Hospital Staffing Case Study Essay

There are a number of hazards in this case that deals with staffing, communication, and the hospital policies. Other contributing factors were the vital signs were not monitored properly on the patient and the patient did not receive oxygen or ECG monitoring after surgery. When the pulse oximeter started to alarm, the patient was not assessed. A complete review of the department’s staffing protocol, communication system, management style, and policy needs to be assessed for failures in the system. A manager was not mentioned in the incident and that is a major problem. The manager of the ED department should be available to assess the nurse patient ratio and monitor the department at all times.

The next part in the RCA process takes

The recommendations in this event would be to improve patient safety in the department, improve the post-op process, provide a post-op monitoring database, improve staffing protocols, and have the managers involved in monitoring staffing needs. There were several barriers that did not comply with the hospital’s safety standards. The improvement team would write a revision to the policy for monitoring patients after surgery. In the policy, managers must provide adequate staffing to ensure that all post-op patients are monitored per hospital policy. The new policy will enforce ED staff to be trained on the conscious sedation protocol and knowing when to call for help. There will also be a policy to have an adequate mix of staff with the proper training to handle the emergency patients. An example of a recommended change would be a policy in place for the nurse to stay with the post-op patient until the vital signs are stable, the patient is voiding, and fully awake. Also, the management staff must provide other staff members to handle the other patients coming into the ED

B, my team would use the Kurt Lewin’s theory to promote change from the improvement plan. The first thing that the team would do is call a meeting with all of the staff. In this meeting, the improvement plan and all of the data will be shared with the people. It would describe the event, what took place, the old system, and the new system that will be implemented. The staff would have time to see how the old system was a safety issues and all of the failures in the system would be discussed. An adequate explanation for the need to change the system would be given during the meeting. Next, the improvement team would provide informational seminars to support the people of the hospital during the transition. These seminars would explain the new policies and procedures. There would also be mandatory training for the staff to learn the new policies. A training manual would be made for all of the employees, and the education department would provide a trainer who is skilled in the new procedures. Every nurse, manager, and physician would receive training on the new post-op monitoring system for all patients. Furthermore, the new policy will have training on ways to provide adequate staffing and treating patients under the conscious sedation protocol. The training would go into details about monitoring every patient effectively until they are stable and fully