more likely to not meet this standard (Table 1) because


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