Data Collection Tool Sponsored by the Hand Hygiene Targeted Solutions Tool

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Data Collection Tool

Sponsored by the Hand Hygiene Targeted Solutions Tool™

The products, technology and/or processes described and/or used on TST may be the subject of intellectual property rights reserved by the Center, The Joint Commission or other third parties. Nothing contained herein shall be construed as conferring to you in any manner, whether by implication, estoppel or otherwise, any license, title, or ownership of or to any intellectual property right of the Center, The Joint Commission or any third party.

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Data Collection Tool

Sponsored by the Hand Hygiene Targeted Solutions Tool™

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Instructions:

• Step 1: Watch “Improving Care with TST” video (6 minutes) at

http://www.centerfortransforminghealthcare.org/multimedia/improving-‐care-‐with-‐the-‐tst/

• Step 2: Review the data collection tool provided by Joint Commission for Center for Transforming Healthcare (see Page 3 to 5)

• Step 3: Go out to your patient care area and “test it” on 3 to 5 observations before Session 2.

• Come back next webinar and tell us your experience

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Data Collection Tool

Sponsored by the Hand Hygiene Targeted Solutions Tool™

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Definitions of Contributing Factors

Observable contributing factors (11):

Column

# Contributing Factor Definition

6 Dispenser location _{The alcohol based hand-‐rub dispenser(s) is not optimally located in the} path of the health care provider’s workflow, and/or the access to the dispensers are either obstructed or hidden.

7 Dispenser empty _{The alcohol based hand-‐rub dispenser(s) accessible to the observed}

health care provider is empty.

8 Dispenser broken _{The alcohol based hand-‐rub dispenser(s) accessible to the observed}

health care provider is broken or not functional.

9 Equipment shared The health care provider did not wash hands due to the use of shared equipment between patients (e.g., vital sign machine, portable x-‐ray, etc.).

10 Hands full supplies _{Health care provider’s hands are full of supplies or equipment (e.g., food} trays, lab supplies).

11 Hands full meds Health care provider’s hands are full of medications.

12 Improper use of gloves _{Health care provider did not wash hands before putting on gloves or} after taking gloves off.

13 Follow person entry or exit _{Health care providers entering or exiting the patient care area followed} someone who did not wash hands.

14 Frequent entry and exit Frequent entry and exit of patient care area.

15 Admissions or discharge process Lack of streamlined admission or discharge process led to unnecessary, frequent entry or exit o the patient care area by the health care provider.

16 Isolation area (gown + gloves) _{Prior to entering or exiting the isolation patient care area, the health} care provider did not wash hands before or after putting on personal protective equipment (e.g., gloves or gowns, when required). Non-observable contributing factors (4):

Column

17 Lack of immediate feedback _{Lack of feedback to the health care provider for hand hygiene} compliance coaching.

18 Distracted or forgot _{Distracted/ forgot/ lack of knowledge/ chose not to wash}

19 Perception HH not required _{Perception that hand hygiene is not necessary if nothing is touched in} the patient care area.

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Data Collection Tool

Sponsored by the Hand Hygiene Targeted Solutions Tool™

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Column

20 Perception of skin irritation Health care provider perceive that the following will cause skin irritation:

• Alcohol based hand rub is more drying that soap and water

• Frequent hand hygiene at work causes skin irritation

• The use of gloves eliminates the need for hand hygiene and avoids skin irritation

Other contributing factors:

Column

21 Other contributing factor _{Please specify other observable or non-‐observable contributing factors} that are not listed above.

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1. Use a separate row for each entry or exit.

2. When there is a defect (wash in/out=no), check any applicable observed contributing factor. 3. The “observed by asking” section is for JIT coaches only.

4. Emergency situations are EXCLUDED from the data collection process.

Collected by: Role (circle one): Observer Coach Unit:

Non Observable Date of observations:

Hand Hygiene Observation and Contributing Factor Form

Possible Contributing Factors to Washing

Observable 1 2 3 4 5 6 7 8 9 10 Instructions:

1 2 3 4 5 Did person wash?6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21Dispenser location 22

Entry or exit? Observation NumberCheck box if observed during roundsRN = NurseNA = Nursing

Assistant MD = DoctorRT = Repiratory Therapy PT = Physical Therapy Diet = Dietary Technician Lab = Lab Technician

HSK = Housekeeping all others please identify in comments Enter hour of observation

in 24-hour (military) time Dispenser emptyDispenser brokenEquipment sharedHands full suppliesHands full medsImproper use of glovesFollow person entry or exitFrequent entry or exitAdmissions or discharges processIsolation area (gown + gloves)Lack of immediate feedbackDistracted or forgotPerception HH not requiredPerception of skin irritationOther contributing factorComments

EN EX EN EX EN EX EN EX EN EX EN EX EN EX EN EX EN EX EN EX Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No Yes No

6. Dispenser location is not in path of person or is obstructed or hidden 7. Dispenser is empty

8. Dispenser is broken

9. Equipment shared or disposal area (use of equipment shared between patients i.e. vital sign machine, portable x-ray, etc)

10. Hands full: supplies or equipment (e.g., food trays, lab supplies) 11. Hands full meds

12. Gloves (e.g., improper use of or not washing before or after putting gloves on or off)

13. Person entering or exiting followed someone who did not wash 14. Frequent entry and exit of patient area

15. Admissions or discharge process

16. Isolation area (gown + gloves when required)

17. Lack of immediate feedback to person for hand hygiene compliance 18. Distractions/forgets/lack of knowledge/chose not to wash

19. Perception that if nothing is touched in the patient care area hand hygiene is not necessary

20. Perception of skin irritation or dislike of alcohol-based hand rub 21. Other

Contributing Factors Circle role of health care

professional observed

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other

CM / SW = Case Mgmt / Social W orker

Pharm = PharmacistRad = Radiology Tech

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other

RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other RN NA MD RT PT Diet Lab HSK CM / SW Pharm Rad Other