IC_AnesMar30_2011F_อ.สุสันณ์

How to Reduce the Risk for Exposure to and  Acquisition of Infectious Diseases in Hospitals1. Rapid screening of infectious disease  exposures and/or communicable infectious  diseases (patient, personnel, visitor)2. Rapid institution of appropriate isolation for  patients with known or suspected  communicable diseases 3. Strict adherence to handwashing and PPE4. Maintaining up to date immunizations in  healthcare workers and patients/visitors5. Effective post exposure prophylaxis

Empiric transmission‐based precautions Clinical syndrome Potential pathogens Empiric precautions  (always includes Standard Vesicular • Varicella‐zoster, • Herpes simplex Precautions)Cough/fever/upper lobe  • Smallpoxpulmonary infiltrate • Vaccinia viruses • Airborne plus Contact Precaution • TB • Contact Precautions only if herpes Cough/fever/pulmonary  • Respiratory viruses simplex, localized zoster in an infiltrate  in a patient with a  • S. Pneumoniae immunocompetent hosthistory of recent travel  to  • S. aureuscountries with active  • TB • Airborne Precautions plus outbreaks of SARS, avian  • SARS Contact Precautionsinfluenza • Avian influenza • Airborne plus Contact  Precautions plus eye protection • Droplet Precautions instead of • Airborne Precautions if SARS and  TB unlikely



Healthy Work Environment• Skilled Communication• True Collaboration• Effective Decision Making• Appropriate Staffing• Meaningful Recognition• Authentic Leadership The American Association of Critical‐Care Nurses (AACN)

Adopter Categorization and CharacteristicsGroups % Defining Characteristics Relationship to PeersInnovators 2.5 Adopt change first; typically have access to Typically are not closely integrated with resources and are very interested in social peers in local networks.Early 13.5 trends and advances, often outside of their own community. Well integrated and respected in localadopters networks; similar to their peers in Viewed as making judicious choices in socioeconomic status and in other personal adopting new ideas; once these individuals characteristics. Effective opinion leaders begin using an innovation, the rate of adoption emerge from this group. increases significantly. Early 34 Contemplate their adoption of a new idea for a Not opinion leaders within their localmajority 34 16 longer period of time than either of the first networks. Latemajority two groups.Laggards Skeptical of new ideas, and they do not adopt Not opinion leaders within their local a new idea until most of their peers have networks. already adopted it. Usually isolated from the rest of their Last among the local network to adopt a new network. idea; peer pressure is almost always necessary. Borbas C, Morris N, McLaughlin B, et al. CHEST 2000; 118:24S–32S

James A. Banks

DiversityFeminine expectations Masculine expectations• To be liked • To be successful• To make friends • To make colleagues• Everyone to win • Just want to win• To be included • Include those who can help me• Get praise and recognition • Get money and other perks• Expected others to recognize • Expect to toot my own horn my worth• To do my job well • To use this job to land a better one• Share my problems with • Build relationships to help my others career• To avoid risks • Willing to take risks Eleanor J. Sullivan

Gender Differences in Communication Women tend to Men tend to• Wait to be noticed • Interrupt more frequently• Use qualifier (prefacing and • Talk more, longer, louder, and tagging) faster• Use questions in place of • Disagree more statements • Focus on the issue more than• Relate personal experiences a person• Promote consensus • Boast about accomplishments• Withdraw from conflict • Use banter to avoid a one-down position Eleanor J. Sullivan

Recommendations for Gender-Neutral CommunicationWomen may need to Men may need to• State your message clearly • Listen to objections andand concisely suggestions• Solves problems without • Listen without feelingpersonalizing them responsible• Say what you want without • Suspend judgment until thehinting information is in• Eliminate unsure words • Explain your reasons• Not cry • Not yell Eleanor J. Sullivan

Diversity Physicians1. Focus on patient care. less comfortable with healthcare administrative  functions. IC team should talk with physicians regularly and  listen to their concerns. The key to communicating with physicians is the  ability to integrate IC concerns and clinical  concerns. Michael F. Doody 

Diversity Physicians2. The confidence and decisiveness physicians make  them independent and sensitive to \"interference\".  less likely to intuitively buy into management  initiatives that promote teamwork.3. Physicians' scientific orientation  interested in quantitative solutions less tolerant of what they might perceive to be                 the \"soft\" management strategies. Michael F. Doody 

Team Stages1. Forming • Commitment not yet made • Confusion-what do they want from me? • Is this project worth my energy?2. Storming • Fighting • Why did I agree to do this? • Is this ever going to get better? • Do I want to continue?

Team Stages3. Norming • Come together4. Performing • Follow team rules • Can I help?5. Adjourning • Good decisions • Shared roles • Appreciate each other • Breakthrough ideas • What’s next? Bring it on! • Deforming • Mourning Ken Miller, Linda Diamond, and Harriet Diamond

8 Key Principles of Physician Buy-in1. Treat a physician like they would treat a patient: listen and emphasize.2. Solicit physician input through interviews and focus groups.3. Respect physicians’ time.4. Make it quantitative. Mark Wenneker, MD, MPH, and Stephen Blattner, MD, MBA

8 Key Principles of Physician Buy-in5. Link the work to performance and quality programs.6. Communicate frequently about a project’s intent and progress.7. Address skepticism head-on.8. Reward and recognize physicians’ contributions. Mark Wenneker, MD, MPH, and Stephen Blattner, MD, MBA