Effective communication for positive patient outcomes in the hospital setting
Josie King, a one and half-year-old baby, died of dehydration and misuse of narcotics while in Johns Hopkins Hospital after suffering first and second-degree burns. Before this incident, Josie’s mother had reported that Josie’s eyes were rolling behind her head, and Josie always cried for drinks. This was a symptom of dehydration which the medical staff caring for Josie failed to notice. Besides, before administration of the narcotic, Josie’s doctor had given a contraindication to narcotic administration to her. However, even after Josie’s mother, Sorrel King told the nurse about this concern, the nurse still went ahead and administered methadone to Josie, which eventually led to her death. Such incidents often happen in our hospitals due to poor communication and failing to listen to and respect the concerns of patients’ loved ones as in the case of Josie.
According to Calder et al. (2017), effective communication practices are crucial for positive patient outcomes in the hospital setting. Clinicians should adhere to teamwork and effective communication with their patients and significant others; thus, reduce medication errors and consequently promote patient safety and effective practices. The “equal team member” model involves sharing of information with team members regularly which promotes communication in all directions, and ensures that all stakeholders, including patient’s relatives, are involved in patient care. This inspires all stakeholders to be alert and be able to detect and promptly respond to potential error signals, rather than dismissing them. Alomi et al., (2017), also argues that updating current medications is a vital step towards eliminating medication errors. The authors argue that an up-to-date medication profile should be written in a visible location on each patient’s file as an important safety measure.
Documentation in nursing practise should have clear, precise, and accessible patient information, which is a vital component of safe and quality patient outcomes. When patient’s relatives’ raise a concern about the safety of their loved one, nurses should document in the relatives own words.
References
Alomi, Y. A., Khayat, N. A. Y., Baljoon, M. J., Abdulraheem, Y., & Bamagaus, H. M. A. J. (2017). National Survey of Hospital Medication Safety Practice during Mass Gathering (Hajj-2016) in Makkah, Saudi Arabia: Drug Information. J Pharm Pract Community Med, 3(4s), s8-14.
Calder, L. A., Mastoras, G., Rahimpour, M., Sohmer, B., Weitzman, B., Cwinn, A. A., Hobin T., & Parush, A. (2017). Team communication patterns in emergency resuscitation: a mixed methods qualitative analysis. International Journal of Emergency Medicine, 10(1), 24. https://doi.org/10.1186/s12245-017-0149-4
Implementation of national safety goals to reduce harm to patients
In 2016, $146 trillion was used to cater to patient harm. 30-70% of these adverse events were possibly avoidable. Thus, healthcare needs to improve patient safety. To attain this, the organizational culture of quality care and patient safety, in which its leadership supports teamwork, attitudes, actions, and technology that reduce the risk of patient harm should be present. According to Danielson et al., (2019), error reporting, clinician behaviour, reduced mortality, and reductions in adverse events are all related to safety culture.
The Joint Commission institutes standards for ensuring patient safety in all healthcare settings through the National Patient Safety Goals methods and regularly revises these goals based on their effectiveness, cost, and impact. In our health facility, some of the National Patient Safety Goals that have been implemented include; prevention of hospital-acquired infections, promotion of safe surgery, and prevention of medication errors, pressure ulcers, and falls. Besides, according to Mascioli & Carrico (2016), prevention of inpatient suicide is one of the goals of National Patient Safety. In our facility, inpatient suicide is prevented thorough assessment of environmental risks and screening patients seeking services for behavioural health reasons on admission.
Prevention of hospital-acquired infections has been prevented by adhering to aseptic technique each time a healthcare worker attends to a patient. The WHO guidelines for safe surgery which include precise patient identification, surgical site marking, ensuring pulse oximeter is in place and working. Also, identification of patient allergies and any difficulty in breathing preoperatively have been implemented in our health facility. In the intraoperative phase, just before incision, all surgical team members verbally confirm the patient, site, and procedure. The nurse then re-checks for sterility of equipment as the anaesthetist reviews any patient-specific concern. The surgeon anticipates critical events, including duration, anticipated blood loss, and any difficulties that can be encountered. Post-operatively, the surgical team counts sponges, instruments, and needles and reviews patient recovery concerns. The leaders of our health facility show commitment to safety standards both in their decisions and behaviours. Besides, decisions that support patient safety are methodical, rigorous and comprehensive. Just and reporting cultures where healthcare workers are encouraged to provide safety-related information and report errors are encouraged.
The hospital administration collects data at every encounter with an admission to a hospital, a diagnostic procedure, or on an evaluation of in-patients. The results of the data revealed that hospital-acquired infections, falls and pressure ulcers and incidences of risky surgery had reduced tremendously since the implementation of safety standards.
References
Danielsson, M., Nilsen, P., Rutberg, H., & Årestedt, K. (2019). A national study of patient safety culture in hospitals in Sweden. Journal of patient safety, 15(4), 328-333.
Mascioli, S., & Carrico, C. B. (2016). Spotlight on the 2016 national patient safety goals for hospitals. Nursing2020 Critical Care, 11(6), 19-22.
Pain management
Pain is defined as an unpleasant sensory and emotional experience related to tissue damage or any other damage. Pain is subjective because no chemical can measure pain. In the United States, 20-30% of the population suffers from acute and chronic pain. There are several barriers to pain management in some health facilities due to patient and physician factors such as fear of causing addiction. However, nursing management of pain includes positioning, use of relaxation and breathing exercises, and music therapy.
In our unit, pain management policy is on the wall, an easily visible area. The nurses working in the group knew where the written policy was located. The pain management policy stated that every patient who experienced pain and any other distressing symptom should be relieved to improve the quality of their lives. The system also states that opioids should be prescribed for managing pain and relieving distressful symptoms in appropriate and adequate doses. The policy recognizes that pain is subjective; therefore; doses largely depend on the outcomes of interventions.
Before administration of any pain medications, physicians should take a comprehensive history that includes physical and medical history, treatment objectives, discussion of benefits and risks, periodic review, and the type and dose of medication. Besides, patient education on pain management is also documented in the policy. That is; empowering patients to control their course to the highest possible magnitude through breathing exercises and keeping the room silent. The pain management policy describes the WHO three-step ladder for pain management which includes management of mild pain with non-steroidal anti-inflammatory drugs, acetaminophen plus adjuvants. Combination opioids, tramadol and adjuvants manage moderate pain while opioids and adjuvants manage severe pain. The practice is based on current practice. Rosenquist& Ellen (2019) postulates that current pain management should include a thorough assessment of the patient and patient education on non-pharmacologic management of pain. Also, the precise prescription should be adhered to prevent opioid dependence and addiction.
The pain management practise supports a culture of patient safety and improved quality because it champions for pain relief for every patient experiencing pain. According to King & Fraser (2015), continuous unmanaged leading to suppression of the immune system; therefore; the patient is exposed to poor wound healing and vulnerable to infections. Besides, the prescription of analgesics is based on how the patient reports the intensity of their pain and the history of the patient. Also, the physician should encourage patients to control their pain as much as possible
References
King, N. B., & Fraser, V. (2015). Untreated pain, narcotics regulation, and global health ideologies. PLoS medicine, 10(4).
Rosenquist, M. D., & Ellen, W. K. (2019). Overview of the treatment of chronic non-cancer pain. UpToDate. Waltham, MA Accessed September, 26.