Influencing Quality Within Healthcare
Core and complex concepts in nursing practice are patient safety and quality care. These concepts are interrelated as you cannot provide quality care to patients without implementing safety measures. Safety can be defined as freedom from psychological and physical injury and is considered as a basic human need (Potter, Perry, Hall, & Stockert, 2017). Hospitals and health care operations strive to continuously improve the quality measures that enhance patient safety, reduce the amount of readmission within 30 days of discharge, and lower the change of hospital acquired infections. The overall goal of quality is to achieve best practices, which is determined by measuring the actuality of care delivered compared to ideal outcome (Sherwood & Barnseiner, 2017). This paper will summarize a patient case scenario that highlights safety and quality care measures. Along with the summary of the scenario will be a description of the nurse’s role, how the patient played in their own safety, identify how the care environment affected the patient’s safety and quality of care provided, and determine if a quality model was employed.
An oncoming dayshift registered nurse was given report on a post lung transplant patient that was admitted for altered mental status. A detailed report was given which included how the patient was confused throughout the night and got out of bed on his own without calling for help. The overnight nurse stated that he found the patient on his knees next to the bed and helped him up and to the bathroom. Later that night the patient had pulled out his IV and mittens were provided to ensure that he did not pull at any other lines. This was the first patient that the oncoming day shift nurse assessed after receiving report on 3 other patients. The patient could not state his name, was agitated, and continuously tried to get out of bed. The nurse set the bed
alarm, ensured the bed was in the lowest and locked position, and raised all side rails before leaving the room to tell the charge nurse that the patient needed a sitter. The charge nurse decided to move the patient to a room that was closer to the nurse’s station but was not able to get a sitter at that time. After the nurse exited the new room, which was located next to the nurse’s station, the bed alarm was heard as well as a loud thud. The patient had climbed out of bed and hit his head.
Nurse and Patient Role
This was a preventable adverse event that resulted in patient harm as the patient hit his head. The patient’s mental status was altered and therefore could not comprehend education provided on safety and needed frequent reinforcement, reorientation, and 24-hour supervision for his safety. The nurse, however, did understand the severity of the situation by acknowledging the need for a patient sitter and should have asked one of her assistants or the charge nurse to sit with the patient until a sitter could make it to the floor. It would not have been possible for the primary registered nurse to stay in the room with the patient for an extended amount of time since she had the responsibility of three other patients that needed assessments and morning medications.
Environment and Outcome
This patient was located in the last room at the furthest end of the hallway and far from the nurse’s station. The patient should have been moved to a closer room during the night after the over night primary nurse found the patient out of his bed and on his knees. It was already known that the patient was confused and a high fall risk upon admission and these patients should always be close to the nurse’s station for added safety precautions. As well as moving the patient to a closer room, the charge nurse should have already put a request in for a 24-hour patient sitter. Since the patient was left alone in his current mental state, he suffered a fall and negative patient outcome.
Every medium or high risk fall patient are cared for with fall precautions that include measures such as wearing slip resistant socks, bed/chair alarms, fall signs and wristbands, and in certain cases being moved closer to the nurse’s station and placed with a sitter for their safety.
With every fall or significant event on the unit comes a post-fall or post-event huddle. This is where quality and safety precautions are measured, and the nurses determine how improvements could be made. It is documented what level the bed alarm was set on, how many side rails were up, what additional measures were taken prior to the event, and what medications were given.
The event is then entered as an incident report so management can track data.
Providing quality care to all patients and ensuring their safety is necessary in the nursing and healthcare field. In order to achieve best practices, quality improvement and patient safety models must be followed, and data should be tracked to determine the best course of action for positive outcomes. Post event huddles are a way in which nursing staff can reflect on their practices and come up with ways in which outcomes can improve.
Potter, P. A., Perry, A. G., Hall, A., & Stockert, P. A. (2017). Fundamentals of nursing. Ninth edition. St. Louis, Mo.: Mosby Elsevier.
Sherwood, G. and Barnsteiner, J. (2017). Quality and safety in nursing: A competency approach to improving outcomes (2nd ed.). Wiley Blackwell.
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The First Posting of each Week is Due on Thursday:
You watched the Chasing Zero: Winning the War on Healthcare Harm. Think about the profound effect the care these families received had on the future of so many people.
Respond to the following in a minimum of 175 words:
- How do you positively or negatively affect the quality and safety of the care your patients receive?
- Think of two specific cases or examples you or your organization may have experienced or might experience.
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