Executive Summary
The workaround in healthcare are the behaviors that temporarily fix or circumvent a perceived or an evident flow to achieve better patient care outcomes (Debono et al., 2013) . Workarounds in the workplace are used to address poor workflow design, solve problems, save time, enhance safety mechanisms and bypass system and organizational issues (Debono et al., 2013) . Healthcare is a fragmented, complex, unevenly regulated and decentralized industry where clinicians are required to display professional autonomy while learning how to improve patient outcomes (Rushton & Stutzer, 2015) . Healthcare is comprised of fleeting, acute interactions and long-term relationships between the patient and clinicians which shape how clinicians behave during work and respond to clinical practice demand (Rushton & Stutzer, 2015) . Workarounds are implemented by clinicians as a response to the provision of complex care within a healthcare system that demands professional autonomy and continuous learning. However, workarounds can both augment and subvert patient safety (Debono et al., 2013) . In augmenting patient safety, workarounds help in the delivery of services, adapt to inefficiencies and provide improvement opportunities for the patient. In subverting patient safety, workarounds undermines health standards and also masks deficiencies thus jeopardizing patient care.
According to Rushton & Stutzer (2015), the two most common workarounds in critical care are the improper use of protective equipment and medication verification. The improper use of protective equipment can result in the transmission of diseases to susceptible patients who are always at risk of developing hospital-acquired infections. The transmission of diseases requires various factors which include an infecting organism, a recipient susceptible to the organism, and a transmission method from the infecting organism to the recipient (Rushton & Stutzer, 2015). The protective equipment provides a medium through which diseases can be transferred from the nurses to the patients. In this regard, patient care standards necessitate that nurses should properly use personal protective equipment to protect the patient and themselves from contamination or transmission of diseases.
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Introduction
The use of personal protective equipment by healthcare workers in a healthcare setting is mandated by the Occupational Safety and Health Administration (OSHA). OSHA regulations require all healthcare workers to appropriately use personal protective equipment such as masks, gloves, eye protection and gowns to prevent or control the transmission of healthcare-associated infections to the patients and themselves (Williams, 2010) . The use of personal protective equipment is an important topic in healthcare because errors or improper use of this equipments may reduce or negate their intended outcomes. The improper use of personal protective equipment leads to healthcare-associated infections which jeopardizes patient safety. In Canadian hospitals, it is estimated that 8,000 deaths occur annually as a result of over 220,000 healthcare-associated infection occurrences (Williams, 2010) . Also, 8% of patients admitted in Britain are affected by healthcare-associated infections with the improper use of personal protective equipment's playing a major role in these infections (Williams, 2010) . The increase in healthcare-associated infections presents further social, physical, financial and psychological costs to patients and also increases financial costs to the healthcare system.
This paper addresses the topic of workarounds with a special focus on the improper use of personal protective equipment in the healthcare system. The paper analyses the use of protective equipment in hospitals and the range of outcomes their use can produce. The paper describes the disadvantages of the improper use of personal protective equipment's, strategies to enhance their proper use and the role of clinical leaders in enhancing the proper use of the equipment. The paper also discusses the stakeholder viewpoints of the topic and provides recommendations for the future.
Analysis of Improper Use of Protective Equipment Workarounds in Healthcare
The use of personal protective equipment by workers provides protection or reduces the risk of infection against hazardous exposures such as hepatitis B virus (HBV), human immunodeficiency virus (HIV) and hepatitis C virus (HCV) ( Leiss, 2014). However, recent studies have shown that many healthcare workers do not wear protective gear in the appropriate time or manner while others shun the use of protective gear. A recent survey by Williams (2010) showed that 89% of safety professionals observed healthcare workers without protective equipment when they were required to have. The survey further indicated that 29% of the safety professionals observed this trend on numerous occasions. In another survey study on the use of personal protective equipment among critical care clinicians for the control of influenza, findings showed that adherence to infection prevention and control strategies were generally poor. The findings indicated that only 62% of critical care clinicians adhered to the use of personal protective equipment when assessing patients suffering from influenza (Daugherty et al., 2009). A study by Leiss (2014) also found out that 41% of the nurses used the specified type of personal protective gear during workarounds. However, the study also reported that the use of a specified type of personal protective gear was two times higher among nurses working in institutions that strongly advocate for patient safety than those that do not.
According to Williams (2010), t he use of personal protective equipment by healthcare workers in a healthcare setting is mandated by the Occupational Safety and Health Administration (OSHA) when administrative and engineering controls are not effective or feasible. However, recent studies have shown various factors that have formed a major drawback to the use of the equipment thus compromising patient safety. One of the factors is the weak safety climate in healthcare organizations. The findings of the research showed that most organizations and healthcare institutions had partially implemented the use of personal protective equipment thus hindering the provision of safe patient care ( Leiss, 2014). Another factor for the inappropriate use or no use of personal protective equipment is non-availability of the equipment (Lakshmi & Paul, 2018). This report further suggested that other reasons for the inappropriate use of personal protective equipment’s were emergencies, busy schedules, equipment non-use by co-workers, discomfort while using protective equipment and the risk of offending the patients through the use of protective equipment. The effect of the non-use of personal protective equipment is an increase in healthcare injuries and infections. Other factors cited for the increase in healthcare injury was safety concerns, lack of funds to implement safety programs such as protective equipment and insufficient support from management on health and safety functions.
The improper use of personal protective equipment is attributed to high levels of non-compliance. According to a study by Williams (2010), 69% of the healthcare workers thought the personal protective equipment was not required, unattractive, unavailable near workstations, uncomfortable and also too hot. Another study recorded that lack of time, unavailability of protective equipment when needed, negative perception that protective equipment interfered with nursing, physical discomfort and difficulty in communication especially when wearing face masks led to the improper use of personal protective equipment ( Leiss, 2014). These factors put the nurses and patients at risk of developing hospital-acquired infections. Another study by Daugherty et al. (2009) recorded that 50% of the nurses reported that it was not convenient to comply with recommended standards for personal protective equipment. In addition, the same study reported that 21% of respondents were of the opinion that patient care was interfered by the use of personal protective equipment. The study thus affirmed that different social and physical factors aided in the improper use of protective equipment, therefore, leading to increased risk to both the nurses providing care and the patients.
Clinical leaders and employers have contributed to the improper use of personal protective equipment’s. There is a lack of understanding or poorly defined roles and responsibilities for leaders in many healthcare organizations. The reason is that while healthcare professionals are required to demonstrate professionalism through proper use of protective gear, the legal responsibility for proper protective gear use falls on the employer (Lakshmi & Paul, 2018). OSHA has designated the responsibility to the employers to enhance a culture of safety through the designing, implementation, and maintenance of effective safety practices. The leaders contribute to improper protective equipment use through lack of funds to implement safety programs and insufficient support from management on health and safety functions. A strong organizational climate that supports and advocates for better patient outcomes through safety programs leads to the implementation and better use of personal protective equipment’s thus enhancing patient safety outcomes.
References
Daugherty, E. L., Perl, T. M., Needham, D. M., Rubinson, L., Bilderback, A., & Rand, C. S. (2009). The use of personal protective equipment for the control of influenza among critical care clinicians: a survey study. Critical care medicine , 37 (4), 1210-1216.
Debono, D. S., Greenfield, D., Travaglia, J. F., Long, J. C., Black, D., Johnson, J., & Braithwaite, J. (2013). Nurses’ workarounds in acute healthcare settings: a scoping review. BMC health services research , 13 (1), 175.
Lakshmi, A., & Paul, C. M. (2018). A study on personal protective equipment use among health care providers, Tamil Nadu. International Journal Of Community Medicine And Public Health , 5 (5), 1771-1774.
Leiss, J. K. (2014). Safety climate and use of personal protective equipment and safety medical devices among home care and hospice nurses. Industrial health , 52 (6), 492-497.
Powell-Cope, G., Nelson, A. L., & Patterson, E. S. (2008). Patient care technology and safety.
Rushton, C. H., & Stutzer, K. (2015). Ethical implications of workarounds in critical care. AACN advanced critical care , 26 (4), 372-375.
Williams, C. K. (2010). An Assessment Tool and Interactive Simulation for Using Healthcare Personal Protective Equipment (Doctoral dissertation).
