WEEK 5 PROJECT/ Quality management plan controls

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MHC6303 WEEK 5 LECTURE

A Young Man in a Tough Job

Ken, a healthcare management professor, recalls a personal story that occurred years ago when he was working as a nurse's assistant while attending college. He worked the night shift, from 11:00 p.m. to 7:00 a.m., in a twenty-bed orthopedic ward of a not-for-profit hospital. The staffing never changed—one registered nurse and one nurse's assistant—but the workload certainly did. The patient census ranged from seven or eight to eighteen or nineteen. More importantly, the types of patients and their needs varied greatly. Most patients on the floor were hospitalized following orthopedic surgery, ranging from a young man hurt in a construction accident to elderly people recovering from total hip or knee procedures. Ken remembers that on some nights, it was quiet and he would sit at the nursing station, trying to read some schoolwork but often nodding off to sleep. Other night's patients required the assistance of one or two staff members to change positions or use the restroom. Managing staffing requires reviewing schedules and projecting needs based on acuity of care and numbers of patients. These are both important to prevent patient safety issues and aberrant quality of care events.

So far you have experienced events leading a patient safety issue. Next you will experience the actual event. Review the following for more information on this topic.

Resources:

Carayon, P., Wetterneck, T. B., Rivera-Rodriguez, A. J., Hundt, A. S., Hoonakker, P., Holden, R., & Gurses, A. P. (2014). Human factors systems approach to healthcare quality and patient safety. Applied Ergonomics, 45(1), 14. doi:10.1016/j.apergo.2013.04.023

One Bad Night

Ken remembers one very demanding night when he was literally running from room to room, his tennis shoes squeaking on the shiny tiles as he darted up and down the hospital hallway. That was the night his mistake harmed a patient.

He doesn't remember for certain why Howard was hospitalized. Howard was in his eighties and somewhat confused about time and place, but he was continent of bladder and would put on his call light when he had to go, which was frequently during the night. The care plan for Howard was to assist him to the toilet. He needed the assistance of one person with the aid of a walker.

Howard moved slowly. The process of helping him swing his legs from the bed to the floor, sitting him up, positioning the walker, going with him the few steps to the toilet, adjusting his pajama bottoms, steadying him as he urinated, helping him wash up, and returning him to bed could take five minutes or more. All the while, call lights would be going off up and down the halfway.

Ken knew that some of the other patients needed immediate assistance. He was frustrated but trying his best. One time, he decided to take a shortcut. He had Howard sit on the edge of the bed, helped him position the urinal, and said he would be back in a minute. Ken had taken no more than a couple of steps out the door when he heard a thud as Howard hit the floor.

Howard didn't just slump to the floor; he fell hard, striking his head. A large gash opened on his head near his temple, blood covering his face and the floor. Howard was conscious but barely alert. Fortunately, his injury wasn't worse. Howard was stitched up, cleaned up, and put back to bed. Ken never saw Howard again and never knew if there were lasting effects from the fall.

Now that the event has happened, identifying the root cause analysis is important to solving the "real issues. Review the following for more information on this topic.

Resources:

Weil, T. P. (2015). Patient falls in hospitals: An increasing problem. Geriatric Nursing (New York, N.Y.), 36(5), 342. doi:10.1016/j.gerinurse.2015.07.004

Taylor, D., Rizzo, C., & Liu, S. W. (2016). 270 exploring older adult emergency department fall patients' understanding of their falls: A Qualitative study. Annals of Emergency Medicine, 68(4), S105. doi:10.1016/j.annemergmed.2016.08.285

It Shouldn't Have Happened

The incident report was very clear. Ken had made a mistake. He should never have left Howard standing and unattended. Ken felt very bad about causing a serious injury to a patient, but he couldn't help feeling that it wasn't entirely his fault.

The hospital never made staffing adjustments when the workload changed. The nurse on duty rarely assisted with the self-care patients, concentrating instead on medications, intravenous systems (IVs), wound care, and documentation. Furthermore, Ken had never received training on how to prioritize work during busy work shifts.

The topic for this week is patient safety. You will consider issues of safety and quality, from individual cases to broad perceptions of healthcare quality. Focus on practices and procedures that enhance quality and prevent injuries from occurring in the first place.

Healthcare caregivers want to provide high-quality care, and they should not be placed in a situation where they are required to do more than they can. In the course project task this week, you will create a quality management plan. If Ken's hospital had implemented a safety improvement project that focused on patient falls, perhaps Howard would not have fallen on that very busy night years ago.

The concept of maintaining an ongoing environment of quality, patient safety, and performance improvement requires an ingrained way of thinking that influences how a person sees and understands patient safety and how a person acts. The integration of change to quality improvement in a well-managed healthcare organization focuses on teamwork that results when resistance among staff is overcome and the implementation process is enhanced. Review the following for more information on this topic.

Melnyk, B. M., & Newhouse, R. (2014). Evidence-based practice versus evidence-informed practice: A debate that could stall forward momentum in improving healthcare quality, safety, patient outcomes, and costs: Editorial. Worldviews on Evidence-Based Nursing, 11(6), 347-349. doi:10.1111/wvn.12070

Preventing patient falls. (2015). Association of Operating Room Nurses.AORN Journal, 102(6), P7-P9. doi:http://dx.doi.org.southuniversity.libproxy.edmc.edu/10.1016/S0001-2092(15)01011-X