Category: Safety

Form selected

Informed consent refers to the process of interaction between a patient and a surgeon before a surgery or an invasive procedure (MAPS, 2016). More than 30% of Americans do not understand general medical information. An Informed consent form helps patients to understand critical health information before surgeries or invasive procedures. Not only does it help patients, it is the right of every patient to be provided with information before any procedure.

As such, the Minnesota Alliance for Patient Safety (MAPS) has developed an informed consent form to help improve patient understanding. The specified improvement is crucial since it allows making informed decisions and respecting patients right to accept or refuse the suggested care. Therefore, it is important that there should be understanding between a patient and a healthcare practitioner concerning the management of the relevant information.

Comparing MAPS Form with Pogzars Text

Pozgars (2016) text requires the practitioner to refer the patient to other specialists for specialist treatment in case complications arise during the main procedure. (Pozgar, 2016) This section of the text also requires the surgeon or doctor to explain the reason for the procedure, the expected outcome, and risk facing the patient undergoing the procedure. The Minnesota Alliance for Patient Safety (MAPS) informed consent form complies with these requirements as stated in Pogzars text.

According to Pozgars (2016) description of the requirements for the informed consent, it is crucial to include the essential information about the disorder from which the patient suffers. The identified element is present in the MAPS consent form since it requires to fill in the information about the reasons for being admitted to the hospital. Furthermore, the form compels the patient to confirm that they have got themselves familiar with the details of the procedure and, therefore, accept it (Pozgar, 2016).

However, the form does not allow indicating the details of the treatment, which seems to be a major omission. The form, however, includes the details such as the reason for the procedure, i.e., it sheds light on the purpose of the treatment in accordance with the template provided by Pozgar (2016). The statement concerning the patients awareness of the associated risks, as well as the alternative treatment methods, is included into the MAPS template, although it does not allow for a detailed description of the identified issues. The form also allows the patient to indicate whether they are aware of the prognosis of refusing from the treatment (Pozgar, 2016).

Likewise, the form can be used to show that the patient is fully aware of the nature of the suggested intervention. The form requires providing not only the signature of the patient and the physician but also the witness and, if possible, the interpreter.

The identified elements allow not only meeting the requirements and standards set by Pozgar (2016, p. 327), i.e., providing the patients signature and date, but also point to the fact that the process of verifying and confirming the necessary information is carried out according to the existing legal standards. The signatures of witnesses, therefore, make the consent form designed by MAPS a perfect example of receiving an informed consent from a patient before an invasive procedure or surgery (Pozgar, 2016).

Therefore, the MAPS informed consent form can be viewed as an important tool for receiving confirmation from a patient regarding their agreement to undergo an invasive procedure or surgery. While some of the elements could use more elaboration, the current consent form is rather adequate. It could be suggested, though, that the opportunities for describing the procedures and treatments, as well as their alternatives, to patients could be provided (Pozgar, 2016). Thus, with minor adjustments, the selected form can be utilized to receive an informed consent from patients before carrying out invasive interventions or surgeries.

References

MAPS. (2016). Informed consent. Web.

Pozgar, G. D. (2016). Pharmacy (12th ed.). Burlington, MA: Jones & Bartlett Learning.

Abstract

The article includes a succinct and clear abstract highlighting the studys background, purpose, methods, findings, and implications for practice. The background explains that perioperative RNs are well equipped to anticipate and address patient safety risks. Its purpose was to identify critical patient safety concerns from the perspective of RNs. The data collection method involved anonymous e-mail surveys of 3,137 RNs. The study found ten critical patient safety concerns that have implications for RN training and resource allocation.

Introduction

The research problem is clearly stated in the introduction. Statistics on the prevalence (30%) of adverse events in perioperative care settings and RNs role in managing patient safety concerns are utilized to form a cogent argument for the study. The problem is significant to nursing education and investment in perioperative care to improve patient safety outcomes. The justification for the study is that although RNs are accountable for patient safety in perioperative care, their high-priority safety issues are unknown. There are no hypotheses stated, but a study objective and three research questions are included in the paper. A theoretical or conceptual framework was not used; however, it is implied that understanding RN prioritization of patient safety concerns can help prevent adverse events through training and resource allocation. The implied framework is linked to the objective through a common variable  RN-reported high-priority patient safety concerns.

The literature review section is missing entirely. Nonetheless, the study uses relatively current resources published between 2001 and 2013 in the background and discussion sections. In the discussion, the review is logically organized into 10 patient safety issues. In the background, the review examines national healthcare quality initiatives and medical error statistics to support the need for the study. It clearly justifies the need for research on the perspectives of the nurses on the issues of patient safety.

Methods

The research involved a descriptive study design. This design fits the study purpose because it entails collecting data to describe high-priority patient safety issues from the perspective of RNs. Further, this non-Interventional approach depicts experiences or contexts as they are. The design links well with the convenient sampling approach (AORN member surveys), and statistical analysis (descriptive statistics) used to organize, tabulate, and present the data (pie charts).

The study used a convenient sample of 3,137 respondents drawn from a target population (AORN membership) of 37,022. The results section includes an adequate and clear description of the characteristics of the sample, including the respondents clinical settings, hospitals, hospital size, roles, experience, and educational attainment. A detailed convenience sampling procedure is discussed. It includes a well-defined criterion for inclusion (literacy in English and active AORN membership) and exclusion. The justification given for the sample size used is that only 3,137 returned surveys were useable.

The study protocol is clear and concise. It involved sending e-mails to 37,022 respondents in the AORN database. The e-mails included a link to an anonymous survey and an informed consent letter inviting eligible nurses to participate in the study. Ethical approval was sought from the universitys IRB. The respondents received a follow-up e-mail prompting them to participate. Returned surveys indicating the top five issues from a list of 20 were included in the analysis. The article describes a survey tool used as an instrument for data collection. Its conceptual definition as a tool for measuring rank-ordered patient safety issues is consistent in its operational definition. Thus, it measured the intended concepts, i.e., high-priority patient safety concerns as identified by the respondents.

The authors ensured the content validity of the survey tool through a pre-test involving experienced perioperative RNs and expert advice. The authors address threats to internal validity (selection bias and attrition) by using predetermined questions and sending e-mails to all AORN members. Threats to external validity are addressed by sampling respondents from five regions and different practice settings and with diverse educational preparations and experiences. Thus, the studys results could be generalized to wider clinical settings. The authors obtained ethical approval from the universitys IRB to use human subjects, implying that information pertinent to the research was disclosed to the participants prior to participation. There is no indication of any ethical issues. The study includes adequate details about the research process to allow other researchers to replicate the study.

Results

The characteristics of the sample are described using descriptive statistics. Attributes such as employment setting, location, job role, experience, and academic attainment are summarized in pie charts. The studys three research questions are answered in separate sections. First, the result section identifies the top patient safety issues from the data collected. Second, the top-rated issues by clinical settings and regions are presented using pie charts. Third, the high-priority safety concerns by RN characteristics are analyzed.

The type of data collected was quantitative  categorical data. In this study, data analysis procedures entailed descriptive statistics and Pearson chi-square tests. Descriptive statistics were ideal for summarizing, tabulating, and depicting RN characteristics  nursing role, experience, and academic attainment. Pearson chi-square test was useful in analyzing categorical (ranked safety issue) data by clinical setting, region, and RN attributes.

Data presentation involves tables and charts. Respondent attributes, regions, and clinical settings are summarized in pie charts, while high-priority patient safety issues are depicted in tables. The text in the results section supplements the data in the tables. It interprets and clarifies the meaning of the data summarized in the tables.

From the survey results, ten high-priority safety issues were noted, among them avoiding surgical mistakes (68.6%), medication errors, subnormal body temperature, etc. The results of descriptive statistics indicated that most (81%) participants worked in hospitals with a bed capacity of 200-499 beds (43%) and located in the Midwest (26%). The respondents were predominantly staff nurses or clinicians (45.9%) with over 15 years of perioperative care experience (71.1%) and had a PhD in other fields other than nursing (37.5%). The authors found differences in priorities by facility type (hospital versus ambulatory surgery center), region, and RN characteristics, i.e., education and role.

Discussion/Implications for Practice

In the discussion section, the authors attempt to relate their findings to the studys purpose and research questions. The discussion centers on the top ten safety priorities for perioperative RNs identified as per the study purpose and the first research question. The high-priority issues identified are discussed in relation to the respondents clinical settings and regions in line with research question two. Further, the relationship between high-priority issues and RN characteristics is discussed in line with last research question.

The findings of the study are consistent with those from previous studies. The most commonly reported adverse events to the National Quality Forum and The Joint Commission are among the safety issues captured in the studys findings. Tabulated resources with information on the perioperative safety issues support the studys findings. Although the authors indicate that the ranking of the high-priority issues differs from how the priorities are rated in the study, they do not explain how their findings conflicts with previous work.

Two major study limitations are noted in this article; however, the researchers do not discuss them in the context of practice or future research. The first one is that the studys convenience sampling approach could have affected the representativeness of the study sample since it relied on the AORN membership database only. The low response rate contributed to a low sample size (n=3,137). In addition, the sampling frame  data on all perioperative RNs in the US  was lacking. Therefore, it was not possible to tell if the sample bore all the characteristics of the population. The second limitation relates to the possibility that respondents were surveyed more than once.

The authors identify gaps in existing instruments for assessing pressure injuries that warrant new research. The studys findings have potential implications for nursing practice. The high-priority issues identified could be the basis for designing effective nursing academic programs and resource allocation to improve safety outcomes of surgical patients.

Overall Presentation and Final Summary

The title describes the major variables of the study, i.e., high-priority safety issues, and target population (perioperative nurses in the US). However, it does not indicate whether the type of study is qualitative or quantitative. The abstract provides an accurate and concise summary of the research. It captures the research background, purpose, methodology, findings, and practice implications as described in other sections of the article. The report follows a logical flow with clear chapter designations. It begins with the introduction and background to the study, which culminates in the research purpose and questions. The other sections include methods, statistical analysis, results, discussion, limitations, and the summary. The writing style is clear to the reader. The authors are objective and use evidence to support their assertions. The background is concise, providing only the critical information; however, the discussion section appears tedious.

Article Identification

• Flawed American healthcare delivery system.
• Not only a gap but a chasm.
• Technology provokes complexity.
• Changing public healthcare needs.
• No easy road for improvements.

The modern American healthcare delivery system is not perfect. Investigations developed by the US Institute of Medicine at the beginning of the 21st century proved that patient safety was a critical issue (Carayon et al., 2014). In this report, the authors admit to the existence of not only a gap but a chasm between what people have and what they could have (Institute of Medicine, 2001). Despite a number of positive aspects associated with technological progress, many healthcare facilities continue to experience problems and deal with complexity. Public healthcare needs are undergoing certain changes, and medical workers are having to work hard to achieve success. The authors of the chosen article identify organizational, management, coordination, and information challenges and explain that it is necessary to be ready to take a path toward improvement that will not be easy.

Description of Challenges

• Waste of resources.
• Countless coverage voids.
• Loss of information.
• Weak support for managers.
• Knowledge and training gaps.

The relationships between nurses and patients are not simple, and many challenges have the potential to occur in the modern healthcare delivery system. One example includes the waste of resources such as energy, equipment, supplies, and even ideas (Institute of Medicine, 2001). Despite numerous intentions to stabilize the conditions under which people can ask for help and care, the problem of coverage voids remains unsolved. Loss of information occurs, and managers suffer from weak support, training gaps, and a shortage of knowledge. The role of patients in such situations is not to keep quiet but to speak up about their concerns. Nurses have to be prepared to listen, promote cooperation between their patients and the medical staff, and search for solutions.

Explanation of Improvement Aims

1. Promote safety in healthcare facilities.
2. Keep services effective.
3. Support the idea of patient-centered care.
4. Introduce timely services and ideas.
5. Continue working efficiently.
6. Provide equitable care to all patients.

The relation between offered care and the outcomes that patients may observe presents a significant topic for discussion. The authors introduce six goals for improving the system, which can be easily applied to any kind of practice:

1. Safety is crucial for health care, and nurses should know how to help patients avoid injuries;
2. Effective services are the core of the care delivery system, and they are based on scientific knowledge and need refraining (Institute of Medicine, 2001);
3. Patient-centered care should be applied to practice because every nurse must recognize patients needs, preferences, and values to make correct clinical decisions;
4. A timely manner in service provision cannot be neglected, and nurses should avoid delays in their services;
5. Efficient services include care and help with no extra waste of equipment and supplies;
6. The provision of equitable care includes high-quality services free from prejudice regarding gender, ethnicity, or socioeconomic status.

Evaluation of Ten Rules

1. Healing relationships in care;
2. Customized care;
3. Patient as the source of control;
4. Exchange of knowledge and information;
5. Evidence-based decision-making;
6. Safe environment for patients;
7. Transparency;
8. Anticipation of patients needs;
9. Decrease of waste in healthcare facilities;
10. Cooperation between clinicians.

The care environment affects patients, nurses, and other practitioners. It motivates the participants, improves human well-being, and solves current problems and challenges. The Institute of Medicine (2001) introduces ten rules that can help make a successful redesign of the healthcare delivery system possible:

1. Continuous healing relationships are key in care. According to this model, a nurse visits a patient, reports on current health conditions, stays responsive, and offers different means of communication to make sure a patient and his/her family feel comfortable;
2. Customized care has to be promoted. A nurse should learn the needs and values of patients to inform medical workers about possible choices and preferences;
3. Patients should feel that they possess some control. Nurses must provide patients with enough information so that patients participate in decision-making;
4. Exchange of knowledge cannot be ignored. It is an obligation of a nurse to provide patients with access to their medical information;
5. Evidence-based decision-making processes are integral in health care. Nurses may share scientific knowledge to facilitate the work of clinicians.
6. A safe environment helps to reduce risks in healthcare facilities. The role of a nurse is to pay attention to patients and their physical needs and avoid errors in care.
7. Transparency of information is required. Nurses should include patients and their families in discussing care plans, alternative treatments, and clinical practices.
8. The anticipation of patients needs is a serious aspect of care. A nurse should cooperate with a patient, respond to demands, and make sure all information is properly understood.
9. Elimination of waste is recommended. Nurses must maintain awareness in their work and tasks to make sure that resources are not used in vain and patient time is properly organized.
10. A collaboration of clinicians offers the last chance to redesign modern health care. The exchange of experience, direct communication, and coordinated care must be developed in settings through regular meetings and the creation of special groups.

This model provides a good chance to improve care outcomes.

Determination of Principles

• Patients needs are recognized.
• Collaboration is promoted.
• Resources and outcomes are combined.
• Exchange of information is supported.
• Evaluations and improvements are observed.

A correct implementation of the ten principles can change the existing system. Patients can enjoy the outcome when all their health-related needs are recognized by nurses. Clinician collaboration is an opportunity to think about patients and their families. Patients are treated in a safe environment as resources are properly combined with expected outcomes. The exchange of information and evaluations determines the quality of care and provides patients with a chance to leave feedback and offer recommendations.

References

Carayon, P., Wetterneck, T. B., Rivera-Rodriguez, A. J., Hundt, A. S., Hoonakker, P., Holden, R., & Gurses, A. P. (2014). Human factors systems approach to healthcare quality and patient safety. Applied Ergonomics, 45(1), 14-25. Web.

Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Web.

Errors are a part of human nature. However, in the medical sphere, the price of human error can be too high, as patients and their lives depend on everyday decisions and actions that doctors and nurses make. According to the BMJ, medical errors are the third leading cause of death in the United States, right after cancer and heart disease. Standing at 250,000 deaths per year, medical errors managed to surpass respiratory diseases and now constitute about 10% of all deaths in the US (Makary & Daniel, 2016). As such, this is a serious problem that must be addressed on individual, hospital, and community levels. Studies identify several main reasons for medical errors. These are long duty hours, inadequate experience, inadequate supervision, and complex case scenarios, where errors are common (Bari, Khan, & Rathore, 2016). Nurses play an important role in healthcare and can affect patient safety on all levels. Thus, it is their duty to promote quality healthcare and reduce the possibility of medical errors. A nurse can improve patient safety through personal action on an individual level, through research and valid suggestions on a hospital level, and through political action on a communal level.

Individual Level Safety Strategies

In order to promote client safety strategies on an individual level, it is necessary to look at what constitutes the majority of medical errors, and figure out what could be done in order to improve the situation. Long duty hours affect the nurses in a negative way, reducing their attentiveness and making them more prone to error (Stimpfel, Sloane, & Aiken, 2012). The only thing that could be done on an individual level is to know ones limits and step aside when said limits are reached. Even the simplest medical procedures, when performed by a drowsy nurse, can lead to decreased efficiency and even danger.

Inadequate experience is the second cause of the medical error. Sometimes, new nurses have little experience with certain complex procedures that should be reserved for more experienced personnel (Bari et al., 2016). This can be remedied in two ways. A more experienced nurse can provide feedback and consultation in order to eliminate the chance of medical error. Alternatively, the procedure itself should be performed by a more experienced nurse in the first place.

Inadequate supervision relates to the previous two factors mentioned before. The nurse should always be alert not only to her own actions but to the actions of others. By forming a self-monitoring network among nurses, it would be possible to eliminate the majority of medical errors (Bari et al., 2016). Lastly, in the case of complex medical scenarios, a nurse should always request peer assistance and refer to more experienced nurses for help. A decision made together is less likely to be erroneous, as chances of spotting a potential mistake improve significantly.

At this stage of medical error prevention, patients play an important role. Instead of waiting passively for the medical personnel to make a decision, they should actively participate in the process. Being attentive to instructions, asking for explanations in regards to medical procedures and medications, and not causing any conflicts would significantly reduce the chances of medical error (Black, 2013).

Hospital-Level Safety Strategies

Hospitals implement a number of strategies that are aimed at preventing and reducing the number of medical errors. These programs are mostly aimed at preventing direct contamination of the patients from unsterile medical equipment, hospital discharge control, patient education, shift duration limitations, and effective management (Karla, Karla, & Baniak, 2013). The majority of healthcare facilities are aware of what is causing medical errors. However, the situation remains the same largely because these programs are not implemented widely enough. There are several roles a nurse could play in the implementation of these strategies. Being the front-line healthcare provider and having the most contact with the patients, a nurse can implement these hospital strategies directly and offer feedback on their implementation and effectiveness. Lastly, a nurse could propose changes to these strategies, based on personal experience and research.

Community-Level Strategies

There are several stakeholders involved in promoting patient safety strategies on a communal level. These stakeholders are nurses, government officials and legislators, hospital staff, and patients themselves. Each has a specific role in the process of healthcare. Nurses provide healthcare directly, hospital staff organizes the process, legislators provide laws under which hospitals operate, and patients are the recipients of medical care. On a communal level, a nurse can interact with patients during campaigns of patient awareness and exercise. By providing knowledge about patient rights, patient awareness, various diseases and afflictions that could be prevented, a nurse would indirectly affect medical error rates. The concept of preventive care resides on a statement that an illness is easier to prevent than to treat. By reducing the number of hospital admissions through preventive care, a nurse would reduce the chances of medical errors being committed.

Various nursing organizations play an important role in communication between other nurses, hospital staff, and communal legislative and political forces. There is strength in numbers, and promoting a healthcare-related initiative is much easier when there is an organization backing up a measure or a proposal. Nursing organizations have political weight and can promote change in hospitals or communities. Some steps that such organizations may take to reduce medical error is developed new guidelines and legislative initiatives to improve the quality of healthcare. Changing the medical system from 12-hour shifts to 8-hour shifts would also be a massive improvement, as nurse fatigue is a major source of medical errors (Stimpfel et al., 2012). In additions, nursing organizations serve as grounds for interaction and experience exchange between individual nurses. Learning from more experienced nurses offers an opportunity to grow as a professional and gain the experience necessary to avoid making medical errors in complicated situations. Almost every state has a nursing organization to represent itself, although the majority of them is concentrated around the countrys largest medical conglomerates and facilities. The most famous nursing associations in the USA are ANA (American Nurses Association), Academy of Medical-Surgical Nurses, American Holistic Nurses Association, Emergency Nurses Association, and others (North American nursing organizations, n.d.). Together, these associations are capable of promoting patient safety on all levels, ranging from individual hospitals and localities to state and even country levels. Although on this scale, the efforts of an individual nurse are not very noticeable, it is the communal effort that could bring massive changes in healthcare on a community level. All stakeholders mentioned above are interested in reducing the number of medical errors, as nobody is immune to sickness and disease. The real challenge is to come up with effective working strategies on reducing patient error and implementing them on a large scale.

References

Bari, A., Khan, R.A., & Rathore, A.W. (2016). Medical errors; causes, consequences, emotional response and resulting behavioral change. Pakistan Journal of Medical Sciences, 32(3), 523-528.

Black, N. (2013). Patient reported outcome measures could help transform healthcare. BMJ, 346, 167.

Karla, J., Karla, N., & Baniak, N. (2013). Medical error, disclosure and patient safety: A global view of quality care. Clinical Biochemistry, 46(13), 1161-1169.

Makary, M.A., & Daniel, M. (2016). Medical errorthe third leading cause of death in the US. BMJ, 353(2139), 15-23.

North America nursing organizations. (n.d.). Web.

Stimpfel, A.W., Sloane, D.M., & Aiken, L.H. (2012). The longer the shifts for hospital nurses, the higher the levels of burnout and patient dissatisfaction. Health Affairs, 31(11), 2501-2509.

Study of Factors

Medication errors are among the most widespread and potentially adverse safety issues that directly impact nursing practice, hospital revenues and expenditures, and patient satisfaction. According to Cheragi, Manoocheri, Mohammadnejad, and Ehsani (2013), 64.55% of the nurses who took part in their research have experienced medication errors, whereas 39.86% of mistakes were not repeated. The delivery of medications is a high-risk activity that can lead to various adverse consequences, including the increased length of stay, different comorbidities, additional costs spent on treatment, and, in some cases, fatal outcomes.

Nursing leadership can draw attention to this problem by emphasizing the importance of systems thinking. The prevalence of medication errors is directly related to other issues such as understaffing, high workload, the lack of training, unclear safety guidelines, and the unit environment (Frith, Anderson, Tseng, & Fong, 2012). In this case, strategic leadership (objective-oriented leadership) could help nursing professionals understand what aims they have with regard to medication errors (e.g., decrease the number of errors to 50% by 2018), how these aims can be achieved (ensure adequate staffing and training of newcomers), and what other issues need to be considered (reorganize the unit and the environment so that they support the clinical practice). The lack of policies regarding understaffing and time pressure directly relates to the greater number of medical errors; for example, the higher number of total hours per one nursing shift increased the number of medication errors made by nursing professionals (Frith et al., 2012). Therefore, it is obligatory to address understaffing, time pressure, and burnout in nurses at the organizational level to reduce the number of medication errors.

Recommendations

The recommended evidence-based strategy for the issue is a computerized provider order entry (CPOE). The strategy was proven to be effective by Radley et al. (2013) despite its modest adoption in American hospitals and clinics. CPOE can decrease the number of medication errors due to poor handwriting or wrong transcription; it also often includes information about dosage, harmful interactions, and clinical decision support (Radley et al., 2013).

To collect information about the safety concern, it is suggested to conduct monthly surveys among nurses and patients; surveys will contain questions about medication errors, their severity, and perceived cause. All surveys will need to be anonymous to exclude social desirability or any other bias. The surveys will be collected at the end of the month, analyzed by a nursing leader and a manager; its findings will be presented in the unit in written form and e-mailed to all nursing professionals. With the help of these surveys, the manager will be able to assess and find the most important perceived cause of medication errors and address it accordingly.

Implementation Plan

Quality indicators will include nurses adherence to the use of CPOE, the number of prescriptions provided via CPOE, and the number of medication errors made during the implementation period (six months; surveys will be conducted at the end of each one). To monitor outcomes, monthly data on the number of medication errors will be compared to the number of prescriptions via CPOE with regard to other factors such as possible understaffing, the length of nursing shifts, and the complexity of the patients case. The procedure of medication prescription will be changed; all nursing professionals will be required to use CPOE to provide patients with prescribed medications. Error increases will also be monitored like some of the studies report that the use of CPOE can make the number of medication errors greater in some cases (Radley et al., 2013).

Additional training will be required for the nursing staff as well. All nursing professionals will need to get acquainted with the four-step process of medication prescribing and administering (ordering, transcribing, dispensing, administration). Although CPOE-software is usually user-friendly, it will require five to ten training sessions so that the working process at the rehabilitation center can continue without severe disruptions due to nurses inability to work with the system. To provide sufficient training and improve the clinical care with CPOE, nursing professionals will need to visit several short lectures and three to five practical workshops that will focus on CPOE usage. Furthermore, the management also plans to send instructions for CPOE use to nursing professionals directly so that they can study those at any time suitable for them.

There are several limitations in the CPOE-approach. First, it increases the technology dependence of nursing professionals; any disruptions in the program will adversely influence the working process. Second, as was already mentioned, CPOE can increase the number of medical errors in some cases. It is suggested to use a clinical decision support system together with CPOE to avoid additional medication errors (Radley et al., 2013). Third, the implementation of CPOE might at first negatively influence the time of admission and discharge, especially during the first month of implementation, as the working process will adapt to the usage of CPOE on a daily basis. Fourth, there is no clear evidence that the use of CPOE can directly prevent patient harm, although it does decrease the number of medical errors approximately by 12% (Radley et al., 2013). Its effectiveness will be evaluated both by the manager and nursing professionals throughout the implementation process.

References

Cheragi, M. A., Manoocheri, H., Mohammadnejad, E., & Ehsani, S. R. (2013). Types and causes of medication errors from nurses viewpoint. Iranian Journal of Nursing and Midwifery Research, 18(3), 228-231.

Frith, K. H., Anderson, E. F., Tseng, F., & Fong, E. A. (2012). Nurse staffing is an important strategy to prevent medication errors in community hospitals. Nursing Economics, 30(5), 288-294.

Radley, D. C., Wasserman, M. R., Olsho, L. E., Shoemaker, S. J., Spranca, M. D., & Bradshaw, B. (2013). Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal of the American Medical Informatics Association, 20(3), 470-476.

Electronic Health Record (EHR) is a system used by primary caregivers to track a patients hospital history. On the other hand, workarounds are unapproved temporary healthcare practices that do not conform to workflow regulation standards. Practically, EHR is integral in promoting quality healthcare through informed decision making. Despite EHR playing a significant role in providing safe and quality services to patients, clinicians still use workarounds leading to undesired healthcare outcomes.

In most hospital environments, clinicians handle different duties at a time, which makes them prone to losing or distorting vital information about their patients. Therefore, adopting an EHR is important because it helps them record all essential information needed for correct diagnosis and dosage. According to Melton (2017), EHR is pivotal in decision support and medication documentation. This implies that primary caregivers benefit from EHR through proper communication, consistent policy implementation, and sustaining a given cultural practice, which helps achieve patient safety.

One of the workaround that most colleagues use is getting medication to patients who need emergency attention. In most scenarios, healthcare providers use workaround when their work is interrupted by the set EHR policies that endanger a patients life. This could explain why most colleagues prefer bypassing EHR protocols. However, there is evidence that workarounds are mainly adopted by clinicians who are not conversant with the set EHR regulations (Blijleven et al., 2017). Some of the expected outcomes of workarounds are giving wrong dosage and misdiagnosis. According to Blijleven et al. (2017), though workarounds can help caregivers in emergencies such as getting medication quickly during an emergency, it harms the efficiency, effectiveness, and patients safety.

In all, EHR plays an integral role in achieving standardization and safety in the healthcare industry. Through electronic capture of every detail of a patient, it can be easy to make sustainable medical decisions. However, following EHR protocols is impossible in some situations, which forces primary caregivers to bypass it. Though in some scenarios it helps, it has predominantly produced undesired outcomes.

References

Blijleven, V., Koelemeijer, K., Wetzels, M., & Jaspers, M. (2017). Workarounds emerging from electronic health record system usage: Consequences for patient safety, effectiveness of care, and efficiency of care. JMIR human factors, 4(4), 1-27.

Melton, B. L. (2017). Systematic review of medical informaticssupported medication decision making. Biomedical Informatics, 9(2), 1-7

According to the instructions, the patient should strictly take 1.5 liters of the fluid. Diuretic medication is key in managing chronic heart failure at stage three. The procedure is critical in helping patients with heart disease learn how to practice self-care and be responsible for their lives. The below is an outline strategy on how to administer medication to Jackson suffering from heart failure.

A four-prone approach can be implemented to help the patient adhere to the medication regime. Firstly, communication with the dietician is critical to understand the patients condition (OBrien and Greene 847). Through clear and open communication, the physician will understand the patient better and offer the right help. Secondly, monitoring will help the patient take the medication and record output for continuous care (Patel et al. Drug therapy in heart failure). For example, monitoring the edema status will help in managing the levels of the condition. Third, it will assist in educating the patient on how to take her medication. The patients should know the correct measurement of cups or glasses of fluid to take; hence, education is essential in administering the medication (Patel et al. Drug therapy in heart failure). For example, educate the patient to avoid taking food high in sodium. Four, encourage and offer behavior management to the patient. Patients usually lack the motivation to live and take healthy steps towards recovery. Therefore, it is important to encourage them to take their medication regularly as recommended by the physician (OBrien and Greene 847). For instance, make the patient adhere to the fluid measurement and take the medication strictly. Besides, encourage the patient to reduce fluid intake by managing behavior and controlling the available fluid. Through the four steps, the administration of the medication will be simple and patient-centered at stage three.

Works Cited

OBrien, Emily C., and Stephen J. Greene. Real-world evidence for medication safety. JACC: Heart Failure, vol. 7, no. 10, 2019, pp. 846-848. Web.

Patel, Pooja H., et al. Omecamtiv Mecarbil: A Novel Mechanistic and Therapeutic Approach to Chronic Heart Failure Management. Cureus, vol. 13, no. 1, 2021. Web.

Introduction

Infant health has always been an extremely important matter in the context of health care, as childrens early development catalyzes some major modifications in their future health conditions. For this reason, both practitioners and caregivers should pay attention to the environmental factors that may potentially affect the childs development and health. Such factors are not limited by their nature, as they tackle socio-economic peculiarities, health factors, and natural conditions surrounding the child. In terms of the present paper, the notion of air quality will be discussed as a major environmental factor impacting infants health and development. This problem was chosen due to its relevance regardless of socio-economic status and location, as everyone is affected by air pollution to a certain extent (Gouveia & Mascolli, 2018). The issues overview will include its description, methods of health and safety promotion, and resources aimed at assisting caregivers.

Factor Description

Prior to outlining the tangible methods to address the issue, it is necessary to dwell on its definition and manifestations both outside and inside a house. Thus, the notion of air quality stands for the condition of air in a specific area, considering the levels of air pollution of the amount of gases, dust, and fumes potentially harming ones health (Wolkoff, 2018). Air pollution may be generally divided into outdoor and indoor. Whereas it may seem that the outdoor atmosphere is more dangerous in terms of the pollutants exposed, indoor air pollution presents a bigger threat due to the lack of proper air ventilation. Moreover, the existence of many items that are rarely cleaned leads to the beneficial environments for pollutants existence within the house.

According to Carlsten, Salvi, Wong, & Chung (2020), the notion of air quality is extremely important in the context of infant care for the following reasons:

• The infants height is highly dangerous because they are exposed to heavy and harmful pollutants that exist closer to the ground;
• Their lungs and immune system are developing, which means that exposure to air pollutants harms the development patterns while presenting a threat that cannot be handled by infants body;
• At the stage of cognitive development, infants tend to touch a lot of items and put them in the mouth. As a result, they interact with toys and other items that are likely to have dust and other pollutants on the surface;
• Air pollutants are likely to cause a predisposition for allergies and asthma in the future due to improper lung development at an early age.

Health Promotion Plan

When discussing the issue of air quality promotion, it is necessary to divide the action plan for caregivers into two major parts: indoor and outdoor health promotion plan. According to Wolkoff (2018), as far as indoor air pollution is concerned, the following measures should be taken:

• Elimination of items and surfaces that are hard to clean on a regular basis. The house should have a surface without porous parts that contain much dust and pollutants;
• Air quality-friendly cleaning tools. When using toxic cleaning products, children become exposed to hazardous chemicals instead of dust, leaving the risk of allergies and asthma;
• Regular cleaning. The surfaces such as furniture and rugs should be cleaned every day;
• Air ventilation. The house should be ventilated at least twice a day. The best option would be to install an indoor ventilation system, but such an endeavor may be financially challenging. In the case of traditional ventilation, it is of paramount importance to check the air quality rates in the area prior to opening windows.

It is generally accepted that spending time outdoors is essential for a childs well-being. However, it is of paramount importance for the caregivers to be aware of the air quality hazards prior to taking the infants outside. According to Carlsten, Salvi, Wong, & Chung (2020), the following steps are to be taken:

• Caregivers are to check the air quality index when going outside with the kids;
• When taking infants for a walk outdoors, it is necessary to create an itinerary that avoids industrial areas or heavy traffic in order to prevent children from pollutants;
• When it is necessary to take a child outside on a poor air quality index day, it is recommended to use personal protection equipment (PPE).

Intervention

When dealing with air quality, caregivers should remember that the issue itself obtains a global character. As a result, besides being managed by the caregivers, air pollution should be primarily addressed by local policies and government because ordinary residents may only contribute to the issue solution. A proper intervention is required by the government because governors are public advocates obligated to provide families with a beneficial environment. Indeed, data shows that rapid intervention in terms of air pollution rate minimization eventually leads to better rates of childrens health in the community (Children and air pollution, 2020). For this reason, a primary suggestion to address the issue would be to resolve the problem of air pollution on a state level in order to mitigate the risks for average families within the area.

Accident Prevention & Safety Promotion

When following the advice created to secure better air quality, it is also necessary to make sure that the accident risks are minimized. Thus, for example, when ventilating the house, caregivers are to make sure that the windows are equipped properly to prevent fall risk. Another safety promotion aspect is choosing proper cleaning products with minimum odor. Considering the fact that the house should be cleaned on a daily basis, children should not be exposed to the constant smell of concentrated products. Finally, the notion of safety should go beyond ones home, as air quality is an issue that exists within every infants environment. Hence, when speaking of toddlers visiting kindergarten, it is essential to choose a facility that is not located within such hazardous areas as heavy roads and factories.

Community Resources

Community resources are extremely important in the context of air quality, as various organizations may be beneficial in terms of promoting the mitigation of air pollution and financial support aimed at creating a safe environment. Thus, when speaking of Broward County in Florida, an essential community resource is the Florida Department of Environmental Protection (WEBSITE: https://floridadep.gov/air-topics. USE: AIR QUALITY CHECK, COMUNICATION WITH PUBLIC SERVICES). Caregivers are able to contact this public organization anytime in case they have any questions concerning the air quality conditions in the area, means of air pollution protection. They may also report an issue concerning air pollution in their area of residence in order to raise public awareness and promote public action. Another important community resource is Floridas Office of Early Learning (WEBSITE: http://www.floridaearlylearning.com/parents/family-resources. USE: SAFETY TIPS, FINANCIAL AID RESOURCES). By contacting this organization, caregivers have the opportunity to find out the information considering the safety tools beneficial for infants as well as find the resources for financial aid in case they need assistance in order to secure a healthy environment.

National & Web-Based Resources

An important national resource in terms of air quality promotion and knowledge in the American Lung Association. This organization encompasses a number of clean air campaigns and relevant data concerning the safety of kids and adults. Thus, with the help of this source, caregivers can reach for assistance, donate money for the air-cleaning initiatives in the area, and access the most relevant data on air safety. As far as Web-based resources are concerned, caregivers should use online tools in order to be constantly aware of the air quality index outside. Caregivers are able to check the air quality of any location worldwide. The source also provides information on the statistics of the worst pollution indicators during the day.

Conclusion

Infant development and health promotion are undeniably essential in terms of a childs health pattern formation and future outcomes. For this reason, all the issues that might present a risk for the infants should not be ignored by the caregivers. This presentation was primarily aimed at defining the ways to eliminate the hazardous impact of air pollution on infant health. It was estimated during the presentation that monitoring air quality index, ventilation, and thorough cleaning served as the most efficient tools in the context of risk mitigation. Still, the notion of air pollution remains a public issue, so caregivers should be aware of resources that help them advocate for their right to raise children in a pollution-free community.

References

Carlsten, C., Salvi, S., Wong, G. W., & Chung, K. F. (2020). Personal strategies to minimise effects of air pollution on respiratory health: advice for providers, patients and the public.European Respiratory Journal, 55(6). Web.

Children and air pollution. (2020). American Lung Association. Web.

Gouveia, N., & Mascolli, M. A. (2018). Air pollution: An important threat to infant health. Bjog  An International Journal of Obstetrics and Gynaecology.

Wolkoff, P. (2018). Indoor air humidity, air quality, and health: An overview. International Journal of Hygiene and Environmental Health, 221(3), 376-390.

An acquaintance of mine had experienced chest pains and was referred to her GP for a check-up. The GP gave verbal instructions for a receptionist to make an ECG appointment within the earliest possible dates. The patient was promised to be contacted soon. The clinic did not contact my friend within the next two days, and she decided to call to clarify the ECG appointment. The receptionist had trouble recalling making the appointment; after that apologized for failing to arrange one and promised to call back. The next day, the receptionist contacted my friend and informed her that her ECG appointment was in two weeks. Ultimately, the ECG results did not indicate any heart impairments; however, such a delay might have been harmful to a patient with a severe condition.

The first factor contributing to this patient safety incident was the lack of properly embedded communication patterns in the healthcare organization since the GP failed to provide written instructions to the receptionist. Secondly, the incompetence of the receptionist, who neglected the patients appointments urgency, was a significant factor. Thirdly, impaired teamwork in the health care organization contributed to miscommunication and hindrance to patient safety. To mitigate the problem, one might recommend implementing electronic means of communication to record all instructions pertinent to patient procedures (Wu & Busch, 2019). Furthermore, it is encouraged to train the staff for a better quality of teamwork to ensure responsible and unified decision-making and prioritization of timely care delivery.

Thank you for your post and for sharing your experience with a patient safety issue. Indeed, understaffing is a significant problem in the contemporary healthcare system. Your recommendations are reasonable since they address practical ways of mitigating similar risks to patient safety through long-term goals. Moreover, I find it reasonable to refer to the organizational benefits such as reputation and image that might motivate healthcare institutions to improve their patient safety policies. However, the recommendations you have suggested seem to be far-reaching without properly identifying the appropriate ways to facilitate staffing and personnel distribution. Your recommended solutions might benefit from articulating the policy-making and addressing the causes of understaffing. Since burnout is one of the leading causes of increased intention to leave among healthcare staff, it might be beneficial to find ways of minimizing burnout in the teams (Hammig, 2018). In such a manner, the cause mitigation might help improve staff experiences and increase the level of patient safety.

Thank you for presenting your case and analyzing its implications for patient safety. You made it clear that the causes of the patient safety risks were related to insufficient staffing and poor information systems management. Indeed, the shortage of qualified professionals to conduct surgeries is a problematic issue that might be mitigated by utilizing payment encouragement. In addition, policymakers need to create a favorable workplace environment to engage a talented workforce in healthcare work (Hammig, 2018). In addition, as you have reasonably argued, digital system error is another vital aspect of care quality and safety since it might jeopardize the functioning of a whole unit. To expand your recommendation to substitute the system, one might suggest implementing an extensive training intervention. It would not only educate the staff on the proper usage of the new system but also on the ways it might help them cooperate as teams more efficiently (Wu & Busch, 2019). Thus, the long-term patient safety benefits will be promoted and ensured.

Reference

Hammig, O. (2018). Explaining burnout and the intention to leave the profession among health professionals  a cross-sectional study in a hospital setting in Switzerland. BMC Health Services Research, 18(1), 1-11.

Wu, A. W., & Busch, I. M. (2019). Patient safety: A new basic science for professional education. GMS Journal for Medical Education, 36(2), 1-15.

Introduction

• Topic: Collaboration to improve patient safety;
• Goals/Objectives:
  • Improve medication and diagnostic safety;
  • Prevent unnecessary hospital admissions;
  • Improve patient data privacy.
• Rationale:
  • Poor collaboration compromises patient safety (McVay, Stamatakis, Jacobs, Tabak, & Brownson, 2016).
  • Harm to patients.

My practicum project topic is Incorporating effective team collaboration to improve patient safety. Three goals guided the project: improvement of medication and diagnostic safety, prevention of unnecessary emergency department hospital admissions, and the enhancement of patients data privacy. These three goals are instrumental in the development of patient safety standards.

The rationale for undertaking the practicum project is rooted in the fact that about 25% of patients who seek medical or health services are harmed by poor healthcare systems (World Health Organization, 2019). This problem is further compounded by the lack of collaboration among healthcare teams, which makes it difficult for professionals to coordinate healthcare functions. Consequently, the practicum project plan seeks to change this outcome by improving collaboration levels among healthcare teams.

Methodology

• Observations.
• Focusing on human behavior.
• Verbal and nonverbal expressions.
• Insiders point of view.

The project setting was the healthcare environment where patients received emergency and medical services. As mentioned at the start of this presentation, the proposed intervention focused on improving team collaboration standards to promote safety standards. The linked data was collected by observing human behavior and verbal or nonverbal expressions of professionals working in the healthcare setting. From an insiders point of view, I was able to analyze the healthcare system and make recommendations for its improvement, based on key areas of healthcare system delivery that could be enhanced through collaboration.

Findings

• Enhance level of coordination.
• Share decision-making responsibilities.
• Promote cooperation among healthcare workers.
• Nurturing partnerships.

The observations I made during my practicum experience demonstrated that enhancing the level of coordination among healthcare teams was instrumental in improving patient safety standards. In this regard, there was a need for healthcare teams to collaborate with one another and nurture partnerships, which are not only beneficial to the administration of healthcare functions but also instrumental in creating a safe environment for patients to receive health services. This objective could be achieved by sharing decision-making responsibilities.

Review Procedures

• Peer review assessments.
• Appraising patient satisfaction standards.
• Comparing hospital admission rates.
• Reviewing patients feedback (McVay et al., 2016).

The review procedures that could be used to assess the practicum goals have been used in several public health studies, such as those authored by McVay et al. (2016). At an industry level, peer-review assessments could be done to compare how improvements in patient safety standards contrast with other health-based initiatives designed to achieve the same goal. Reviewing the level of patient satisfaction, through open feedback, is also another assessment method that could be used to assess the project objectives. This metric is instrumental in reviewing end-user views regarding changes in healthcare service delivery systems because high levels of patient safety improves patients satisfaction levels. Lastly, comparing hospital admission rates with historical figures is also a useful tool for reviewing the project objectives.

Potential Outcomes

• Create enjoyable healthcare environments.
• Improve patient safety levels (World Health Organization, 2019).
• Reduce worker absenteeism rates (McVay et al., 2016).

One of the potential outcomes that could be realized from the implementation of the practicum project recommendations is the development of productive and enjoyable healthcare environments. This outcome is beneficial to both patients and healthcare staff because increased levels of collaboration would create work harmony for teams who would, in turn, improve the quality of care offered. In this regard, implementing the findings of the practicum project could reduce worker absenteeism rates .

Implications for Practice

• Enhance organizational leadership capacity (Saravo, Netzel, & Kiesewetter, 2017).
• Minimize preventable harm.
• Support collaboration in the healthcare environment.
• Enhance the global push for universal health coverage (Pina et al., 2015; World Health Organization, 2019).
• Minimization of potential exposures to harm.
• A reduction of medical errors.
• Lower litigation costs (Dingake, 2017).

The views expressed in this presentation have many implications on the healthcare sector because the lack of effective coordination among healthcare staff is a systemic problem in many jurisdictions. The enhancement of organizational leadership capacity is a possible byproduct of implementing the findings because team collaboration should be enhanced through effective leadership. If this approach is adopted, there would be a decline in preventable harm and increased support for collaboration in the healthcare environment. Lastly, as different countries strive to attain universal health coverage, the findings of this study could help them to achieve this vision because patient safety is at the center of its realization.

From an organizational perspective, the findings of the practicum experience could impact the healthcare environment through a reduction of medical errors, which are common causes of patient safety concerns. In addition, they could help minimize potential exposures to harm, which is a key tenet of healthcare service delivery. Lastly, the potential for lower litigation costs is also a possible outcome because increased incidences of medical errors could force patients to seek legal redress.

Recommendations

• Supporting a safety culture.
• Adapt systems to detect errors.
• Improve medical error reporting.
• Routine monitoring of patient safety.
• Address root causes.

Based on the insights provided in this paper, the need for organizations to have a supportive culture for promoting patient safety should be emphasized. There is also a need to adapt existing care delivery processes to detect systemic errors because such incidences are often poorly diagnosed because of misinformation or the lack of sufficient data. This recommendation should be coupled with the improvement of medical error reporting procedures and the routine monitoring of patient safety standards. In this regard, there would be a low probability of undertaking superficial assessments because the root causes of the errors would be identified and patient safety improved.

Scholarly Products

• American Nursing Association (ANA, 2019).

The findings of this practicum experience are useful to the advancement of the nursing practice because the healthcare discipline is at the core of service delivery. Consequently, the findings could provide scholarly material that support the objectives of the American Nursing Association, which relies on evidence-based practice to advance the nursing profession and improve health for all. The American Nursing Association is the preferred organization for publishing the findings of the practicum experience because, for over a century, it has been dedicated to the improvement of healthcare and patient safety standards by representing the interests of registered nurses in the country. Based on the fact that the practicum project was centered on the observation of healthcare systems and processes, from a nursing perspective, the American Nursing Association emerges as a natural pick for disseminating the findings. The evidence published on this platform could later be used to expand the findings of academic research studies that focus on interdisciplinary collaboration in the healthcare setting. The outcomes of the process could also be published in nursing journals.

Synthesis and Conclusion

• Patient safety.
• Collaboration.
• Evaluation.
• Implications in practice.

Major advances in the nursing field and other tenets of the healthcare sector have been developed based on empirical findings in the medical setting. The pieces of information highlighted in this presentation come from the same methodology. Therefore, they are valid in informing practice. Collaboration is an important area of healthcare practice that has widespread implications on patient safety, but it is often ignored because it is difficult to bypass existing systems and procedures of healthcare service delivery without interfering with the functions of other healthcare departments. This challenge presents an accountability problem, which can only be addressed by examining the healthcare service delivery model as a chain of interconnected functions. This philosophy of analysis informs this study because collaboration is presented as an interconnected web of healthcare services. More importantly, the discussion has been broken down into four main sections: patient safety, collaboration, evaluation and implications on practice. Broadly, this presentation has highlighted patient safety as a major concern in the healthcare sector. The need for healthcare teams to collaborate effectively and minimize incidences of medical errors has also been assessed. However, for the best results to be realized, there needs to be a proper evaluation of the desired objectives to make sure that all teams work towards their achievement. This is the only way the recommendations outlined will have a positive impact on the healthcare practice.

Note

Presenting my practicum project plan required a comprehensive understanding of multiple issues, which influence care delivery in the healthcare setting. For example, the target audience had to be established in advance to tailor the messages to fit the appropriate context, as proposed by Alspach (2010), Tabak, Reis, Wilson, and Brownson (2015). In addition, the methodology used had to be acknowledged because the findings were developed in a context-specific healthcare setting. The distinction I made throughout the process of undertaking the project was to focus on safety concerns. There was also a deliberate attempt to link safety to systemic failures of the health care system through the actions of health professionals Therefore, patient safety issues that emanated from other aspects of healthcare service delivery were omitted from the discussions. In addition, when preparing the presentation, I strived to include relevant and important data to avoid laboring the audience with too much information. The objective was to present information in a simple and concise manner. Overall, the project gave me an opportunity to integrate academic learning in a practical healthcare setting. Therefore, the practicum experience was an important experience, as it helped me to observe and learn from different healthcare professionals that work in the nursing field.

References

• ANA. (2019). Nurses advancing our profession to improve health for all. Web.
• Dingake O. (2017). Human rights, TB, legislation, and jurisprudence. Health and Human Rights, 19(1), 305-309.
• McVay, A. B., Stamatakis, K. A., Jacobs, J. A., Tabak, R. G., & Brownson, R. C. (2016). The role of researchers in disseminating evidence to public health practice settings: A cross-sectional study. Health Research Policy and Systems, 14(1), 42-46. Web.
• Pina, I. L., Cohen, P. D., Larson, D. B., Marion, L. N., Sills, M. R., Solberg, L. I., & Zerzan, J. (2015). A framework for describing health care delivery organizations and systems. American Journal of Public Health, 105(4), 670-9. Web.
• Saravo, B., Netzel, J., & Kiesewetter, J. (2017). The need for strong clinical leaders  Transformational and transactional leadership as a framework for resident leadership training. PloSOne, 12(8), 1-9. Web.
• World Health Organization. (2019). Patient safety. Web.
• Alspach, G. (2010). Converting presentations into journal articles: A guide for nurses. Critical Care Nurse, 30(2), 8-15.
• Tabak, R. G., Reis, R, S., Wilson, P., & Brownson, R. C. (2015). Dissemination of health-related research among scientists in three countries: Access to resources and current practices. Biomed Research International, 5(2), 1-10.