ADV Leadership 4- resp 2

RUBRIC:

Peer Interaction

20 pts-Exceptional

.

One post written in response to fellow learners’ post and each between 100-150 words. Response is substantive insightful and contain at least one reference.

Scenario

Put yourself in the role of an advanced practice nurse leader working in an urban emergency department (ED) in your state. You just received a report of a patient death. The patient was recently discharged to home from the ED after being diagnosed with a complicated urinary tract infection. The patient died two days later in presumed septic shock. As the advanced practice nurse leader, you examine the case and find that multiple issues contributed to this event.

· The patient presented during peak hours in the ED. The ED is currently under pressure from administration to keep wait times down. Patient discharge is sometimes hurried to allow for additional patients to be seen.

· Two nurses and a nurse practitioner called in sick during the shift, which likely contributed to staffing issues that day.

· A serum lactic acid level was drawn, but the results did not return until after the patient was discharged home. The elevated level was likely never seen by a nurse or medical provider.

· The patient was discharged with a 10-day course of ciprofloxacin and advised to follow up with their primary care provider (PCP) in 2 days. The patient was uninsured and did not follow up with their PCP as recommended.   

Discussion Questions

1. Analyze the complex practice, organizational, and system issues presented in this scenario. Include at least 2 examples of each in your response.

2. Based on your findings from question one, consider the resources available in urban areas at the state and national level. Also consider the disparities in care that the the uninsured can experience. Using this information and other scholarly resources, formulate potential solutions. Discuss two solutions that would address the factor(s) that contributed to the patient death. Address cost, feasibility, policy and other resources, including staffing. Include rationale for your solutions. 

3. Select one of the solutions from question two. Identify one policy change needed to implement your solution. What quality improvement measure(s) would need to be evaluated in order to demonstrate an improvement in patient safety and care?  

STUDENT’S POST:

The scenario in this week's discussion shows how systems and organizational failures can have devastating or fatal consequences for patients. It should be no surprise that this scenario is more common in the healthcare system. In complex systems like healthcare, the breakdown of one department can have a rippling effect. Unfortunately, this scenario resulted in the patient losing his/her life due to systems failure or communication failure. There are several breakdowns in the system in this scenario, such as short staffing due to staff members calling in sick and a hurried or rushed discharge process to improve turnover time. Failure to address staffing issues and pressure to enhance turnover time in ED is an organizational issue, and management needs to evaluate and remediate to provide safe care for the patients. Even though a serum lactic acid was drawn as a significant indicator in sepsis, the results were not verified before discharge.  Staff members' failure to identify and verify if the patient has the resources to obtain prescribed medication shows system failure. Either the policy and protocols do not depict the staff's responsibility to evaluate the results before discharge, or there is no set policy for sepsis identification or treatment. One other issue is to assess a patient's ability to pay or obtain the prescribed medication due to lack of insurance. The fatal outcome could have been prevented if these system failures did not occur.

All people should have access to the full potential of health. Social determinants of health as defined by the World Health Organization (WHO) refers to the conditions in which a person is born, grow, live, work, and age can contribute to or detract the health of individuals or communities. Exclusion or discrimination based on race, ethnicity, age, gender, socioeconomic status, sexual orientation, gender identity, mental health, or geographical location influences health status (HHS). Significant racial and ethnic health disparities continue to permeate many facets of healthcare. Cultural incompetencies and diversity issues combined with a shortage of healthcare providers in underserved minority communities add to the disparity in healthcare. 

One solution for the staffing issues, especially during peak ED hours, is to have a policy to address staff shortages, such as using agency nurses, float pool staffing. Having a safe nurse-patient ratio is essential to provide safe and competent care for the patients. Providing treatment in an efficient and timely manner is two of the six domains identified by the Institute of Medicine (IOM), Reducing ED wait times (Shen & Lee., 2018). According to the American College of Emergency Physicians  (ACEP) fact sheet on ER wait times, one of the reasons for the long wait times in ED is the critical shortage of staffing and an increase in the patients visiting ED. Fast track systems initiated by several emergency rooms are another way to decrease ED wait times (Wood, 2017). With this process, the provider-nurse team meets the patient at the first encounter to expedite the ER triage; labs or tests are ordered without wasting, which will decrease the wait time and improve turnover time.

Reference

Centers for Disease Control and Prevention. (2006) Recommendations to improve preconception health and health care—United States: A report of the CDC/ATSDR preconception care work group and the select panel on preconception care. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/maternal-infant-and-child-health (Links to an external site.)

https://minorityhealth.hhs.gov/assets/pdf/hhs/HHS_Plan_complete.pdf. (n.d.). https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=10

Office of Minority Health. (July 07, 2018.). Retrieved from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=2&lvlid=10

(n.d.). Retrieved from http://www.who.int/

Shen, Y., & Lee, L. H. (2018). Improving the wait time to consultation at the emergency department. BMJ open quality, 7(1), e000131. https://doi.org/10.1136/bmjoq-2017-000131 (Links to an external site.)

Wood, D. (2017, October 10). Nurses creating solutions for er wait times. https://www.americanmobile.com/nursezone/nursing-news/nurses-creating-solutions-for-er-wait-times/