Maria Pascual RN MPH CIC is an Infection Control Practitioner for UC San Diego Medical Center. Her responsibilities cover both the inpatient and outpatient areas for both Nursing and Non-nursing departments. In addition to her clinical and educational responsibilities, she is the Project Manager for the unit’s information systems activities which includes automation of surveillance components. She served as Treasurer for APIC San Diego and Imperial Counties from 2005 to 2007. Prior to being an ICP her experiences are in the Nephrology setting including adult and pediatric Renal Replacement Therapy in both the chronic and acute settings and, in multi-center NIH clinical trials. She received her BSN from Wayne State University, Michigan and her MPH from the University of Michigan.
Name of Project: Electronic Isolation Precaution Orders
Problems:
1) No consistent method for maintaining isolation precautions (esp contact precautions) when patients get ransferred.
2) No method for knowing if an admitted patient was on precautions for MDRO on a previous admission.
3) Needed a method to notify other departments about patients on certain precautions (FE: airborne and EVS for C-Diff.
Solution: Development of Isolation Orders that were sent as electronic data streams to Nursing, Facilities Engineering (FE) and Environmental Services (EVS).
1) Isolation precaution order set can be accessed by both physicians and nurses.
2) New admission and transfer orders will include Isolation Orders that are mandatory screens for physicians needed to fill in, indicating whether the need for isolation.
3) In addition a Protocol Order Set is used by both physicians and nurses for those instances when a patient may develop an MDRO at a time other than at new admission or transfer.
4) Facilities Engineering receives daily notification of airborne isolation and positive flow room orders.
5) EVS receives notification of C-Diff patients so their staff would be aware of cleaning that needs bleach.
6) Nursing has these orders printed out as part of their Patient Care Orders (electronic kardex).
7) The Infection Control Unit received 3 types of printouts on a daily basis:
(a) Active isolation orders: will list all inpatients who are currently on isolation
precautions.
(b) Cancelled orders: list of patients whose isolation orders have been cancelled and who are still in-house. The IC staff review the cases and see if isolation needs to be reinstituted.
(c ) Discharge report: lists patients who had isolation orders and have been discharged.
Impact and Outcomes:
1) Better tracking of patients as they move around the inpatient areas.
2) Better Communication between the IC unit and the inpatient staff.
3) Better education opportunities: IC is able to do ongoing education on the rationale for isolation especially when it comes to reinstituting precautions on discontinued orders.
4) Improved monitoring of airborne isolation rooms by FE.
5) Increased awareness of Medical Staff of active IC unit participation with regards to isolation.