Clinical Standard Audit Essay

In accordance with the World Health Organisation (WHO 2008) checklist and Local trust policies, a team briefing was held before the day’s list started. The checklist is part of a second Global Patient Safety Challenge initiative entitled ‘Safe Surgery Saves Lives’, aimed at reducing the number of surgical deaths worldwide and was launched in June 2008. This not

My first encounter with a Certified Registered Nurse Anesthesia (CRNA) was during my undergraduate nursing OB/GYN rotation. I was impressed with the CRNA when she placed the epidural to the patient in labor. I remembered patient had difficulty staying still due to the contraction, but the CRNA took her time to explain the procedure while comforting the distressed patient. Once the epidural was in placed and the medication started working, I could tell the relief the patient experienced. I realized then that a CRNA goes beyond the delivery of anesthesia, pain management and monitoring of patients. Thus, obtaining this degree will prepare me to ease the patient’s mind through education, pain management, monitoring, experience and compassion.

The significance of the study is to discuss and clarify why bedside reporting is the best method of patient handoff. The benefits associated with this kind of bedside reporting and if implemented, how it will be of help to

Over the last 15 years or so a number of cases concerning patient care and safety have come to light prompting investigations and inquiries that have led to changes in the way care is delivered. These include inquiries at Winterbourne View hospital, Mid-Staffordshire hospital(Mid staffs) and Harold shipman to name a few.

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

Giving and receiving an incomplete or inadequate patient hand-off could mean the difference between life or death. In 2006, The Joint Commission addressed hand-off communication as a National Patient Safety Goal, and in 2010, the objective became a standard. However, evidence still shows there are gaps and that “substandard or variable hand-offs have contributed to errors, care omissions, treatment delays, inefficiencies from repeated work, inappropriate treatment, adverse events with minor or major harm, increased length of stay, avoidable readmissions, and increased costs” (Halm, 2013). The Joint Commission reported in 2017 that “ineffective hand-off communication was the cause of the majority of medical errors, including sentinel events” ("Inadequate Handoff Communication," 2017). The hospital I selected for my clinic hours uses a communication form that has not been updated in several years. These are the reasons why I chose to update and improve the current hand-off form for my sustainable product to promote better communication and increase patient safety. Furthermore, research proves that “successful hand-off improvement programs have the potential to substantially improve patient safety” ("Inadequate Handoff Communication," 2017).

A focused audit will be done on all patients undergoing operative or invasive procedures for the next year. Results will be analyzed by the nurse manager and discussed at staff meetings. Evaluation of compliance will be done at the staff meetings and any recommendations for improvement will be discussed and approved at these meetings. Implementation of any recommendations will be instituted the following month. Summaries of the audit and any recommendations for improvement will be sent to the PI committee on a quarterly basis.

Nursing handoffs is a type of report between two clinicians that are responsible for patients care and is an important part of transferring patient information (what, how, who and where) from one healthcare provider to another in clinical practice (Smith and Schub, 2014). Ineffective, inconsistent and incongruent communication during these handoffs continues to be a problem and a threat to patient safety. Effective handoffs are instrumental in providing for the successful quality of care that the patient is to receive (Abraham, Kannampallil & Patel, 2013). Medical errors, treatment delays, inappropriate treatment and/or care omissions can happen as a result of miscommunication during handoffs which could potentially lead to patient harm, longer stays, readmissions and/or increased costs.

Timing is everything when it comes to patient health outcomes. The purpose of this study is to provide a comprehensive review of the critical value reporting process critical results to the appropriate staff members according to the guidelines described in the National Patient Safety Goals (NPSG) of the Joint Commission Accreditation on Healthcare Organizations (JACHO). The Joint Commission has listed the following NPSG for 2015: identify patients correctly, improve staff communication, use alarm safely, prevent infection, identify patient safety risks, and prevent mistakes in surgery (The Joint Commission, 2015). A pathologist first introduced critical values by the name of Lundberg over 30 years ago. A critical value was viewed as an indication that the patient was in graved danger unless interventions were done to address the decline in health status (Plebani, M. and Piva E. (2010). The national patient safety goal that reflects the benchmark on our medical-surgical/Telemetry unit was staffing communication in reporting critical values. Our facility as a whole was at 73% compliance for staffing communication. Our hospital 's compliance goal for staffing communication is 90%. However, our unit is currently at 75% compliance. Various factors contribute to the timeliness and compliance of reporting critical values including work force, material and methods, and equipment.

At least half a million deaths per year could be prevented with effective implementation of systemic improvements in operating rooms. Specifically, multiple studies have found implementing the use of the WHO Surgical Safety Checklist would significantly reduce surgical morbidity and mortality due to surgical errors.

It has been proven that bedside handover with ISBAR has provided a safety transition and met patient’s satisfaction that gives more opportunity to clarify information (ACSQHC 2012). Although, bedside handover with ISBAR is strictly implemented, there are difficulties in the application due to ‘changes in complex social practices’ of the nurses that somehow limits its uptake (ACSQHC 2012, cited in Jeffcott, Evans & Cameron 2009). This literature review will provide a background and rationale as to the effectiveness of bedside handover with ISBAR framework in clinical settings; and to identify the common barriers to effective communication in bedside handover.

Medical auditors perform audits and reviews clinical documentations, physician billing records, administrative data, and coding records. They establish compliance within the industry regulations and maintain quality assurance. You can work at a medical facility along with other auditors, medical office managers or even an accountant.

Mr Johan experiences symptoms of panic attack when he feels self-conscious in front of other people when performing certain tasks. He reported feeling faint and had black out of thoughts during those episodes, whereby he was not able to think of anything. Both his hands would tremble and become numb. He would also be sweating but experienced no symptoms of pounding heart or choking

Clinical practice guidelines (CPG) are designed to improve the quality of healthcare services, decrease unwanted, ineffective and harmful interventions for patients. CPG are used to facilitate treatments for each individual patient’s by maximizing the benefits, minimizing the risk of harm and obtain treatment with an acceptable cost. Researchers had proven that CPG is a bridge for change and improving health outcomes. The effectiveness of CPG is perceived to be helpful in clinical decision making. CPG are developed to assist healthcare providers such as doctors and nurses in decision making for specific clinical outcomes (Vlayen, et. al. 2005)

As the recommendation has been established as best practice this chapter will propose a clinical audit to review the extent to which the recommendation is applied in practice. Practitioners have a responsibility to continually improve their standards of care (Nursing and Midwifery Council, 2010). Clinical audits are a valuable tool for professionals to monitor their current practice and promote improvements in care (Benjamin, 2008).