Discuss witnessed safety issues related to this goal
In my nursing practice, several safety issues are reported on a daily basis, and this affects healthcare and management of patients and the entire society. Some of the safety issues I have witnessed include;
Blood transfusion errors that are related to patient misidentification.
The NPSG.01.01.01 states that patients should be identified in at least two ways. Using the patient's name followed by the date of birth is very important. When the correct patient is identified, they all get the exact blood type during transfusion. Some of blood transfusion errors also occur during labeling of the specimen and use of samples from the wrong patients (The Joint Commission, 2017).
Poor communication among caregivers
In hospitals where there is infective communication among the caregivers, health tends to deteriorate. Patients are the most likely people to be affected by this because they are in the middle of health and the caregivers. Therefore, the NPSG.02.03.01 goal is to ensure developed written procedures to manage critical results of tests as well as important diagnostic procedures.
Poor safety of using medications.
In many hospitals medications used in various departments usually, have on them labels. Therefore, errors are likely to be noticed because patients get wrong medications for their treatments. When patients receive drugs that are not meant to treat their conditions, some of the end up becoming worse or even dying. It is always important to label all the medications including the containers, syringes, and cups to help reduce risks associated with safe medication management. Evidence-based practice (EBP) involves thorough investigations in the treatment of the patient. EBP improves everyday practice by the provision of functional data to guide in nursing interventions (Heather & Linda, 2016).
Healthcare transitions and policies
In my current setting of work, healthcare transition is well handled to ensure improved inpatient care and home care. Only a few cases of chronically ill patients have been reported because their conditions are controlled very well. Their conditions don't deteriorate and re-visits to the hospital are minimal. Re-hospitalization cases are few because communication and harmonization among the healthcare providers in my facility of work and the patients are highly maintained. There is also care navigation models that address and provides viable solutions to every patient transition which helps decrease the wide gap in the care provision. The Patient Protection and Affordable Care Act (PPACA) is one of the policies significantly used by my employer. He uses this to talk about the dispute of provisional gaps as well as increasing the charges by motivating guarantors and care amenities to help implement the transitional care programs and services. This policy is also applied in the facility to help reduce re-admission rates by decreasing hospital Medicare in all the discharge cases. This policy effectiveness was evidenced by emphasized communication and coordination between the caregivers and the patients that prevented high rates of hospital re-admissions (Moreno, 2014).
The facility also uses the transitional care model for the youths whereby it has targeted adolescents and young adults. Young people with chronic illnesses may arise with many challenges to their families, caregivers, and the healthcare system. Therefore, educational camps are always set once in a month by my employer to help the youths understand about condition-specific issues and self-management skills. Several nurses have also been trained by the hospital to help deal with adolescent based conditions, and this has helped improve health among the young people. EBP in this case has helped the nurses create a conducive environment for the young people to help in promotion of the culture of evidence-based decision making (Farokhzadian, Reza & Leila, 2017).
This project is aimed to help healthcare organizations evade communication-related misunderstandings and faults during the course of passing severe as well as necessary patient information from one physician to the other. Ineffective hand-off communication is documented as a dangerous patient well-being problem in health care. In about 80% of many significant therapeutic mistakes, are associated with poor communication between the nurses in the course of relocation of patients. When information is passed from one nurse to the next, by the time it reaches the patient, it tends to be misinterpreted which may cause harm to the patient, delayed treatment, wrong medication, and increased length of stay in hospitals. The effectiveness of Hand-off Communication project has been reported to have increased client and family happiness and fruitful transfer of patients from one hospital to the next. Reduced re-admissions have been reduced by 50 percent and minimal resources have been used.
I agree with the evidence provided because the project has facilitated the examination of various communication processes between two settings of caregiving. Facilities are also teaching staffs on how to constitute successful hand-off information which has provided real-time performance feedback to the healthcare system (Joint Commission Center for Transforming Healthcare, 2017).
National Database of Nursing Quality Indicators
NDNQIs are lawful signs of nursing because they help nurses achieve higher quality and more coordinated care leading to job satisfaction and creating a practice environment that is conducive to both the patient and the nurses. Nursing quality is measured by use of these indicators improving nurses' strengths of work and improving the reimbursement of current payment for performance policies. Hospital-acquired conditions have also been lowered following NDNQIs including the adverse side effects of the same.
This type of information empowers nurses because it provides plan and intervention for specific units that require improvement. NDNQI delivers clear evidences that support staffing and changes within an organization. Nursing workforce related to patient care is also measured via this tool making nurses improve their skills on how they handle patients because certification is also guaranteed (Press Ganey, 2013).
Lewis Blackman story (Case Western Reserve University, 2014)
Ketorolac short-term medication branded with the name 'Torodol' used to treat moderate to severe pain in adults. It should not be used to manage mild pain including chronic pain. Ketorolac is a potent NSAID that blocks both COX one and two reversibly preventing the production of prostaglandins (Russell & Ronald, 2014). The effects of this drug help decrease swelling, pain or fever.
In the management of moderately severe acute pain, intravenous ketorolac is given as 30 mg as a single dose or 30 mg q6hr for not more than five days. The patient should not exceed 120 mg daily (Aronson, 2014). A child receives a single dose of giving of 1 mg/kg intramuscularly or 0.5 mg/kg intravenously with a maximum of 15 mg. Ketorolac should not be exceeded than standard dosage because this reduces the efficacy of the drug, increasing the risk of adverse effects.
The patient experiences high chances of ketorolac side effects. Most patients report with signs of digestive disturbances such as peptic ulcer perforation as well as gastrointestinal bleeding (Aronson, 2014). There is also abnormal renal functions where the patient present with oliguria. This was the case with the patient in the case scenario who had reduced urine output. There is also high chances of hypotension and associated myocardial infarction.
The patient in the case scenario was given a four-dose adult course of ketorolac. The resident didn't appreciate the fact that the patient was not producing urine. During the surgical procedure, third-spacing of fluid is likely to occur resulting to renal hypoperfusion (Aronson, 2014) Therefore, the ketorolac administered was supposed to be given with a lot of care to avoid this complication. It is essential to pay attention to urine output and maintenance of renal functions. Ketorolac causes kidney failure where the patient urinates less than usual or nothing at all. Lewis, our patient, was likely to have been overdosed with ketorolac and fewer fluids given which led to dehydration followed by septic shock.
Dismissal for the undetectable blood pressure
Lewis having undergone an invasive surgery at 15 years old, the health care providers might have thought that he was still healthy. In their nursing care plan, they had written that the prognosis was a good outcome with no complications. Since our patient was being handled by a resident who was not well experienced in such cases, she might have missed the complexity in Lewis's case. All she might have thought is that the blood pressure machine had a problem demonstrating a mindset that there was no complication at all. I also would have thought the problem was with blood pressure machine because only in rare cases blood pressures are missed.
When the crisis developed
In many hospitals, care delivery is usually deranged during the weekends since fewer staffs are available. Care of patients is left to the residents and interns which makes it very hard to reach the senior physicians when needed. This makes it difficult for the fewer staffs to handle and detect such complications. Lewis's case is most likely to have developed on a weekend because during the weekdays it is not likely to miss an attending physician in the hospital.
The patient is likely to have died of septic shock which is a life-threatening condition that leads to organ dysfunction. It occurs in patients with infections or associated circulatory abnormalities like Lewis, the patient. Patients with septic shock have persistent hypotension where the arterial mean pressure is not maintained (Singer, Deutschman & Annane, 2014). The signs and symptoms of septic shock range from moderate sepsis to severe sepsis. Most of the symptoms are usually non-specific such as fevers and chills. The patient is also confused with difficulty in breathing, nausea, and vomiting. The blood pressure is decreased, and temperatures shoot very high. It is caused by a gram-positive bacteria although fungal organisms could also be a cause.
Septic shock is diagnosed by changes that occur in the microvascular that are not explicitly manifested in the vital signs. The clinical examination might also not detect the presence of septic shock. In clients with septic shock, cardiac and blood pressure readings are accurately observed. Laboratory analysis such as complete blood count and blood chemistry are essential for diagnosis purposes. Management of septic shock has several goals. The first goal is to initiate antibiotics, the broad spectrum type as early as possible. Correction of hypoxia, hypotension as well as hypoperfusion is the second goal. Organ system maintenance is also a vital goal to monitor cardiovascular progress (Vallet, Pinsky & Ceconi, 2013). Many cases of septic shock have been reported in patients who have used ketorolac drug with high mortality rate cases.
Characteristics of Helen Haskell attributes to a "good" or professional nurse/Physician
A respectable nurse ought to have achieved enough teaching and tutoring about emergent cases. They should have the ability to recognize and rescue any patient with distress. They should have critical thinking skills to help manage patients to avoid misdiagnoses cases. A good physician is goal oriented with good behavior and knows what the importance of quality care t...
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