1.Identify and discuss the Clinical Practice Issues of concern in Betty’s Care during her Hospitalisation.
2.Identify all National Health and Safety Standards that have been breached in Betty’s care and discuss how these standards have been breached.
3.From the list of identified National Health and Safety Standards you have identified in question 2, choose two (2) standards, and discuss how those 2 standards could have been maintained by the healthcare staff in the delivery of care to Betty and her family during her hospitalisation.
4.Based on your 2 chosen standards, what recommendations would you make for changes to health care practice at the ward level? Support your recommendations with rationales supported by evidence-based literature.
1.Betty has been admitted to the hospital care unit due to the fact that she has been suffering from breathing trouble and chest congestion. After she was admitted to the hospital, the immediate diagnosis declared that he has been suffering from pneumonia. The major clinical practice issues, in this case, is due to the fact that Betty is an aged individual and she is currently suffering from multiple medical concerns including hypertension, asthma, osteoarthritis and hypercholesterolemia.
It can be said in the context that most of the people are not able to get the proper forms of medical treatment on several occasions due to age related complications (Ackley et al., 2016). After her diagnosis was done, she was admitted to the respiratory ward of the hospital. The ward of the hospital has four beds and the aged lady was given the bed at the extreme corner of the room. This will raise the clinical issues due to the fact that it will not be possible for the lady to move freely. Moreover, as the location of the bed is much away from the nurse’s wards it may not be possible for them to provide with immediate care during the time of emergency.
It is also important for the nurses to keep a well-maintained track and record of the medication that has been provided to the patient (Alkon et al., 2016). Nevertheless, in the given case it has been seen that the nursing staffs are not able to remember about the medication that has been provided to the patient. The medication chart is one of the important medical records that are needed in case of all future references for providing medical treatment. In the given case, the lack of the medication chart is one of the major clinical issues. Moreover, due to her age, it may not be possible for Betty to keep a track of her mental health. Hence, the clinical issue in this context is due to the fact that the nurses have to keep a track record of the activities of the patient (Camicia et al., 2013).
It has been seen in the case that the nurse had not given the extra care that is needed to deal with Betty in order to deal with the mental disturbance issue. It was important in these cases for the nurse to provide the mental support and assurance to the patient that can help them during the time of recovery. Due to the negligence of the nurse, Betty had to suffer the consequence of laceration and suffer from high level of bleeding. This also resulted in the hip fracture of the patient that was diagnosed from the X-ray report of the patient.
After considerable discussion with the patient’s daughter, the doctor had decided to conduct a surgery for the fractured hip of the patient. However, four days after the surgery was over, it was noted that the patient has not displayed much sign of improvement. On the contrary, it was observed that bad odour was spreading from the surgical site. Hence, it can be said that decision of conducting the surgery owing to the condition of the patient was not done in proper manner. The clinical condition of the patient worsen due to the fact that proper care was taken for the recovery of the patient during the period of post-surgery.
2.The standards of the National Health and Safety Standards have been issued by the health care department of the Australian government. This was done in collaboration and coordination with the group of the judicial commission along with that of the stakeholder groups of healthcare (Gulanick& Myers, 2013). The main purpose of these health standards is to ensure that quality and safety standards of the health care are being maintained and it is possible for the patients to get the best quality of healthcare service. It is also possible to monitor the organizational performance of the healthcare sector and also that of an individual nurse with the help of the parameters of these standards (“Accreditation and the NSQHS Standards | Safety and Quality”, 2017).
The standard 3 of the National Safety and Quality Health Service Standards is about “Preventing and controlling of Healthcare associated infection”. This will help to ensure that the patients are kept in the neat and healthy environment can prevent the risk of disease from being spread. In the given case study, there has been a clear breach of this standard. It has been seen that there has been seen that in spite of her vulnerable condition Betty has not been kept in the clean and safe environment within the hospital.(“Australian Commission on Safety and Quality in Health Care”, 2017). Safety measures also were not incorporated during the time of surgery that had resulted in the worsening condition in the post-surgery period.The standard of preventing falls and harm from the falls also has been violated in the context due to the fact that the patient has suffered from the accident during the night time. This is also the clear violation of the standard 10 and 9, which is “Preventing Falls and Harm from the falls” and “Recognizing and responding to Clinical Deterioration in Acute healthcare”(“Accreditation and the NSQHS Standards | Safety and Quality”, 2017).Due to the violation of these code of conduct, it was not possible for Betty to get the best care from the administration of hospital. This is due to the fact that the nurses have not been able to respond properly according to the deterioration of the mental condition of the patient.
The standard 4 is about “Medication Safety”. It is important for the nurse and the health workers to keep track of the medication that has bee provided to the patient that can help them as the reference source for future treatments(“Australian Commission on Safety and Quality in Health Care”, 2017). In the given case, however, the nurses have violated the protocol of this standard by not keeping a note of the medication that was given to the patient at the emergency ward.Proper documentation of the medication can also ensure that safety is being maintained while prescribing to the patients. The patient also needs to be informed about the medication that has prescribed. This will ensure that the patient will be aware of the side-effects that are associated and thereby able to take proper intervention steps(“Accreditation and the NSQHS Standards | Safety and Quality”, 2017 and Standard, 2012).
In the given case, it has been seen that the nurses have not followed the steps of the proper identification. It is the duty of the clinical leaders to specify the needs of the individual patients according to their current medical condition. The nurse has not been able to identify the case ofBetty and also the critical nature of her medical condition. This will not allow the nurse to provide the right kind of intervention measures that are needed. Without the process of patient identification, it may not be possible for the health workers to properly match the needed requirements of the medical treatment process (Castellan et al., 2016).
The breaches within the clinical process and also within the safety process have comprised the level of quality health service for the case of Betty(“Australian Commission on Safety and Quality in Health Care”, 2017).
3.It is important for the healthcare centres to avoid the breaching of the healthcare code in order to ensure the safety of the patient.
In the case of Betty, one of the major breaches that have been identified is the lack of patient’s safety from the nurses and other healthcare workers. In the given case, there has been a clear breach of the standard 9 and 10 of the National Health and Safety Standards. It is important for the nurse of an organization to respond to medical deteriorated condition of a patient. This can be achieved by regular monitoring process of vulnerable patient. (Morton et al., 2017). The health care organization needs to implement the special policy that will ensure that none of the patients had to suffer due to negligence. There are various patients admitted to the hospital, who are more vulnerable due to their age related issues and physical or mental challenges. Hence, they are at the risks of facing worse medical condition. Special care also needs to give for the patients, who are being admitted to the emergency ward with critical condition. Moreover, due to the high-pressure situation of in the emergency department, it may not be possible for the nurse to keep a track of the medical treatment that is being provided to the patients. Hence, it is important for the hospital management to allocate the skilled and experienced nurse to perform the duty in the emergency ward. The nurses and the healthcare workers need to have the skill of maintaining the record that can be used in cases similar to that of Betty for future purpose. From the sides of the management of the hospital, it is necessary for them to improve upon the infrastructure related to the healthcare information system. This will help the nurse and other healthcare workers to have the ability to keep track of the medication that is being given to the patient. The nurses also need to have sufficient knowledge about the use of the medication and also the proper dosage that is necessary according to the current and past medical condition of the patients. They also have to provide the efforts for the aged individuals like the case of Betty, who is also suffering from the mental disorders. The healthcare organization need to appoint mental health care nurses, who will have the ability to make the patient feel comfortable with the hospital environment. It is important from the perspective of the hospital to invest in awareness and training program for the nurses. This is one of the important steps for improving up on safety skills within the hospital working staffs (Boyd& Sheen, 2014).
The breach within the safety is also associated bridging the conduct of preventing fall and the harm associated with fall. In the case of Betty, this thing is mainly applicable due to her age and the risk of fall that is associated due to her age and limited functioning ability. It is important to follow all the major safety protocols in order to minimize the harmful effect associated with fall and injuries of the patient within the hospital (Moorhead et al., 2014). It is important to keep all the vulnerable patients like aged individuals under 24-hour strict surveillance. This will ensure that they do not have to carry out any movement activities on their own. The nurses should have improved level of communication in order to understand the exact requirement and trouble of the patient. This will help them to provide maximum assistance.
Nevertheless, in many cases like that of Betty, it is not possible for the patient to properly communicate with the attending nurse due to the mental stress and poor mental ill condition. Hence, it is important for the hospital to recruitment mental health counsellors, who will have the ability to properly communicate with the patient and also understand their exact mental and physical condition. In the given case, it was seen that the patient has been kept in an isolated bed away from nurse’s ward. Hence, it is important to plan properly about the location of the bed in the hospital, which will ensure that all beds are easily accessible to the nurse and allow them to immediately intervene during the time of emergency (Doenges et al., 2014).
There are various risks that are associated with fall. This includes the risk of injuries, bone fracture and muscle cramps. For aged people any minor injuries can we prove fatal due to the fact that their body does not have the capability of full recovery. Proper documentation of all the risks that are associated with the fall is also and necessary intervention that needs to be implemented. There also should be a strict protocol for all nurses who are responsible for monitoring the condition of the patient. The bed of the patient especially the aged individual should be designed in a proper manner in order to avoid the risk of fall (Vandervoort et al., 2014).
The fall prevention plan is one of the important accessory official steps that are needed in order to deal with the harmful consequence and injuries that can compromise upon the health condition of the patient. Proper equipment and instruments are the basic infrastructures that the Healthcare institution need to have in order to provide full assistance to the physically disabled patient, like that of Betty that can help them to prevent the consequence of fall. Quality management planning is also an important part of fall prevention that the patients are provided with immediate health care support in the emergency department during any unprecedented accidents. With the help of the proper documentation, it is possible to prepare and advance planning and duty allocation of the nurses, which will help the hospital management to identify any negligence during the time of the accident with the patients (Elo, 2017).
Hence, with the help of proper documentation and nursing protocol guidelines, it is possible for the Healthcare Institute to use relevant literature for helping the patient get the best quality of health care service.
4. In order to implement the changes in the policies for preventing any Healthcare breach, it is important for the hospital to properly monitor all the activities of the nurses and other Healthcare workers. The management of the hospital needs to implement proper monitoring system in order to evaluate the performance of individual nurse (Lehne& Rosenthal, 2014).
This thing can be achieved with the help of patient survey, where every patient and the family will be enquired about the experience they have gained from the health care service of the hospital and also the behavior of the nurse and Hospital staffs (Brazil et al., 2017). From the guidelines of the nursing protocols, it is clear that proper training and guidance should be provided to every nurse in order to ensure that they are able to properly communicate with the patient and their family and also understand their needs. They also need to have professional guidance in order to avoid all type of negligence is that can compromise upon the health condition of the critical patient. They also need to have the skill of proper data documentation that can help them to ensure full safety of the patient and use all their information of medical history for providing future treatments (Magrabi et al., 2013).It is important for the hospital to keep proper documentation of the National Health and Safety Standards that can help them to deal with the all the major challenges in the healthcare service. This will also help them to easily monitor the breach within the standards that can compromise upon the quality of the healthcare (Matney et al., 2016).
References
Accreditation and the NSQHS Standards | Safety and Quality.(2017). Safetyandquality.gov.au. Retrieved 19 August 2017, from https://www.safetyandquality.gov.au/our-work/assessment-to-the-nsqhs-standards/
Ackley, B. J., Ladwig, G. B., & Makic, M. B. F. (2016).Nursing Diagnosis Handbook-E-Book: An Evidence-Based Guide to Planning Care.Elsevier Health Sciences.
Alkon, A., Rose, R., Wolff, M., Kotch, J. B., & Aronson, S. S. (2016). Health and Safety Checklist for Early Care and Education Programs to Assess Key National Health and Safety Standards.Maternal and child health journal, 20(1), 114-127.
Australian Commission on Safety and Quality in Health Care.(2017). Safetyandquality.gov.au. Retrieved 20 August 2017, from https://www.safetyandquality.gov.au/
Boyd, L., & Sheen, J. (2014). The national safety and quality health service standards requirements for orientation and induction within Australian Healthcare: A review of the literature. Asia Pacific journal of health management, 9(3), 31-37.
Brazil, K., Carter, G., Cardwell, C., Clarke, M., Hudson, P., Froggatt, K., …& Kernohan, W. G. (2017). Effectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial. Palliative Medicine, 0269216317722413.
Camicia, M., Chamberlain, B., Finnie, R. R., Nalle, M., Lindeke, L. L., Lorenz, L., …& Jones, T. (2013). The value of nursing care coordination: A white paper of the American Nurses Association. Nursing outlook, 61(6), 490-501.
Castellan, C., Sluga, S., Spina, E., & Sanson, G. (2016). Nursing diagnoses, outcomes and interventions as measures of patient complexity and nursing care requirement in Intensive Care Unit. Journal of advanced nursing, 72(6), 1273-1286.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2014).Nursing care plans: Guidelines for individualizing client care across the life span. FA Davis.
Elo, A. (2017). Designing a Nursing Care Plan Application for Nursing Education in Finland.
Gulanick, M., & Myers, J. L. (2013).Nursing Care Plans-E-Book: Nursing Diagnosis and Intervention.Elsevier Health Sciences.
Lehne, R. A., & Rosenthal, L. (2014).Pharmacology for Nursing Care-E-Book.Elsevier Health Sciences.
Magrabi, F., Aarts, J., Nohr, C., Baker, M., Harrison, S., Pelayo, S., …& Coiera, E. (2013). A comparative review of patient safety initiatives for national health information technology.International journal of medical informatics, 82(5), e139-e148.
Matney, S. A., Dolin, G., Buhl, L., & Sheide, A. (2016).Communicating nursing care using the health level seven consolidated clinical document architecture release 2 care plan.CIN: Computers, Informatics, Nursing, 34(3), 128-136.
Moorhead, S., Johnson, M., Maas, M. L., & Swanson, E. (2014).Nursing Outcomes Classification (NOC)-E-Book: Measurement of Health Outcomes.Elsevier Health Sciences.
Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017).Critical care nursing: a holistic approach. Lippincott Williams & Wilkins.
Standard, Q. I. G. (2012).Australian Commission on Safety and Quality in Health Care.
Vandervoort, A., Houttekier, D., Vander Stichele, R., van der Steen, J. T., & Van den Block, L. (2014). Quality of dying in nursing home residents dying with dementia: does advanced care planning matter? A nationwide postmortem study.PloS one, 9(3), e91130.
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