Implementing FIRST-ADLX with Clinical Pharmacists working in the Leukemia Clinical Pharmacy at the public hospital

I am Seif Ayman, Clinical Pharmacy at a public hospital in Egypt. I have worked at this hospital since I graduated in 2013. I was very interested in working there to help patients and their relatives understand the correct use of drugs and how to manage common adverse effects related to medications. Besides working as a Clinical Pharmacist, I implement medical awareness sessions for the health care professionals at the hospital.
My participants in these sessions were 12 junior Clinical Pharmacists working in the Leukemia Clinical Pharmacy at the public hospital

Hygiene is generally considered a critical issue in most public hospitals in Egypt since most hospitals do not comply with infection control guidelines. The concept of poor hygiene in general and poor hand hygiene specifically resulted in an increase in hospital-acquired infections and an increase in the length of stay at the hospital. As a Clinical Pharmacist in the Leukemia department, I realized that poor hygiene affected immunocompromised patients who have cancer. Also, I realized that the medical team needs better hygiene practices. Therefore, I decided to implement an awareness program for healthcare professionals at the Leukemia department.

I started by collecting data from the pharmacists and the physicians to understand where the gap lies. I used the focus group method to collect data. I found that most of the healthcare professionals in the department are not keen to learn about hand hygiene guidelines. As a result, they do not apply it because they see that it wastes their limited time. In addition, they misuse the sanitizer. They need to value the importance of such a necessary procedure. They do not differentiate between mandatory safety precautions and optional ones.  I invited them to a two-hour training program composed of 2 one-hour sessions to tell them why and how they should wash their hands.

When I designed the program, I planned to implement the five domains of the FIRST Framework.

1- Focusing: I used many techniques as using the names, asking them about their prior knowledge and reflecting on it, and acknowledging their experience and contribution.

2-Interacting: I designed activities to help learners interact with each other and share their ideas and reflections.

3-Reviewing actively: RAR model was put into consideration. For example, increasing readiness by explaining activity instructions, then inviting learners to the activity (watch a video about how bad hand hygiene spreads infection at the hospital), then asking them about their reflections and action items

4- Sequencing: Each session was designed to include a blend of push and pull activities. The overall flow was logical.

5-Transfer Learning into performance: Job aids(posters of hand hygiene) was handed out to learners.

After observing the feedback, I realized we could use training to add knowledge, improve skills, or even change our mindset. But these competencies may be added to learners if there is a well-structured design and delivery of the training.  In addition, I felt the importance and the meaning of being a facilitator. A facilitator helps learners achieve the intended learning objectives without pushing or pulling all the time!

The Learners were delighted to understand a vital topic such as hand hygiene using engaging and interactive methods. The impact of training extended to reach other departments in the hospital. Pharmacists from other departments requested to attend a similar program. I was happy to see the hand hygiene hand poster all over the hospital. The mind shift was noticeable. Now pharmacists remind each other to wash their hands according to the WHO standards. They tell each other to apply correct hand hygiene before and after the Intravenous drug admixture.

Before the training, I wondered whether the learners would be interested in attending the entire program. As the training proceeded, I felt the learners’ enthusiasm to learn more. This feeling made me motivated to complete the program. Implementing the FIRST Framework was very inspiring to me. One of the most meaningful actions I learned from this framework is balancing push and pull. I will no longer aim to push too much information. I will be aware of keeping the learner status in a dynamic state.

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