I am a registered and specialized trained Assistant Medical Officer (AMO) at Emergency and Trauma Department (ED). I have been working in the Government Hospital for fourteen years. In addition I am also working together other with twenty AMO’s, ten registered staff nurses and seventeen nursing aid in this department. In Malaysia AMO plays a major role in early diagnosis and treatment of patient whereby they are assign in hospital and clinics. AMO working in the ED are competent in the provision of emergency cares and function as the main front liner care provider that includes provision of emergency treatment, stabilization, definitive care and function as an important component of the Trauma Team (Ministry of Health Malaysia (MOH), 2005).
ED function as a core business at government hospitals, it plays a crucial role in the emergency treatment of patients. In addition the department also plays a role in pre hospital care, call center and training services to all staff at the hospital. The South African Constitution (1996) provides that ‘No one may be refused emergency medical treatment’. In Malaysia, although the ED exists to deal with cases of emergency and trauma, but functions as outpatient department (to treat cold cases) which is still there, especially after office hours or public holidays. Sometimes we overlook the simple case where inaccurate treatment can invite to suffering for the patients. When this happens it increases the workload of the staff in the unit. There are many procedures at ED such as Intubation of patient, Cardio Pulmonary Resuscitation (CPR), Continues Bladder Drainage (CBD), Chest Tube Insertion, Incision and Drainage (I&D), Toilet and Sutures (T&S) etc.
I acknowledge that my practice may not always be evidence based and lack of understanding of the wound infection from T&S procedure. I do fully realize that as a health care professional, I have a duty of care for every patient (Nursing & Midwifery Council, 2004). Reflection has become an important component practitioner to experience and learn from their world of practice (Johns, 2002; Wilkinson, 1999). Whitton et. al (2004), reflection constitute of three processes from past experience; analysis of confidence, knowledge and consideration of options.
‘How to Reduce Wound Infection in Toilet and Suture (T&S) Procedure at Emergency Department (ED)’ is my dissertation topic. I chose this topic because wound infections from T&S procedure are one of the most common hospital acquired infections; these complicate illness, increase patient discomfort, affecting the economy, patient and relative income. Apart from that I can analyze to my knowledge, skills and practice as regards in infection control and can displays the credibility of medical personnel in implementing the tasks entrust by MOH.
Reflective account is selected option for exploration of this dissertation. In my opinion with reflective account I can find the strength and weaknesses of this problem which may be critical to reflect the situation at that time. The effect of this reflection will provide a change in practice to apply various methods of treatment, innovation and processes. Reflection is a fundamental skill for nurses to ensure that quality of care is continually considered and improved (Price, 2003). I also use the Plan-Do-Study-Act (PDSA) (Appendix 1) cycle to implement when making changes to improve myself. I repeat this cycle much time for continuous improvement. For me PDSA is common sense based approach that easy to understand. Moen et.al (1990) stated the model of PDSA we will know a change is an improvement.
Infection may occur in many ways. Not following the procedure of Infection Control Guide Line such as the practice of hand washing, contaminated equipment (lack of sterilities), not using personal protective equipment (PPE) such as mask, glove, apron etc. Apart from that practicing using of expired date equipment such as suture and...