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Patient safety in the hospital setting
Pillars of patient safety
Patient safety
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Recommended: Patient safety in the hospital setting
Preventable hospital admission is a key patient safety and quality concern. A major cause of preventable readmission is poor coordination and communication of care during transitions. Transitions beteeen settings are vulnerable periods for patients. Transition contains admission and discharge between skilled nursing facilities, long-term care facilities, acute care hospitals, and assisted living facilities. Indigent coordination between a cure setting and primary care provider can results in poor longitudinal planning. About 50% of patients go see their primary care providers within a two week time period after discharge. Comprehensive programs can improve care while transitioning between setting, which can reduce a thirty day hospital readmission.
Interprofessional teams in health care are considered to be one of the best approaches to improve patient outcomes. Interprofessional teams provide the means to integrate patient care with input from many different professional disciplines (Rose, 2011). Nurses are an important part of the interprofessional team, since they are often the team member that is closest to the patient (Miers & Pollard, 2009). I recently participated in a team that developed a work flow for daily readmission rounds. The team was interprofessional, the hospitalist, who was an APRN led the team. There was the case manager and the primary nurse who were both RN’s. The team also consisted of a resident, pharmacist, nutritionist, physical therapist, and social worker.
State and federal regulations, national accreditation standards, and clinical practice standards are created, and updated regularly. In addition, to these regulations, OIG publishes a compliance work plan annually that focuses on protecting the integrity of the program, and prevention of fraud and abuse. The Office of the Inspector General examines quality‐of‐care issues in nursing facilities, organizations, community‐based settings and occurrences in which the programs may have been billed for medically unnecessary services. The Office of the Inspector General’s work plan for the fiscal year 2011 highlights five areas of investigation for acute care hospitals. Reliability of hospital-reported quality measure data, hospital readmissions, hospital admissions with conditions
A transitional care nurse or nurse navigator could be utilized to assure a smooth transition from the hospital into the community. The nurse navigator bridges the gap between the hospital care and post-acute care, while working closely with hospital staff, primary care doctors, specialists and community resources (Lamb, 2014, p. 191). Following the client’s discharge, a home health nurse would assume care and begin coordinating services. This nurse would be responsible to assure that all the care services are in place and there is a smooth
This paper’s brief intent is to identify the policies and procedures currently being developed at Midwest Hospital. It identifies how the company’s Management Committee was formed and how they problem solved and delegated responsibilities. This paper recognizes the hospital’s greatest attributes and their weakest link. Midwest Hospital hired Dr. Herb Davis to help facilitate the development and implementation of resolutions for each issue.
At the multidisciplinary meeting, the nurse will collect and assess the information provided by the other disciplines and family members stating that the patient is not at her prior level of functioning and then analyze the information to develop a diagnosis of deconditioning. Next, the nurse identifies outcomes for the patient to get stronger, achieve prior level of function, have activities of daily living (ADL’s) met in a safe environment by planning for home health, equipment, and 24/7 supervision through family or placement in a facility. This will be implemented by coordinating delivery of a walker and a 3 in 1 chair prior to discharge to daughter’s home with the home health agency nurse, physical therapist, and aide scheduled to start that day. In a week, the nurse evaluates that outcomes are being met by following up with patient, daughter, and home health agency evaluating that the patient is getting stronger, ADL’s are being met, and will soon be able to return to living independently. To achieve these standards of practice, every nurse should be aware of her own nurse practice act to ensure to be functioning with in the laws of the nurse’s state and to ensure the best outcomes and safety of the patients. In closing, it is every nurses duty to be the best nurse they are capable of being by looking at the scope of nursing practice which gives us the framework to achieve
Hospitals recognized the need for the case management model in the mid 1980’s to manage the lengths of stay of hospitalized patients and the treatment plans (Jacob & Cherry, 2007). In 1983, the Medicare prospective payment program was implemented which allowed hospitals to be reimbursed a set payment based on the patient’s diagnosis, or Diagnosis Related Groups (DRG), regardless of what treatment was provided or how long the patient was hospitalized (Jacob & Cherry, 2007). To keep the costs below the diagnosis related payment, hospitals ...
Unsuccessful transitions of care are evident in the statistics related to hospital readmission rates. There has been a numerous amount of studies conducted to examine methods to prevent and improve transitions of care. Naylor et al. conducted a randomized, controlled trial for transitional care of older adults hospitalized with heart failure. While this study didn’t necessary focus on pharmacist interventions in transitions of care, it emphasized important points of transition of care that should be considered to reduce and prevent hospital readmissions. The study utilized advanced practice nurses to manage the elderly patient transitions from hospital to home. They were in charge of developing an individualized plan consisting of the schedule and content of patient care to manage heart failure, comorbid conditions and other health and social problems that contribute to poor outcomes. In another study, Halasyamani et al. developed a discharge
Many nurses face the issue of understaffing and having too much of a workload during one shift. When a unit is understaffed not only do the nurses get burnt out, but the patients also don’t receive the care they deserve. The nurse-patient ratio is an aspect that gets overlooked in many facilities that could lead to possible devastating errors. Nurse- patient ratio issues have been a widely studied topic and recently new changes have been made to improve the problem.
This report explores the importance of communication between nurses, providers and different departments play a crucial role in the safety of quality of patient care and their future health outcomes. When nurses give improper handoff’s the patient and the next nurse on shift will be left at a disadvantage. This can lead to further health complications and longer hospital stays for the patients and possibly death. The fairly new bedside shift report has been proven to catch mistakes during report and improve care in the hospital and for the future overall health of the client.
Confounding variables: Multiple confounding factors exist including the number of “float” RN staff available to supply the unit and the division of patient care between licensed staff and unlicensed assistive personnel (UAP). In addition, the skill set and educational background of the RN’s providing care on the unit are confounding variable that have the possibility to effect the study’s outcome. Patient’s consent is needed to access their medical record, and track outcomes
Through a non-experimental design, the authors analyzed data to determine whether full, reduced, or restricted practice rights for NPs affected the health outcomes of medicare and medicaid patients in those states. The type of NP practice allowed was compared to state rankings for avoidable hospitalizations, readmission rates after inpatient rehabilitation, and hospitalizations of residents of long term care facilities, as well as state health outcome rankings provided by the United Health Foundation. The authors performed a quantitative statistical analysis of previous studies done pertaining to outcomes of medicare and medicaid patients. To be included in the analysis, previous studies had to have a national scope but also provide a state ranking system and an explanation of how the ranking was performed. The authors performed two-sampled t tests on all data to determine if there was a correlation between autonomous NP practice and patient outcomes. The results of comparing potentially avoidable hospitalizations, readmission rates of rehabilitation patients, annual hospitalizations of long term care patients and overall state health outcomes between states with full practice and those without, showed that full practice produces more desirable outcomes. Potentially avoidable hospitalizations per 1,000 person-years in
Transition and handoff reporting are vital tools that are used by nurses in healthcare agencies where there is a continued need for improvement. After reviewing Handoff in Inpatient Surgical Teams, that was developed by the Agency for Healthcare Research Quality [AHRQ] as an educational tool to demonstrate the way a transition and handoff report should be given. The handoff that was exhibited was a great example of why a thorough and complete handoff is necessary. AHRQ Patient Safety (2016) displayed a rapport between the recovery nurse and the unit nurse, which was both professional and detail oriented; the receiving nurse made sure all aspects of the transition and handoff were covered before ending the conversation.
In the patient situation described, the nurse characteristics enabled improved patient care, by ensuring the family understood the true nature of B.H.’s medical status and her prognosis. Experience enables CNS’s to create strategies to provide specialty based anticipatory coaching (Spross & Babine, 2014). The use of caring practice created a trust with the patient and the healthcare team permitting the CNS to coach and guide the family to change B.H.’s code status to include withholding resuscitation. Collaboration allowed the family to be involved in B.H.’s care and clinical judgement allowed the CNS to coach the family into accepting a facility transfer for an opportunity for improved care
Smith,L.L.,Tayor ,B.B., Keys ,A.T .,& Gorto,S.B.[1997].Nurse-patientboundaries: Crossing the line. American Journal of Nursing, 97[12], pp 26-32.
Innovative Care Delivery Models are generally nursing driven, or they are interdisciplinary care delivery models that carry a heavy nursing component and in an acute care setting, including transitional care to home setting. The model should be state of the art, it should focus on improving care making it effective, and cost conscious, it should focus on new roles for nurses and other interdisciplinary members. The model should show measurable improvement in quality, safety, cost, and patient satisfaction. (Joynt and Kimball 2008) Accountable care organizations and Medical Homes are both examples of Innovative Care Delivery models at work. These models show collaboration between disciplines, working together to give the patient the best possible outcome is always the