Adverse Event or Near-Miss Analysis - 5 pages

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SafeAssign Originality Report NURS-FPX6016 - Winter 2022 - Section 03 • SafeAssign Draft Review

%%45To t a l S c o r eTo t a l S c o r e:: High risk Stephanie Johnson

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Adverse Events

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Stephanie Johnson

Capella University February 13, 2022

Introduction

According to Centers for Disease Control and Prevention one among four adults who are older fall annually, one among the five falls re- sults into major injury. This paper is an adverse event of a comprehensive review during the professional writing career of the writer. The sce- nario gets to be analyzed professionally; evidence-based data becomes applicable to support a proposal for quality improvement with an ob- jective of decreasing the inpatient falls. Within this analysis, the hospital where this AE takes place will be identified as SRMC. Analysis of

an Adverse Event

Ms Linda happens to be a skilled nursing facility patient who is 70 years old. She was found wandering at the same time confused. The patient got transported to the facilities emergency room to have her abrupt change of condition assessed. Her medical recent history noted a complete surgery at the right hip in under two weeks before and got rehabilitation therapy. Ms Linda was diagnosed with kidney injury as well as severe sepsis all linked to an infection within the urinary tract. A certified medical assistant had her shifted from the emergency room into the general medical unit. After her arrival, CAN, took the room assignment from the nurse in charge before helping Ms Linda onto the bed. When CAN went back to the emergency room, a code blue got initiated in another’s patient’s room. Nurse in charge of Ms Linda was helping in the event. She got tangled in the bedding claiming her leg was hurt. After X-rays and examining the right hip, the results showed a fractured hip requiring surgical interventions. The Ms Linda fall was because of medical management and not sepsis, the underlying condition. As per the hospital protocols, the nurse upon arrival should complete a call evaluation at the general medical unit. The patient was all alone in her room without supervision, while the nurse was not aware of Ms Linda’s arrival. Deviations from the known admission protocol for new patients caused the AE. In the assessment stage, the missed steps are: · The nurse never got a call from the emergency room charge nurse be- fore discharging Ms Linda from the ER. · The patient had no one attending to her · Fall assessment never got completed · The patient could not reach the call light. Ensuring the established protocol regarding new patients’ admission is implemented would have had the adverse event prevented. Nurse lacked the details regarding the patient’s arrival, and the occurrence of the medical emergency delayed the admission as- sessment. If the Fall risk assessment was completed, it would have noticed Ms Linda to be a Fall risk. The same way, adverse effects like falls happen within various health-care settings like residential homes and nursing facilities. Report from Healthcare Research and Quality Agency states that 1.6 million residents of nursing homes, around 50% fall yearly. In addition, CDC have noted that out of four adults of 65 and above living at home, fall annually. Very small percentage reports to primary care giver. The fall impact cost an estimate of $50.0 billion yearly in healthcare. The long-term effects of the injuries, like being dependent, disability, absentia in work plus household tasks, minimizes the quali- ty of life. Information might have enhanced the analysis. Questions are left unanswered whether the transporting CAN should have waited in the room till completion of the medical emergency. Fall education knowledge gaps might exist in between organizational departments. Additionally, the staffing uncertainty in the night shift might have led to the lack of management on preventing the Adverse event (Lee, et.al,

2018). Implications of Falls for All Stakeholders

Every stakeholder experiences long and short-term ramifications die to inpatient falls. Patients suffer instant implications, like psychological and physical trauma plus pain. On top of a lengthy hospital stay, long term effects comprise of, community and personal loss of faith with- in delivery of health care. The discovery is that the AE involved interdisciplinary team suffers from depression, anxiety plus a life quality that is decreased. The health care experts might as well suffer social isolation, diminished professional confidence in addition to legal considerations. Hospital institution faces repercussions as well due to inpatient falls. The Medicaid and Medicare Services centers has inpatient falls in- cluded as a hospital-acquired condition that is non-reimbursable. The same way, additional extended hospital stays and extra resources to of- fer services for inpatient falls get included within the cumulative revenue loss. The hospitals might as well face a decrease in the staff morale resulting to loss of employees. Falls reflect system failures within organizational processes and structures. Evaluating the contribution of every stakeholder to the AE might enhance the safety culture of the hospital. Patients tend to have gaps within perceived fall risks plus falls commonality.

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Ms Linda has a changed perception because of confusion, a sepsis symptom plus being alone within a new area. The patient has an impaired ability to know the intense of leaving her bed without any help. Emergency room nurse gave report to her receiving unit colleague (Murphy, et.al, 2021). The fateful evening, newly hired CAN in the ER was in charge from a different department and was not aware of the ERs protocols regarding transport and patient attendance. The staffing supervisor measures might have had the AE prevented. The charge nurse in the ER should have oriented the CAN regarding the protocols of the department, especially in an emergency. Instant changes were some to the ER transfer protocols, staffing policy plus CAN orientation after the event. The staffing supervisors should confirm with CANs ability to operate on different units from the Unit director. CAN nurse and ER nurse get verbal confirmation from an ER charge in relation to completion of trans- portation call. Every CAN should have two days of a supervised orientation on all hospital units plus three ER days before working within different departments. Assumptions might be made that every health care staff intends to offer patients the best care. Every care giver wishes

the best outcomes without any patients falling. Evaluation of Technology Aimed at Increasing Patient Safety

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The technologies on quality improvement have been implemented to enhance patient safety plus prevention of inpatient falls. The SRMC facili- ty purchased beds having a three – mode sensitivity alarm for exit. It has also employed utilization of pads that are weight-sensitive which get placed on commodes, chairs, and beds. After activation of the device, an alarm sounds within the nurse’s station and patient room. The alarms for bed exit are situated under the patient’s buttock and shoulder level. This technology application for patients with decreased mobili- ty, changed mental status and frequent toileting plus falls history light increase their safety. Basic outcome measure to assess technologies happens to be incident rate per a thousand patient days for the patient falls, falls with crucial injury and falls with any given injury (Schildmei- jer, et.al, 2018). Inpatient rehabilitation, nursing facilities and hospitals may integrate extra solutions alongside bed exit alarms for fall preven- tion. Though most institutions use sitters, the video monitoring is most effective in minimizing inpatient falls. In addition, implementation of an assessment on a fall risk plus patient centered education is one that enhances patient safety. Relevant Metrics Supporting Need for Improve-

ment

Inpatient falls national benchmarks range from 3.44 – 11.5 falls per 1000 patients on surgical, medical surgical units plus general medical with approximated expenses of over $7000 for every injury. The rates of falls vary in hospitals by type of unit. Present fall rate on general med- ical unit at the hospital is at 7.6 falls/1000 patients in comparison to 1.3 falls/1000 patients at the intensive care unit, and the 3.4 falls/1000 pa- tients at the surgical unite. The SRMC falls metrics shows that the fall assessment device, patient safety procedures, policies, technologies plus fall prevention are unsuccessful. As per the SRMC and national data, AHRQ reports that in between 700,000 and a million individuals within US fall in hospitals. ⅓ of the falls can be prevented through managing the patients underlying risk factors of a fall, plus optimizing the physical de- sign of the hospital plus the environment. The General inspector’s office had a study demonstrating 13.5% of the Medicare patients experienc- ing an adverse effect that is preventable annually. The presented data is quite accurate. SRMC gathers falls data from electronic health records and the reporting system of the hospital. The data gets forwarded to the National Database of Nursing Quality Indicators. Lastly, the data becomes nationally available for validation of patient safety plus quality initiatives. Proposed Quality Initiative to Improve Patient

Safety

The element of safety culture is considered foundation of SRMCs program for fall prevention. Institutional wide education takes place during orientation of new staff plus during yearly competency blitz. The facility had Morse Fall Scale incorporated into the HER, for alerting every med- ical professional of any risk score. Now, reviews on post-falls are performed by different directors due to open positions for the Compli- ance Officer and Quality Director. There lacks a consistency standard in post-fall assessments. Extra inconsistencies from a fall protocol consti- tute of bed alarms, bed assignment plus nurse hand off amidst shifts. Rehabilitation and nursing facilities tackle the patient falls through use of comparable interventions. Use of fall mats, exit alarms and lowering of beds to the floor are popular interventions (Sobieraj, et.al, 2019). Present literature prices that having video monitoring on an inpatient fall program decreases falls while enhancing patient safety.

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The hospital showed a 100% fall decrement in the six weeks project, previous rate of fall was at 2.6 falls per 1000 patients. QI project con- stituted of staff education, VM implementation for high-risk populations plus reassessing the present fall protocol. VM related successful inter- ventions include behavior supervision, redirecting patients and having nurses notified through overhead paging system. The suggested solutions to minimize future hospital inpatient falls are, creating a practice team that is evidence-based to evaluate the present fall protocol plus processes. Second is evaluating whether bed plus alarm exit pads is appropriately employed consistently all over the departments. Third is use of evidence-based practice team in development of a VM program as am intervention of QI in fall prevention. Lastly, have the VM pro- gram outcomes measured through analyzing the fall rates, rule out the effective components then advance the essential processes (Murphy, et.al, 2021). Most healthcare institutions depend on alarms only in prevention of patient falls. Conflicting data like HACs non-payment by CMS, rates of falls plus consistent attempts in falls prevention is still in existence. Additional perspectives on enhancing patient safety plus decreas-

ing falls includes educating families and patients on falls. Conclusion

Patient falls are adverse events that can be avoided. The QI initiatives aid in preventing inpatient falls while enhancing patient safety. It is

essential to adopt a safety culture at an institution one involving family, support staff, patients, leadership plus the healthcare givers.

References

Lee, S. E., Vincent, C., Dahinten, V. S., Scott, L. D., Park, C. G., & Dunn Lopez, K. (2018). Effects of individual nurse and hospital charac- teristics on patient adverse events and quality of care: A multilevel analysis. Journal of Nursing Scholarship, 50(4), 432-440. https://sigmapub- s.onlinelibrary.wiley.com/doi/abs/10.1111/jnu.12396 Murphy, A., Griffiths, P., Duffield, C., Brady, N. M., Scott, A. P., Ball, J., & Drennan, J. (2021). Estimating the economic cost of nurse sensitive adverse events amongst patients in medical and surgical settings. Journal of advanced nursing, 77(8), 3379-3388. https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.14860 Schildmeijer, K. G. I., Unbeck, M., Ekst- edt, M., Lindblad, M., & Nilsson, L. (2018). Adverse events in patients in home healthcare: a retrospective record review using trigger tool methodology. BMJ open, 8(1), e019267. https://bmjopen.bmj.com/content/8/1/e019267.abstract Sobieraj, D. M., Martinez, B. K., Hernan- dez, A. V., Coleman, C. I., Ross, J. S., Berg, K. M.,. & Baker, W. L. (2019). Adverse effects of pharmacologic treatments of major depres- sion in older adults. Journal of the American Geriatrics Society, 67(8), 1571-1581. https://agsjournals.onlinelibrary.wiley.- com/doi/abs/10.1111/jgs.15966

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S o u r c e M a t c h e sS o u r c e M a t c h e s ( (3 73 7))

Student paper 68%

Student paper 100%

Student paper 73%

Student paper 64%

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Student paper

According to Centers for Disease Control and Prevention one among four adults who are older fall annually, one among the five falls results into major injury. This paper is an adverse event of a comprehensive review during the professional writing career of the writer.

Original source

The Centers for Disease Control and Prevention (CDC) report that one in four older adults fall each year, and one in five falls cause serious injury (CDC, n.d.) The following is a comprehensive review of an adverse event (AE) during this writer’s professional nursing career

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Analysis of an Adverse Event

Original source

Analysis of an Adverse Event

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Her medical recent history noted a complete surgery at the right hip in under two weeks before and got rehabilitation therapy. Ms Linda was diagnosed with kidney injury as well as severe sepsis all linked to an infection within the urinary tract.

Original source

Recent medical history noted a total right hip surgery less than two weeks prior and received rehabilitation therapy Ms Jones was diagnosed with severe sepsis and kidney injury related to urinary tract infection

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Student paper

The Ms Linda fall was because of medical management and not sepsis, the underlying condition.

Original source

The fall that Ms Jones suffered due to medical management rather than her underlying condition of sepsis

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The patient was all alone in her room without supervision, while the nurse was not aware of Ms Linda’s arrival. Deviations from the known admission protocol for new patients caused the AE.

Original source

The patient was left alone in her room with no supervision, and the nurse re- ported no knowledge of the arrival of Ms Jones Deviations from the estab- lished protocol for admission of new pts’ let to the AE

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If the Fall risk assessment was completed, it would have noticed Ms Linda to be a Fall risk.

Original source

Completing the fall risk assessment would have identified Ms Jones as a fall risk

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Student paper 64%

Student paper 77%

Student paper 81%

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Report from Healthcare Research and Quality Agency states that 1.6 million residents of nursing homes, around 50% fall yearly.

Original source

The Agency for Healthcare Research and Quality reports that of the 1.6 mil- lion nursing home residents, approximately half fall annually (AHRQ, n.d.)

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Fall education knowledge gaps might exist in between organizational departments.

Original source

Knowledge gaps in fall education may exist between departments in the organization

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Implications of Falls for All Stakeholders Every stakeholder experiences long and short-term ramifications die to inpatient falls.

Original source

Implications of Falls for All Stakeholders All stakeholders experience short and long-term ramifications because of inpatient falls

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On top of a lengthy hospital stay, long term effects comprise of, community and personal loss of faith within delivery of health care. The discovery is that the AE involved interdisciplinary team suffers from depression, anxiety plus a life quality that is decreased. The health care experts might as well suffer so- cial isolation, diminished professional confidence in addition to legal considerations.

Original source

In addition to a more extended hospital stay, the long-term effects include in- dividual and community loss of faith in health care delivery (2017) have dis- covered that the interdisciplinary team involved with the AE has been known to suffer from anxiety, depression, and a decreased quality of life Health care professionals may also suffer legal considerations, social isolation, and di- minished professional confidence

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Student paper

The Medicaid and Medicare Services centers has inpatient falls included as a hospital-acquired condition that is non-reimbursable. The same way, addi- tional extended hospital stays and extra resources to offer services for inpa- tient falls get included within the cumulative revenue loss.

Original source

The Centers for Medicare & Medicaid Services (CMS) have included inpatient falls as a non-reimbursable hospital-acquired condition (Hospital-acquired Conditions, n.d.) Similarly, the more extended hospital stays and additional resources to provide services for inpatient falls are included in the cumulative loss of revenue

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Falls reflect system failures within organizational processes and structures.

Original source

Falls reflect system failures in organizational structures and processes

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Student paper 64%

Student paper 74%

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Patients tend to have gaps within perceived fall risks plus falls commonality.

Original source

(2020) discovered that pts’ have gaps in perceived fall risks and commonality of falls

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The staffing supervisor measures might have had the AE prevented.

Original source

Measures taken by the staffing supervisor may have prevented this AE

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Every CAN should have two days of a supervised orientation on all hospital units plus three ER days before working within different departments. As- sumptions might be made that every health care staff intends to offer pa- tients the best care.

Original source

Furthermore, all CNAs must complete two days of supervised orientation on each hospital unit and three days in the ER prior to working in different de- partments Assumptions can be made that all health care staff want to pro- vide the best possible care to pts

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Evaluation of Technology Aimed at Increasing Patient Safety The technologies on quality improvement have been implemented to enhance patient safety plus prevention of inpatient falls. The SRMC facility purchased beds having a three – mode sensitivity alarm for exit. It has also employed utilization of pads that are weight-sensitive which get placed on commodes, chairs, and beds.

Original source

Evaluation of Technology Aimed at Increasing Patient Safety Quality Improve- ment (QI) technologies have been put in place to increase patient safety and prevent inpatient falls SRMC has purchased hospital beds with a three-mode sensitivity exit alarm In addition, the hospital also employs the use of weight- sensitive pads that are placed on beds, chairs, and commodes

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Student paper

The alarms for bed exit are situated under the patient’s buttock and shoulder level. This technology application for patients with decreased mobility, changed mental status and frequent toileting plus falls history light increase their safety. Basic outcome measure to assess technologies happens to be incident rate per a thousand patient days for the patient falls, falls with cru- cial injury and falls with any given injury (Schildmeijer, et.al, 2018). Inpatient rehabilitation, nursing facilities and hospitals may integrate extra solutions alongside bed exit alarms for fall prevention.

Original source

Bed exit alarms are positioned under the patient at the shoulder and buttock level Application of this technology for pts’ experiencing frequent toileting, decreased mobility, history of falls, and altered mental status can increase patient safety (Cournan et al., 2018 The primary outcome measure to evalu- ate technologies is the incident rate per 1000 patient days (PDs) for patient falls, falls with any injury, and falls with serious injury (Falls Dashboard, 2020) Hospitals, inpatient rehabilitation, and nursing facilities can integrate addi- tional solutions along with bed exit alarms to prevent pt falls

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Inpatient falls national benchmarks range from 3.44 – 11.5 falls per 1000 pa- tients on surgical, medical surgical units plus general medical with approxi- mated expenses of over $7000 for every injury. The rates of falls vary in hos- pitals by type of unit. Present fall rate on general medical unit at the hospital is at 7.6 falls/1000 patients in comparison to 1.3 falls/1000 patients at the in- tensive care unit, and the 3.4 falls/1000 patients at the surgical unite. The SRMC falls metrics shows that the fall assessment device, patient safety pro- cedures, policies, technologies plus fall prevention are unsuccessful.

Original source

Relevant Metrics Supporting Need for Improvement National benchmarks for inpatient falls range from 3.44 to 11.5 falls/1000 PDs on general medical, sur- gical, and medical-surgical units, with estimated costs exceeding $7000 per injury Falls rates in hospitals vary by unit type (Bouldin et al., 2013 The cur- rent fall rate on the GMU at SRMC is 7.6 falls per/1000 PDs as compared to 1.3 falls per/1000 PDs on the intensive care unit (ICU), and 3.4 falls per/1000 PDs on the surgical unit (SU) These fall metrics from SRMC suggest the tech- nologies, fall assessment tool, policies, and procedures for patient safety and fall prevention are not successful

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The presented data is quite accurate. SRMC gathers falls data from electronic health records and the reporting system of the hospital. The data gets for- warded to the National Database of Nursing Quality Indicators.

Original source

The data presented is relatively accurate First, SRMC collects falls data from the hospital reporting system and electronic health record (EHR) The national database of nursing quality indicators (NDNQI®)

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Proposed Quality Initiative to Improve Patient Safety The element of safety culture is considered foundation of SRMCs program for fall prevention.

Original source

Proposed Quality Initiative to Improve Patient Safety The culture of safety ele- ment is the foundation of the fall prevention program at SRMC

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Now, reviews on post-falls are performed by different directors due to open positions for the Compliance Officer and Quality Director.

Original source

Currently, post-fall reviews are conducted by various directors because of open positions for the Director of Quality and Compliance Officer

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Use of fall mats, exit alarms and lowering of beds to the floor are popular in- terventions (Sobieraj, et.al, 2019).

Original source

Utilization of fall mats, lowering the bed to the floor, and exit alarms are not- ed as common interventions

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QI project constituted of staff education, VM implementation for high-risk populations plus reassessing the present fall protocol.

Original source

The QI project included education of staff, implementation of VM for high- risk populations, and re-evaluating the current fall protocol

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The suggested solutions to minimize future hospital inpatient falls are, creat- ing a practice team that is evidence-based to evaluate the present fall proto- col plus processes.

Original source

Proposed solutions to prevent future inpatient hospital falls include forming an evidence-based practice team to analyze the current fall protocol and processes

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Student paper

Patient falls are adverse events that can be avoided. The QI initiatives aid in preventing inpatient falls while enhancing patient safety.

Original source

Patient falls are avoidable adverse events QI initiatives will help prevent inpa- tient falls and improve patient safety

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S., Scott, L.

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Scott, Jennifer L

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Effects of individual nurse and hospital characteristics on patient adverse events and quality of care:

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I am writing in regard to the article “Effects of Individual Nurse and Hospital Characteristics on Patient Adverse Events and Quality of Care

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M., Scott, A. P., Ball, J., & Drennan, J.

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M., Scott, A P., Ball, J., & Drennan, J

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Estimating the economic cost of nurse sensitive adverse events amongst pa- tients in medical and surgical settings.

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Estimating the economic cost of nurse sensitive adverse events amongst pa- tients in medical and surgical settings

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Journal of advanced nursing, 77(8), 3379-3388.

Original source

Journal of Advanced Nursing, 77(8), 3379-3388

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https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.14860 Schildmeijer, K.

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Retrieved November 19, 2021, from https://onlinelibrary.wiley.com/doi/full/10.1111/jan.14860

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I., Unbeck, M., Ekstedt, M., Lindblad, M., & Nilsson, L.

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S., Unbeck, M., Ekstedt, M., Lindblad, M., & Nilsson, L

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Adverse events in patients in home healthcare: a retrospective record review using trigger tool methodology.

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Adverse events in patients in home healthcare A retrospective record review using trigger tool methodology

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BMJ open, 8(1), e019267.

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2018;8(1):e019267

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I., Ross, J.

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Fleischman, Ross J

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Adverse effects of pharmacologic treatments of major depression in older adults.

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Adverse Effects of Pharmacologic Treatments of Major Depression in Older Adults

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https://agsjournals.onlinelibrary.wiley.com/doi/abs/10.1111/jgs.15966

Original source

https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1111/jgs.12440