Prospective Auditing Case Study: How Nurses Turned The MRSA Outbreak

For example, a hospital-wide policy can be made making it mandatory for all critical results to be documented and reported within the hour. Attestations can be put in place for all hospital staff to sign, holding them responsible if policies are not followed. Another suggestion would be to have all critical results reported to two sources, for example the patient’s nurse and charge nurse, to increase the likelihood of rapid documentation. The point of the corrective actions is to ensure that each staff member knows what they are responsible for. For example, laboratory staff knows to document the critical values and alert the appropriate nurse or charge nurse, the nurse or charge nurse knows to document the critical lab values or test result and to alert the ordering physician, the ordering physician knows to discuss a treatment plan with the patient and to document appropriately in the chart, etc. The point is, every staff member has a role to play in assisting the hospital in becoming one hundred percent compliant. This corrective action plan holds each staff member accountable. Those who do not comply can easily be tracked and disciplined by their supervisor.

Managers also inform Specialist personnel who include the Health and Safety Executive, the Department of Health and the Infection Control Doctor. The Specialist personnel such as The Infection Control Team, then inform the media if the case is in the public’s interest for example if it was a case of HIV, Swine Flu or measles. The Non-Care staff, such as a Domestic Assistant, needs to report anything they have seen or heard during work to the nurses.

Providing the best care to each patient starts with providing the proper amount of staff members to each unit. Looking at the needs of different units not only allows administration to see areas for improvement, but also areas that are being handled correctly. Utilizing the indicators provided by The Joint Commission, 4 East, a pediatric medical/surgical floor, has a high rate of falls and nosocomial pressure ulcers that appears to be related to the increase overtime nurses have been working for that floor (Nightingale, 2010). Research has shown increases in adverse events have been related to nurses working over 40 hours a week (Bae, 2012).

As a result of this project, I have made an audit tool for myself as nursing supervisor to complete every two weeks. I will check the EMR to make sure the medication list was reviewed accurately and I will check to make sure the patient education tool added to the resources is being given to all patients. “Improvements in patient safety in the clinic setting require physicians, nurses, and administrators to commit to identifying structural and process changes that make it easier to provide consistently safer care” (Schauberger, & Larson, 2006, p. 421).

The research directed by Stalpers, DeBrouwer, Kaljouw, and Schuurmans (2015) explains their aim was wanting to accumulate knowledge in addition to previous studies referring to the outcome measures such as mortality, length of stay, and healthcare associated infections. To systematically review the literature and establish an overview of associations between characteristics of the nurse work environment (nurse staffing ratios and nurse-physician collaboration).

Fakih and Jones (2013) really bring home the fact that once you communicate to your colleagues that infection reduction is an organizational priority, the first step to reduce CAUTIs is to implement a Comprehensive Unit-based Safety Program (CUSP) developed by Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality. This starts with senior leadership commitment, then involves physicians, nurse leaders,

Another way of monitoring the health and safety procedures is to do spot checks to ensure that staff are compliant. If non - compliance is down to a resident then it should be monitored, recorded and shared with their community health team if necessary to ensure that the same action doesn't keep occurring. If health and safety issues keep occurring then it may be necessary for an external inspector to come in and review the policies and procedures of the company to offer a source of

The American Nurses Association defines accountability as “to be answerable to oneself and others for one’s own actions.” Accountability is part of nursing and it is important for the nurses to recognize the importance of being accountable (Battie & Steelman, 2014).

Where I work the CNAs are the ones that closely care for the patients on daily basis, for this reason it is critical for them to be able to detect subtle changes and report them to the managers. I believe that educating staff on how to detect a change in a patient’s condition can be very challenging, especially considering the complexity of each individual’s illnesses and the fact that there is not always a continuity of staff. Also, new staff may not be fully aware of the individual’s behaviors and misinterpret them as normal. I am fortunate to work for a facility that provides training and tools like the Stop and Watch and SBAR. Interact provides tools and resources that are all examples of current evidence based practice known to improve the safety and quality of patient care (Ouslander et al.,

The nurses noted unsafe and illegal practice by Dr. Arafiles and reported it to the medical board after the hospital board failed to investigate the concerns that had previously been reported by two staff physicians. The reporting of Dr. Arafiles was done by Mitchell and Galle with the intent to prevent additional patient harm by Dr. Arafiles.

This hospital needs to decide what’s more important- pinching pennies in the coming months or saving the lives of patients and millions of dollars in the long run. According to the CDC, many nosocomial infections can increase a patient’s hospital care cost by more than 20 thousand dollars (2009). While studies have shown that increasing the number registered nurses is either cost neutral or cost efficient (Stanton, 2004). It is critical that the hiring freeze be lifted and other safe staffing strategies be implemented. This hiring freeze will do nothing but negatively impact patient outcomes, nursing staff satisfaction, and the financial standing of the hospital.

Moreover, it is their duty to make sure that risk assessments are done and standard prophylactic measures are being implemented. Every nurse is encouraged to document and report any delay or substandard delivery of care. On the other hand, the QRS is a one-week review, which takes place every three years in preparation for announced Joint Commission visits. The purpose of the QRS is to evaluate the hospital’s policies, processes, and structures, and the employees’ performances. Thus, staff nurses are expected to fulfill their competencies, strictly comply with hospital policies, and participate in unit- and hospital-wide QI projects. Some of the ongoing projects in the hospital are reducing Catheter Acquired Urinary Tract Infections (CAUTI), Zero Falls, and Line

In New York, a Hospital was not liable for a physician who just recently left a rehabilitation center and then assigned to operating duty which was stocked with the propofol that killed her. (Eisler, Peter) Now how is this possible for the hospital to wipe their hands and say they had nothing to do with her death? These are the problems caused by not knowing who the hospital is staffing their facility. For all this they might as well hire anyone off streets and call it a day. Thomas Sherman a MD from New Hampshire states “If there’s any hospital executive who thinks this is not happening at their facility, I can tell you, they’re wrong.” Many of the times hospitals believe they are not at risk with drug diversion since there is no report of

As a leader in healthcare, there are a few aspects that must be handled prior to implementing change. The only way to help curb resistance to change, is to be informative. Once the plan comes together, as to enhancing or implementing a new program, there can be an informative meeting of the staff. In this instance, the incident reporting system, the meeting would not be mandatory, but to ensure that the staff feedback is vital in having a successful rollout of the new program. It seems that fear is common when having a new program. This would give a way to calm the fears and make it known that the incident reporting program is not a way to place blame, but to be successful and error free. After the meeting, there would be training seminars

The Comprehensive Unit-based Safety Program (CUSP) toolkit was developed when the Agency for Healthcare Research and Quality (AHRQ) and American Hospital Association (AHA) joined together to initiate a project to prevent healthcare associated infections in hospitals. The project was a national success due to CUSP. Its tools are used to assess the hospitals’ issues at the unit level. CUSP toolkit provides knowledge, materials and assessment tools to change the unit-based culture of behaviors and habits, in order to improve patient safety. There are five basic steps, involved in CUSP – 1. Educate staff in the science of safety. 2. Identify defects. 3. Engage executive leaders. 4. Learn from mistakes. 5. Implement teamwork tools.