SAFETY AND QUALITY

Kelly Ransom

The Joint Commission and the centers for Medicaid and Medicare services have placed clinical standards and specific guidelines related to patient safety, quality care and patient care. Being able to provide care safely and effectively to prevent costly medical errors is the main focus. The clinical standards give nurses and medical professionals with a lay out to go by to prevent "never events". Never events are identified as serious and costly errors in health care services that should never happen. According to CMS, never events are clearly identifiable, preventable and serious errors that harm the patient and reduce credibility of the health care facility. Of the care management events, giving wrong medications to the wrong patient and all medication errors. 

As a nurse in a long-term care facility, our main role is to pass their medications at scheduled intervals. The impact that it makes on our patients is to give medications related to medical conditions and how they affect the resident. We monitor our residents 24 hours a day with three different shifts. When passing medications, the five rights are followed. Right person, right route, right dose, right medication and right time. We had an event in our facility that five rights were not followed and two residents with the same last name were given the opposites medication. One resident had increased HR and blood pressure was lowered significantly and the nurse had to send resident to hospital for interventions. The resident survived and the nurse was terminated. Nurses should make decisions without rushing and without distractions. Using the five rights would prevent most medication errors.

Nurse specific challenges that are present in our facility is lack of communication and following up with orders placed. Also time, stress and fatigue are a few more challenges that are present. Nurses have the ability to speak up for their residents and communicate effectively with the providers. Being able to have adequate staff and staff following the same guidelines is also a challenge. This comes back to lack of communication and the barrier between agencies sending in nursing staff and not following facility policies. The organization faulters in the structure as more events can occur. When full time staff is in place, the facility can track such things as med errors, acquired pressure ulcers, falls, etc. and have care plans in place. The staff being able to follow the care plans has been difficult when there is not consistency.

References

Forster, A.J., Dervin, G., Martin, C. & Papp, S. (2012).  Improving patient safety through the systematic evaluation of patient outcomesLinks to an external site. .  Canadian Journal of Surgery, 55(6), 419-425.  http://doi.org/10.1503/cjs.007811

· Payne, D. (2014).  Elderly care: Reflecting on the ultimate ‘never event’Links to an external site. .  British Journal of Nursing, 23(13). 702.  http://doi.org/10.12968/bjon.2014.23.13.702Links to an external site.

· www.cms.gov