Using certification as a performance improvement strategy to measure, achieve, recognize and sustain injection safe care delivery

Injection safe care is a high risk care process for MOH health facility patients and staff. Our objective was to design and field-test an MOH Injection Safety (IS) Certification process to reduce accidental injuries and occupational exposure to blood-borne disease among Guyana MOH hospital and health center patients and workers. The methodology included an approved set of national injection safety performance standards and a standardized measurement and scoring process. The system was tested in five MOH sites over a seven-month period; the initial phase included orientation, self assessment and action planning. Supportive facility and multi-facility meetings encouraged problem solving and best practice sharing. In the final phase, facility staff notified MOH that they met certification criteria. Trained external assessment surveyors then sought verifiable evidence to corroborate the certification or detail gaps to address. All five sites met certification standards, which resulted in such changes as full pre-exposure vaccinations, injections administered based on standards, no stock outs, recording and addressing NSI. MOH created a national scale-up plan. IS Certification is a data-driven quality improvement strategy aimed at measuring, achieving, recognizing, and sustaining high performing patient and worker safety practices. The certification process teaches facility staff to self assess, develop and manage action plans for improvement, self regulate and be accountable for their own health care practices. The Injection Safety Certification process, as field tested, is practical and operationally manageable, engages staff to buy-in, maximizes the use of available external assessor resources, continues to improve injection safe care, and is sustainable long-term.