You are on page 1of 7

Patient Care Plan

1.

Problem:

Care of the patient with MRSA


State Site:

Problem Linked to: 3 (b), 4 (a), (b), (d), (e), 5 (a), (b), (c), (d), 8 (a), (c), 10 (a)
5c Immunity

Goal (G.1): Ensure isolation and Contact Transmission Precautions (CTP)


Actions (A.1)
A.1.1 Isolate patient in a side room (Refer to Isolation Prioritisation Tool)
A.1.2 Keep the door closed at all times
A.1.3 Contact Infection Control for advice if side room unavailable
A.1.4 Ensure the Contact Precaution Isolation sign is visible

Goal (G.2): Perform Hand Hygiene


Actions (A.2)
A.2.1 Ensure hand hygiene is performed using WHO 5 moments for
hand hygiene
A.2.2 Use soap and water and/or alcohol gel as appropriate
A.2.3 Offer patients hand hygiene opportunities as appropriate
A.2.4 Encourage patients to keep finger nails short and clean
A.2.5 Ensure availability of alcohol gel at bedside
A.2.6 Encourage visitors to decontaminate hands before & after visiting

Goal (G.3): Use of Personal Protective Equipment (PPE)


Actions (A.3)
A.3.1 Wear plastic apron and gloves before entering the patient area
A.3.2 Ensure PPE worn for contact with patient, environment and
equipment
A.3.3 Request visitors to wear PPE when involved in direct care
A.3.4 Request visitors to wear PPE if visiting another patient
A.3.5 Keep PPE on while removing/disposing of used equipment e.g. bed
pan
A.3.6 Discard PPE in a clinical waste bin before leaving patient area

EPR Implementation Team


29/04/2015

Patient Care Plan


Goal (G.4): Environmental Cleaning
Actions (A.4)
A.4.1 Use disposable mops and cloths
A.4.2 Keep lockers & tables clear of clutter to facilitate cleaning
A.4.3 Contact domestic staff for terminal cleaning on discharge
A.4.4 Ensure curtains are changed if applicable
N.B.
Ensure domestic staff use Chlorine Based Product (CBP) for
cleaning (Tristel)
Goal (G.5): Decontamination of Patient Equipment
Actions (A.5)
A.5.1 Provide designated equipment where possible for the patients own
use.
A.5.2 Clean equipment removed from their room with Tristel
A.5.3 Keep items/equipment to a minimum within the room/patient area.
A.5.4 All unused disposable items must be thrown away once patient is
discharged
N.B.
Removed patient crockery/cutlery can be washed in the normal
way.
Goal (G.6): Collection of Specimens
Actions (A.6)
A.6.1 Obtain nasal swab as per MRSA screening policy
A.6.2 Use MRAP-2 headed red top swabs; check swab expiry date before
use
A.6.3 Take other samples as clinically indicated: Sputum, wound, catheter
etc
A.6.4 Use MRSA inpatient Dashboard (in CDR) to see if screening is
required
Goal (G.7: Monitoring for Signs of infection
Actions (A.7)
A.7.1 Check results each shift on CDR
A.7.2 Document results clearly in medical and nursing notes
A.7.3 Inform nurse in charge/medical team of significant results
A.7.4 Inform patient of results & give MRSA Patient Information Leaflet

EPR Implementation Team


29/04/2015

Patient Care Plan


A.7.5
A.7.6
A.7.7

Observe for signs of deterioration (e.g. Bp, HR, pyrexia etc)


Maintain accurate observations of Vital Signs and Fluid Balance
Alert medical staff if indicated and involve PERT when necessary

Goal (G.8): Administer treatment as prescribed


Actions (A.8)
Commence Topical Suppression Therapy (TST) as per MRSA
A8.1
Screening policy
A.8.2 Complete TST before any invasive procedure (if possible)
A.8.3 Ensure IV antibiotic prophylaxis prescribed for any invasive
procedure
A.8.4 Administer Antibiotic Treatment as prescribed
A.8.5 Document wounds on wound chart, refer to Tissue Viability Nurse if
applicable
A.8.6 Document insertion of invasive devices accurately
A.8.7 Maintain daily VIP scoring of peripheral cannula sites
Goal (G.9): Transfer to another department or hospital
Actions (A.9)
A.9.1 Record patients MRSA status; handed this over to receiving team
A.9.2 Inform relevant departments of MRSA status prior to patient transfer
A.9.3 Inform porters/ambulance service of need for Contact Precautions
Goal (G.10): Maintain patient dignity and hygiene
Actions (A.10)
Provide patient information to reduce anxiety

A.10.1
Advise/assist patient to wash daily (If TST prescribed)

A.10.2
Change all bed linen on a daily basis or when soiled

A.10.3
Change nightwear/clothing and towels daily

A.10.5
Place used/dirty linen in the red alginate bags

A.10.6
Dispose of linen as per policy

A.10.7
N.B.
Do not shake linen to prevent unnecessary aerosolisation/
dispersion
EPR Implementation Team
29/04/2015

Patient Care Plan

Supporting Documentation:
e.g. rationale, references, evidence for change of practice
Please refer to the following policies which can be located on the Intranet
http://insight/departments/MedicineBoard/InfectionDivision/InfectionControl/Pages/default.aspx
MRSA Screening Policy
Hand hygiene Policy
Decontamination of equipment
Patient transfer policy
Saving lives audit tools
Isolation and Prioritisation Tool and policy
Disposal of soiled Linen, Waste and Sharps

EPR Implementation Team


29/04/2015

Patient Care Plan

Feedback from Specialist Review Group to Applicant


Results of application:

EPR Implementation Team


29/04/2015

Patient Care Plan

Specialist Group Member:


Signature:

Date:

Appendix 1. Patient Plan Index


1. Activity & Exercise
a. Oxygenation
b. Circulation & perfusion
c. Movement & co-ordination
2. Elimination
a. Bladder function
b. Bowel function
3. Cognition & Perception
a. Comprehension, speech, expression
b. Pain
c. Neurological function
d. Sensory vision, hearing, balance
4. Nutrition & Metabolism
a. Nutritional intake
b. Fluids & electrolytes
c. Hepatic, biliary & endocrine
d. Tissue & skin integrity
e. Maintaining body temperature
5. Health Perception & Health Management
a. Health promotion & self care
b. Safety of self / others
c. Immunity
d. Adaptation / modification / continuing care
6. Sexuality & Reproduction
a. Sexuality / sexual activity
b. Reproductive function
7. Sleep, Rest, Occupation & Recreation
a. Sleep & rest
b. Occupation & recreation
8. Self Perception & Self Concept
a. Identity
b. Body image
c. Self worth & self esteem
9. Roles & Relationships
a. Relationship with others
EPR Implementation Team
29/04/2015

Patient Care Plan


b. Role strain
c. Dysfunctional relationships
10. Coping & Stress Tolerance
a. Stress & stress tolerance
b. Coping strategies
c. Support systems
11. Individual Values & Beliefs
a. Spiritual beliefs
b. Choices & beliefs

EPR Implementation Team


29/04/2015