Quality and Safety in Healthcare

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Quality & Safety

The quality and safety of health care services has been a major issue in the recent past because of the significance of these factors in the improvement of patient outcomes and enhancing the effectiveness of the health care system. Health care professionals and practitioners have increasingly focused on the need to improve the quality and safety of their services given the constant increase in patient population. As a result, various measures have been developed and implemented in attempts to enhance the quality and safety of care services and improvement of practices. These measures include delivery of patient-centered care, safety initiatives, teamwork and collaboration, informatics, quality improvement, and evidence-based practice. There are several ways with which incidents or interactions in each of these components are handled and can be improved based on leadership/management theory content.

Patient Centered Care -- Interaction

A bedside report was not done at bedside and did not incorporate patient or family members. I questioned my preceptor after report was given and was told the patient was resting and they did not want to wake him. When we did enter the room the patient and wife had questions for the registered nurse that was on the previous shift about lab results the oncoming nurse was not aware of yet. The patient/family also seemed bothered they did not meet the oncoming nurse and was not aware of what time change of shift was.

One of the major ways of ensuring patient centered care is through including bedside reporting into change-of-shift report. The failure to incorporate bedside reporting into change-of-shift report contributes to communication failures since patients are not provided with adequate information (Laws & Amato, 2010, p.70). The lack of adequate information and resultant communication failures from failure to include bedside reporting to change-of-shift report affects the ability of caregivers to enhance patient safety. As evident in this scenario, the patient/family was not provided with enough information during change-of-shift reporting and was therefore not involved in making important decisions regarding his/her care plan. This incident resulted in communication failure that resulted in unanswered questions and concerns by the patient and family.

Based on leadership/management content, this situation can be improved through the implementation of a standardized approach to hand-off communication. This would improve the situation by resulting in effective communication through giving caregivers opportunity to ask and respond to questions during hand-offs even when preparing change-of-shift reports. This process will require implementing bedside reporting through educating nursing staff. Moreover, the unit manager and nursing director should provide necessary support in the implementation process in order for nurses to become more aware of patient experiences and issues.

Safety -- Interaction

IV push medication lasix 40 mg was given less than a minute. I asked my preceptor if there was a policy on the amount of IV drug to be pushed within a certain amount of time. I was told yes but I was not able to access the policy on IV push medications during my clinical practice or experience.

Generally, administering medications in current IV line using push method has been characterized by concerns regarding the amount of time needed for such a process. Actually, this process is usually accompanied by questions on how fast is too fast during the administration of IV push medications. These concerns emerge because errors during IV medication can cause serious harm to patients. In addition to vulnerability to errors during administration of IV medications, the potential harm to patients is attributed to the fact that high-alert medications with probable harm are administered through the IV route. While the facility has a policy on IV push medications, it seems that this policy is not implemented when administering the medications. Therefore, the situation can be enhanced through adhering to the policy for IV push medications. Moreover, the practitioners can improve the situation through accessing information regarding the maximum administration rate, especially for medications with high risk of severe impacts when administered too fast ("How Fast is Too Fast?" 2003).

Teamwork/Collaboration -- Interaction

The situation regarding teamwork or collaboration was lack of teamwork and clear communication between techs and registered nurses. As a result, registered nurses usually had negative comments about techs.

The lack of teamwork and effective communication between these professionals was a reflection of poor communication and collaboration between members of a health care team, which contributed to poor quality of care and clinical errors. Generally, patients who are hospitalized are usually allocated a multidisciplinary team comprising various healthcare providers such as registered nurses and patient care technicians, who act as the main figures in the delivery of care services.

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These professionals need to work together towards enhancing patient care given the different roles they play in the process. While registered nurses have a more holistic approach and focus when managing the responses of patients to health issues, patient care technicians or techs perform several functions under nurses' direction and supervision. Therefore, the lack of teamwork and effective communication between these professionals can generate delays in patient care and constant problems from unresolved conflicts in patient care.

The potential medical errors that can result in the lack of collaboration between these professionals contribute to the need for resolving this issue. In essence, effective communication and collaboration between these health care providers is vital in order to enhance patient outcomes and delivery of care services. The situation can be improved through developing a mechanism for carry out physician and nurse rounds. Secondly, there is need to develop a framework through which registered nurses and patient care technicians can meet and discuss patients' plan of care (Evanoff et. al., n.d., p.11). These approaches would be part of establishing communication systems in which registered nurses constantly articulate to the techs the link between certain tasks and the general plan of care.

Evidence-based Practice -- Incident

Nurses are not consistently using evidence-based practice in the hospital facility or delivery of patient care. Nurse Managers and nurse leaders are not providing support for the nurses to implement or constantly use evidence-based practice.

Evidence-based practice has emerged as a major way of enhancing the delivery of care services and improving patient outcomes in the recent past. The significance of evidence-based practice in improving patient outcomes is attributed to the fact that it integrates best evidence from clinicians' expertise, preferences, and patient assessments in care delivery. The situation can be enhanced through providing education to nurses regarding evidence-based practice approach, placing adequate EBP mentors at the bedside, and creating a support system and context through which evidence-based practice initiatives are utilized and sustained.

Quality Improvement -- Incident

There is scarcity of nursing resources and difficulty in involving nurses at all levels during patient care. Nurses also experience challenges in data collection and reporting, which affects treatment and patient outcomes.

The improvement of treatment and patient outcomes requires the successful implementation of quality improvement initiatives. The need to implement quality improvement initiatives is fueled by the role of nurses as vital caregivers in health care facilities. The incident regarding quality improvement initiative at the health care facility requires the development and establishment of effective measures towards this process. The first step towards this process is to establish support leadership where individual accountability and effective response are supported. The supportive leadership will act as the basis for successful staff engagement in the improvement initiatives. Secondly, the facility should develop a framework for determining the best means for utilizing resources. Third, nurses should develop and implemented technological processes that would help streamline data collection and reporting.

Informatics -- Incident

A patient reports of difficulties in finding reliable and accurate information regarding his health. Nurses have also received several complaints regarding the credibility and quality of information provided during delivery of care.

The above scenario is an example of an informatics incident in a health care facility, especially with regards to implementation of health information technology. In essence, the incident is a reflection of a significant gap between the role of health information technology and patient information. The lack of effective health information technology tools could contribute to severe impacts on decision making in the clinical process, especially in relation to the supporting clinicians and patients in a user-friendly manner.

This situation can be improved through effective implementation of health information technology tools and processes. First, leaders at the health care facility should provide education regarding health information systems to clinicians and patients. Secondly, appropriate information systems and technologies should be established in order improve access to information. These systems and technologies should also keep up-to-date information about the patient's medical history. Generally, the scenario requires implementation of comprehensive e-health policies and practices.

In conclusion, improvement of patient care delivery and patient outcomes has become a major issue in the health care sector in the recent past. The need for improved delivery of care services and patient outcomes is fueled by the various issues experienced by clinicians and patients in nursing practice. Some of the major areas related to improving the quality and….....

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