Scottish Patient Safety Programme and the Early Detection of the Deteriorating Patient

The following are the National Patient Safety Goals for 2016: improve the accuracy of patient identification, improve the effectiveness of communication of caregivers, improve the safety of using medications, reduce the harm associated with clinical alarm systems, reduce the risk of health care- associated infections, and for the hospital to identify safety risks inherent in its patient population (Hudson 2016 page 2). Under each category there are specific goals, such

Within this essay, the author will reflect on a critical incident using a reflective model. In order to guide the author undertake this reflection, Johns (2002) reflective model will be utilised. As the first stage of Johns reflective model asks for the description of the event, the descriptive part will be attached (see appendix A). In accordance with the NMC Code of Professional Conduct (2008) the names of the individual involved have been changed using pseudonym in the form of James, Jennifer and Christina for the purpose of maintaining confidentiality. This reflection has been chosen as it has shown the author the inadequacies on her part as a student nurse. Also to highlight the need for the author and professionals to have an

The National Safety and Quality Health (NSQHS) standards ultimately were established to protect the public from harm and to develop and enhance the quality of care delivered by health care organisations (NSQHS 2012). These standards are used as a guideline to aid health care organisations to support the quality improvement programs using the NSQHS framework to ensure patient safety and quality care is being delivered. Standard 9 of the NSQHS specifically addresses the recognition and response to clinical deterioration in acute health care with the aim of early recognition of patient deterioration and suitable action is taken.

From the top to the bottom, everyone is responsible to maintain safety throughout health care organizations. This is one of the fundamental reasons for having these six goals in an attempt to improve the quality in patient care (Finkleman, 2012). We must work consistently and collaboratively adhere to these goals in order to achieve quality improvement. Also, health care professionals need to understand the rationale for applying these concepts into their scope of practice. According to our lesson this week, (Chamberlain College of Nursing, 2016) “Quality Improvement is about inspiring change.” It is never easy to implement change because you are always going to face obstacles.

may help limit healthcare errors, and also hospitals ‘leaders have been encouraged for taking responsibility for making sure patient safety. This healthcare sector settled on a quality matter. Affected patient safety (PS) provides to have more staying power than previous quality initiatives such as continuous quality management(CQM) and also overall top quality management(TQM). It's different in important way: patient safety refers to genuine conditions that affect people's life.

The platitude “mankind is not perfect” ceases to exist in health care facilities. When an individual is admitted to the hospital, it is projected that the treatment provided by the practitioners will not cause that patient any unnecessary harm. Regardless of what is expected, patients are constantly being harmed by their health care providers as a consequence of their treatment. According to an evidence based estimate, “210,000 deaths per year was associated with preventable harm in hospitals” (James 2013). In order to improve those number, the QSEN Competencies has created a format to improve patient safety. The categories are based on knowledge, skills and attitude. In

Looking at the current organization, I can attest on everyone’s effort to adhere to the six aims of the Institute of Medicine. For nurses, it is vital for them to understand these as nurses will be the key players to meeting these quality standards. One important key player, I have read was the inclusion of patients and families in participating in safety promotion. I can agree on this since advanced technology affords the community to be more informed about health issues. In fact, patients can now access their records and communicate with their providers through telemedicine. Hence, nurses should engage them in implementing safety measures as well. As nurses continue to experience being shorthanded at work, maintaining patient

NSQHS Standard 98 ‘Recognising and Responding to Clinical Deterioration in Acute Health Care’. This covers ‘the use of procedures to encourage the recognition of and the responses in a timely manner, to the deterioration of a patient’s condition with all people concerned to be kept informed’.8

As an important role in providing patients with quality and safe care, nurses and management teams pay considerable attention to leadership, management and risk management (Boynton, 2012). Despite of the increasing research of risk management and patient safety, reducing clinical incidents remains a challenge for nurses and management teams worldwide (Mitchell, Williamson & Molesworth, 2016). Research suggests that up to a third of patients have experience with unintended events by nurses’ leadership and management, cooperation of health providers, and organisational support (Elliott, Worrall-Carter & Page, 2014). However, half or more of these events can be avoidable with batter patients care outcomes (Elliott, Worrall-Carter & Page, 2014). In this case study, a patient experienced poor outcome (HCCV v Jarrett, 2013). To promote quality and patient safety, it is crucial to clarify the factors associated clinical incidents when outlining recommendations for clinical health providers (Balshem et al.,

Ensuring the right patient care to the correct patient is an essential, every day part of nursing care (Dhatt, Damir, Matarelli, Sankaranarayanan, & James, 2011). Failure to follow out correct procedure-patient matching may lead to incorrect interventions or treatments being performed on the wrong person (Zipperer, 2014). Unfortunately, this can sometime result in negative effects on patient outcomes, or even sentinel events (Zipperer, 2014). According to the Australian Commission on Safety and Quality in Health Care (ACSQHC) in 2008-09 there were eleven events in Australia with procedures involving the wrong patient or body part resulting in a death or major permanent loss of function (2012). In Australia, healthcare is governed by ten standards. Patient Identification and Procedure Matching is Standard Five under the National Safety and Quality Health Service (NSQHS) Standards, governed by the ACSQHC. As such it is critical, that performance and compliance against the standards is measured on a regular basis. In the ward environment, I am the representative for standard five. Part of my responsibilities, apart from being a clinical resource to fellow caregivers, is to undertake audits and implement quality improvement initiatives within the ward setting to ensure safer patient care. An audit completed recently will be reflected upon using Driscoll’s What? So What? Now What? Reflective framework (Bulman & Schutz, 2013). Throughout which, analysis will be

Every human being deserves efficient and safe health care. Nurses are in the frontline of providing care and have a leading role in making our health care system safer and need to be better prepared with quality and safety competencies (Sherwood & Zomorodi, 2014). In the Institute of Medicines (IOM), To Err Is Human: Building a Safer Health System report opened the eyes of healthcare professionals to the importance of improving health care outcomes (Dolansky & Moore, 2013). Which spearheaded the Quality and Safety Education for Nurses (QSEN) to improve the quality of healthcare funded by the Robert Wood Johnson Foundation (Dolansky & Moore, 2013). Moreover, the QSEN had a mission to address the challenge of assuring that nurses continuously

Within the hospital, I see my approach to serving as a driver for quality and safety by assisting in the development of partnerships to design safe plans to achieve established goals, and further providing recognition of any barriers in achieving the goals. This partnership must extend beyond the hospital and extend to the context of the patients’ in their communities. Together we build relationships, to participate in establishing standard operating procedures and guidelines in risk activities within the hospital and advocacy for the patient’s individual needs and desires, built into the plan in all phases of health, considering the patients risks when they leave our watchful eye and go out into the community.

Currently, patient safety is a key driver in healthcare. It is defined as prevention harm to the patient during a medical procedure and prevents medical errors, adverse effects due to the provision of healthcare rather than underlying disease process of the patient’s. In nursing, attention to patient safety is not new, in the center of the roots, tracing back to the 19th century with a great emphasis on the safety of patients and ethics of the nightingale to protect

In 1852 Florence Nightingale wrote “It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do the sick no harm”. The goal of any of medical facility should be that no preventable harm should befall the patient. This seems an obvious statement. Though this may seem to be an obvious goal, this very goal took second place to medical scientific advances. In 2000, the article To Err is Human: Building a Safer Health System published by the Institute of Medicine, drew attention back to what had once been a foundational goal of patient safety when in the care of the health system. Today, preventable medical errors responsible for patient deaths in hospitals have brought the focus of the medical industry full circle to make patient safety its primary goal. The goal of the 21st century nurse is to: ensure safety by using evidence based safety practices such as proper hand washing to prevent and control the transmission of diseases, to strive for performance improvement by implementing new risk management findings to ensure a safe administration of care such as the administering of medications. And last but not least in order to promote the culture of safety the nurse must claim accountability and report any safety issues that my endanger a patients well-being.

There has been a lot of focused attention on patient safety by policy makers, practitioners and academicians in the last few years (Brennan et al, 1991; Wilson et al, 1995; Vincent et al, 2000) stemming from studies that have indicated the existence of problems with patient safety (Mannion, Davies and Marshall, 2005: 23).