Accreditation

                                       

     The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) sends shivers down the spine of health care workers and sends everyone running to lock med cabinets, cap IV lines, post all necessary signs, answer all questions with "Let me find that out for you" and cross all their T's and dot all their I's. But, wouldn't you rather be a patient at a hospital that was accredited by JCAHO?!

That's like going to a restaurant that is not approved by the Health Department. I was at a very popular Chinese restaurant in California years ago. When we were standing in line a huge cockroach came from the back and walked through the restaurant. Everyone just put their feet up on the table supports as a little old lady from the back came out with her rolled up newspaper and killed it. I can tell you that it didn't stop anyone from eating there.... including me and my friends!

                     

Things would be different for me now though! And, I certainly would not want to be a patient in a hospital that doesn't take safety and responsibility seriously.

The Joint Commission standards include topics such as cleanliness, medication safety, surgical safeguards, patient identifiers, quality improvement policies, infection control and medical response and alarms. Each one of these topics equates to patient safety and reduction in medical errors.

                                   

The math is simple, A (quality improvement) + B (Standards/Accreditation) = C (patient safety). Okay so this equation doesn't really have a positive outcome, but you get the idea.

I have spent the semester learning about how to provide the safest and best quality of care to my patients by striving to learn more on a regular basis, being knowledgeable about procedures and patient safe handling, and abiding by the rules and protocols set up for health care professionals. Accreditation puts a seal of approval on a hospital's activities to let the patient know that the hospital they are trusting with their care is doing all they can to provide the best care.

                                                    

It has been a great semester of learning and focusing on patient care as a trusted and important responsibility, not just another job. What a great opportunity we have as nurses to make a difference in the lives of others by taking our responsibilities seriously and always providing patient-centered care and focusing on the patient perspective. It has been so helpful to read through class material, especially case studies and be reminded of how important it is to stay alert on the job.

Thanks for a great semester!!! I can't believe I'm almost there!!!

                    

A Voice Heard...

                          

If you were given the wrong medication at the hospital.... wouldn't you want to know? If a mistake happened during your surgery... would you want to know why? If a doctor or nurse mishandled your procedure.... would you want to know what happened?

I would imagine that most people would answer "yes" to all of those questions. So let's ask these questions....

If you caused someone pain or made them sick ...  would you want the chance to apologize? If you made a mistake that affected someone else.... wouldn't you want to step forward, explain what happened, and apologize?

Again, I would think that most people would answer yes.

This week we learned about another aspect of Quality & Safety. We reviewed how medical errors affect those that were a participant in the error whether they were the patient or part of the healthcare team.

Through nursing school we have read many case studies about patients who experienced a healthcare error. We once participated in a scenario reenacting a lawsuit that took place against a nurse who made an error that cost a patient her life. My friend played the nurse on the stand. I felt so bad for the whole situation. I had so much sympathy for the patient and their family. What an incredible loss. I also felt sympathy for the nurse. She had dedicated her whole life to nursing. She was a really great nurse and person... but she made a mistake. People are hurt on both sides of the coin when an error in medicine takes place.

                      

We read and discussed a case study this week that involved an error in medication administration that almost cost a patient her life. When all was said and done, she just wanted answers but no one wanted to talk with her.
                     

There was one person who stood out and aside from the rest. He was the anesthesiologist that made the mistake. He felt the need to reach out to the patient and find healing for him and for her by apologizing and discussing the event. That connection was the beginning of healing and moving forward for the patient, anesthesiologist and for others like them.


                                

My take home from this lesson is threefold. I will strive diligently to provide safe and effective care for patients. I will always take responsibility for my actions. I will apologize and communicate with those that may have been wronged. Maybe one more.... I will remember that my patients are people that need to be listened to and heard.


One more week and then one more semester and it's OVER!!!! I will keep learning, I will keep reading. I will keep studying. I will keep improving!

                                 

Working Together.... Safely!

I loved the quote from the beginning of chapter 13 this week, it states:

"All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team, emphasizing evidence-based practice, quality improvement approaches, and informatics."

A vision for health professions education, articulated 

by the Institute of Medicine, 2003

Now don't you want the hospital you or your family will visit to abide by this precept.... I do!

Patients will receive excellent and safe care when everyone is working together and properly educated and up-to-date on best practice methods and procedures.

As we have been continuing to focus on quality improvement, this week's chapter covers educating health care workers on improving care where they work. I think new nurses or those who are continuing their education have an advantage in this area because we are in the process of learning more about our industry and how it can run more effectively and safely. It's not about going through the motions, it is about refining how the motions work in order to facilitate effective procedures and quality and safety in patient care. 

                              

The clinical microsystem involves the patient, family, care givers and other interdisciplinary team members. This is the core of patient care. This is where policies, procedures, safety measures and even hazards really matter. This is the target for improvement. 

                                                

We are taught from the very beginning in nursing school to look at our patients holistically. We can do the same with our job. Sometimes I walk away from work feeling like I am getting paid to be a drug pusher. I hate that feeling and that's the wrong perspective on the situation. On those particular days I can have up to six post surgical patients, most of which had their knees or hips replaced. They are in pain, they are hurting. 

                                         

I have had more success at work when I consult with more experienced nurses, the pharmacists and my supervisor in finding the best combination of pain control methods available to these patients. I have found that combining all our opinions, along with the patient's perspective, can effectively control pain, whether that be a certain combination and schedule of pain meds or other options like positional changes, ice therapy, and movement. It has recently been discovered that having patients walk sooner after hip and knee replacement surgeries can reduce pain substantially and aid in healing. Who would have thought that. But, by combining forces with several team members, this was found to be effective. 

I have and will continue to take what I have learned from this quality and safety class and apply it to my everyday experiences at work. We should always be moving in the forward and upward direction to do all we can to improve our skills, abilities and techniques in providing quality and best practice care for our patients!

                           

.....And just for fun ....

                                

This is how I felt on my first night solo when I received a new admit, my fifth patient, during the first hour on shift!

Errors & Near Misses

                              

A medical error is a preventable adverse effect of care, whether or not it is evident or harmful to the patient. This might include an inaccurate or incomplete diagnosis or treatment of a disease, injury, syndrome, behavior, infection, or other ailment.

This is Wiki's definition of a medical error.

Can I just say that I NEVER want to be responsible for a medical error that causes someone harm or worse yet, death!

We researched and reviewed errors this week for our Safety class. We read the story of a young mother who died as a result of care she received at a hospital. There are actually many stories like this and I think it is important that these stories get heard.

                                
Every time I read a story about an error in patient care that resulted in injury or death I am reminded of how important what I do and don't do are. As much as it is hard to read these stories it is so essential that they are in the forefront of my mind because I need to be ever vigilant in all my actions and procedures so I do not cause harm. I didn't get into nursing to hurt, I became a nurse so I could help. 
                               

Many errors that have occurred have resulted in a change in policy or procedure for patient care. These areas include trauma care, anesthesia monitoring, fetal heart monitoring, wrong site amputation or surgery, sponge counts, fatal allergies, potassium mishaps, decubitus ulcers, and lifting techniques. It is unfortunate that some patients and families suffered, but at least their suffering led to saving the lives of others. 

As nurses and professionals we have policies and procedures in place to protect our patients and ourselves from the adverse reactions of errors.... Follow them!!! Use the six rights of medication administration (right patient, right med, right time, right route, right dose, right documentation). There are things we can do to make sure we don't cause harm.

Even though I am new at nursing, here are some of my suggestions:

Slow down

Don't take any procedure or process for granted

If it doesn't seem right, feel right, look right.....ask for help!

When in doubt, look it up or ask your charge nurse

Listen to the patient and their family

Always assess

Take a step back and review

Always double check when it is required (and sometimes if it isn't)

There are many ways we can support our industry and provide patient-centered safe care. They are all available to us, but it is up to us to utilize what we know and reach out when help is needed. Safety saves lives and those lives are in our hands!

                              

The Golden Rule

                                       

Another week of learning about quality and safety. This is an area that should never get old. We can always strive to get better. This week's readings are entitled, "Assessing Risk and Harm in the Clinical Microsystem". This chapter reviewed the key components to reaching a goal in this area by:

1. Identifying Risk

2. Analyzing Risk

3. Controlling Risk

However, what I actually came away with this week was the importance of communication with and focus on our patients, their feelings and what they are experiencing both physically and emotionally. This became evident after reading our case study this week involving a medical error that cost a 15-year-old his life. Also, it was stressed in the article I read in the AHRQ's newsletter involving family and patient centered care.

My mother taught me a very valuable lesson when I was young and it has remained with me all these many, many, (many), years! Do unto others as you would have them do unto you!

                               

If we reversed our roles with our patients and put ourselves in their shoes, would we slow down? Would we take the necessary precautions? Would we listen more closely? Would we assess and intervene with more sincerity? We should!

Sometimes I find myself busy charting on the computer in the patient's room while they are talking to me. I know I'm busy, but I have been trying to make a conscientious effort to stop and look at them and listen with really intent. I want them to know that I am there for them.

                                       
I think if we can improve our communication skills and really apply our focus to our patients, following procedures would come more naturally. I don't know, maybe that's too simplistic or idealistic but shouldn't it be that way? Shouldn't we consider every patient, regardless of background, differences or worldly opinions, as though they were us or our close family so that we could treat them appropriately?

There are so many reasons for medical errors and sometimes it becomes a domino of small mistakes that lead to one great big one that causes harm. Quality and safety is about knowing your role, following guidelines and procedures put in place to steer clear of error, communicating with patients and other healthcare team members in assessing and intervening, listening and understanding patient needs and following through with appropriate care all the while remembering that the patient is our focal point.
                                       

I think this class is so important because in healthcare we must continually be reminded of the important responsibility we have to give patients the best care possible, the same care we would want if we were the patient. If we can keep that in mind, we will know what to do, when to do it, and what will be best practice.

                            

                                

The chapter we read this week is entitled, "The Role of Health Information Technology in Quality Improvement: From Data to Decision"

I have to hand it to those who are able to collect data from the hospital setting and display it in charts and graphs so that the information can be analyzed and areas of concern can be addressed. That is a hefty task. I expected to learn how this was done before beginning this unit and I feel that I have received a fairly sufficient overview. 

                                 

I learned that this system of data collection and decision making has it share of faults. It is dependent upon the human element for data collection. Some areas of concern are timeliness of reporting, bias interference, accessibility to data, differences in terminology or classification, finding relevant data and agreed upon interpret ability. There are also many forms of statistical analysis such as sampling or analytical approaches including classical statistics, event analysis, and data mining. Then there are different ways the information is shared and applied. 

                                                              

As I read through the chapter I thought about my anatomy class. They stressed and over stressed the importance of using the proper nomenclature in anatomy ensure that everyone, nation and worldwide, is using the same terminology. Then, you get out into the field and start applying all you learn and people use whatever terminology they want to use. So, it would be great if all companies would use the same system and report their data the same way, but in the 'real world' of things, that is not happening. That seems to be the biggest problem with streamlining data collection and analyzing that information for application in quality and safety.

                             

We are changing our computer system at work at the end of next month and I am hoping this will bring our hospital one step closer to a streamlined system of reporting. The system we use now is years and years old. For my nursing practice, I will do my best to utilize our computer charting system with the most accurate data I can give it. That is probably the best I can do to apply what I have learned this week to my career.

                   

Case Study Week #10 Telehealth Work Center

Telehealth

                                                             

A newly hired registered Nurse (RN) is assigned to work at the telehealth work center.  The RN is monitoring the in coming data from home-bound (based) patients from around the county, checking to see if there are any situations which require nursing interventions and taking the appropriate actions. One (1) patient is a type II diabetic. He reports his fasting blood sugar level of 54. Another patient who has congestive heart failure (CHF) and regularly reports in on daily basis does not send in any information (data).

• What is the best course of action for the RN to take regarding the diabetic patient?

• Assessing for symptoms
• Was any insulin administered prior to this result
• Have patient eat 15-20 grams of glucose or simple carbs to increase blood glucose
• Have him then recheck the blood sugar and provide updated information
• Advise small snack if he isn't going to eat within the next couple of hours.  
• What are normal parameters for this patient
• Diet history
• Follow up with diabetic education and nutrition information

• How should the RN proceed regarding the lack of information from the CHF patient ?  

                                             

• Contact the CHF patient
• If can't reach patient, contact emergency contact person
• Determine if this is an emergency situation or just a mistake in reporting from the patient
• Follow protocol for facility if this is an emergency

Telehealth: The Future of Medicine

Hmmmmmmmm.......................