The effects of trained observers (dofficers) and audits during a facility-wide COVID-19 outbreak: A mixed-methods quality improvement analysis - 26/08/21
, Meghan Edlund, BSN, RN b, Candice Keddie, RRT b, Leyla Asadi, MD, MPH, FRCPC c, Domhnall O'Dochartaigh, MSc, RN, ENC(C), CNC(C) d, e, Richard Drew, BSN, RN, ENC(C) b, Matthew J. Douma, MN, RN, ENC(C), CNC(C), CCN(C) d, f, Conar R. O'Neil, MD, MSc (HQ), FRCPC b, g, Stephanie W. Smith, MD, MSc, FRCPC g, Jamil N. Kanji, MD, DTM&H, FRCPC b, g, h, #
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Highlights |
• | Personal protective equipment errors are common. |
• | Bundled infection prevention control audits and continuous quality improvement may reduce pathogen spread. |
• | Audits by trained observers (dofficers) can be used by outbreak response teams to identify opportunities for infection prevention and control quality improvement. |
• | Real-time feedback from dofficers, and quality improvement feedback from an outbreak response team may be associated with a reduction in infection control errors. |
• | Further research is needed to determine if dofficers are causally linked with error reductions. |
Résumé |
Background |
In response to a facility-wide COVID-19 outbreak, our tertiary acute care hospital implemented an evidence-based bundle of infection control practices including the use of audits and trained observers “dofficers” to provide real-time constructive feedback.
Methods |
We trained furloughed staff to perform the role of dofficer. They offered support and corrective feedback on proper PPE use and completed 21-point audits during a 4-week intervention period. Audits tracked appropriate signage, placement and availability of supplies (equipment), correct PPE use, enhanced environmental cleaning, along with cohorting and social distancing rates. Audit data was used to provide weekly quality improvement reports to units.
Results |
Nine hundred and sixty two separate audits recorded 36,948 observations, over 7,696 observer-hours. The most common errors were with environmental cleaning and PPE use; the least common were with regards to equipment availability and cohorting and social distancing. Mean error rates decreased from 9.81% to 2.88% (P < .001). The largest reduction, 22.57%, occurred in the category of PPE doffing errors.
Conclusions |
Dofficer led audits effectively identified areas for improvement. Feedback through weekly reports and real-time correction of PPE errors by dofficers led to statistically significant improvements; however, error rates remained high. Further research is needed establish if these relationships are causal.
Le texte complet de cet article est disponible en PDF.Key words : Audit, Trained observers, PPE Coaches, SARS-CoV-2, COVID-19
Plan
Vol 49 - N° 9
P. 1136-1141 - septembre 2021 Retour au numéro
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