From Invisible to Visible - Positive Deviance Initiative

Ms. Iversen and Ms. Mellgren-Blackford
make casting calls.
Clinic, a multi-disciplinary in-house team to curb
the spread of deadly pathogens. Ms. Iversen and
Ms. Mellgren-Blackford made the casting calls,
inviting people from various units, and worked
with PD/MRSA coach McCandless, to improvise
role-play scenes and scenarios.
During one improv, a nurse asked: “How do I
make sure that the narcotic key is clean when I
am in isolation room?” The solution from a colleague:
“Put it on a disinfectant wipe on the pullout
shelf of the isolation cart inside the room.
Then use the wipe to clean the keys when leaving
the room.”
Another nurse told of a MRSA patient who did
not understand the reasons for his isolation. He
thought he had to be separated from others
because his work in a landfill made him dirty.
This painful story reinforced the importance of
educating patients more effectively about the reasons
for isolation.
The improvs made “the invisible visible,” Carlos
Arce said. In one of the improvs, a physician,
while examining a patient’s leg wound that was
oozing brown goo, paused to shake hands with
the patient’s family, then engaged in some back
Tonda Thomas, RN, inpatient surgical
Chocolate pudding: Making MRSA visible
patting, and resumed the examination. Within
seconds, the patient’s body, the bedding, the
hands and clothes of the doctor, the nurse, and
the patient’s family show brown stains. The
brown goo, which is chocolate pudding, substitutes
for MRSA, demonstrating how routine
human contact spreads the deadly, but invisible,
bacteria.
Nancy Rahm, RN, consultant, EMS outreach,
noted: “The improvs provided an opportunity to
learn from the experience of others. Folks were
carefully recruited for role-plays from different
units, allowing for wisdom to surface from all corners.”
For instance nurses acted out various
scripts to educate a patient about MRSA and how
it is transmitted. One of the participants later
reflected, “Hearing how other people handled this
difficult conversation was very helpful. It helped
me think of the right words to use to empower a
patient in contrast to scaring them.”
In another improv, a lab technician noted that
MRSA can live on fabric and environmental surfaces
for up to 30 days. That was a sobering surprise
for many. In another one Chris Nightingale
emphasized: “The anti-bacterial gel is more effec-
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