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Title: The evolution of a checklist into an infection prevention and control process
Author: Denton, Elizabeth Andrea
Awarding Body: University of Huddersfield
Current Institution: University of Huddersfield
Date of Award: 2014
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Clostridium difficile (C.difficile) infection (CDI) has the potential to be a severe or fatal infection, occurring predominantly in the elderly and other vulnerable patients (NHS England, 2014, a). Since 2010, the Infection Prevention and Control Team in association with staff across an acute Trust have undertaken a collaborative daily checklist review which later became known as the daily review checklist process (DRCP) for all CDI patients. This review included feedback at ward and organisational levels. The DRCP incorporated completion of a checklist through contemporaneous clinical patient assessment and ward level examination of infection prevention and control practices. A grounded theory approach was used to explore the influence of the DRCP on the care and management of patients with CDI. The study consisted of two distinct phases. Phase 1 included a retrospective documentary analysis that examined all checklists (n=928) completed between July 2010 and December 2011. Phase 2 explored the perceptions of different groups of staff (Infection prevention and control practitioners [IPCPs], matrons, ward based staff and senior managers) concerning the influence the DRCP had on the care and management of patients with CDI. The findings from Phase 1 highlighted that the DRCP was used as a form of real time monitoring, providing organisational surveillance to assure safe and effective infection prevention and control practice for inpatients and appropriate and timely responses when care or standards of infection prevention and control may have been suboptimal. Phase 2 findings indicated that staff perceived that the DRCP had been influential in the care and management of patients with CDI. Three main themes were developed: education and learning, developing and sustaining relationships and leadership and change management that offer an explanatory framework for understanding the interactive processes that may have contributed to the care and management of patients with CDI. In terms of education and learning, ward staff valued the situated nature of learning provided by the review process. The DRCP also appeared to conceptualise CDI as an illness suggesting embodiment. Traits such as approachability and helpfulness of the key players involved in the DRCP (IPCPs and matrons) appeared to be fundamental to the DRCP and were particularly significant for developing and sustaining relationships and team work between staff. Finally the DRCP illustrated clinical leadership in practice with the IPCP and matron providing leadership and assistance in the care and management of patients with CDI. The DRCP evolved from a checklist serving as an instrument of surveillance and monitoring to an interactive educative facilitative process assisting staff in the care and management of patients with CDI and in compliance with general infection prevention and control practice. What emerged during the evolution of the DRCP was the influence of a human factors approach and the impact that communication, teamwork, situated learning and leadership had on the process. The key implication that emerged from this study included the contribution of human factors theory to behavioural change and improved patient outcomes. Incorporated within this was the influence situated learning can make to effecting change in knowledge and compliance and the impact relationship development can have on infection prevention and control practices and potentially processes that require different professionals to work together to improve patient outcomes.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: R Medicine (General)