Organizational Systems & Quality Leadership
RTT1 Task 1
Western Governors University Texas
Nursing-sensitive indicators consist out of three categories that include the following: Structure, process and outcome. Structure refers to the organizational aspect of nursing that is made up of staffing levels; experience vs inexperience; educational levels or the make-up staffing at any point on the unit or facility. The Process is aspect of policies and procedures at the facility and Outcomes are determined when greater levels of nursing care and quantity are involved with better patient outcomes (ANA, 2015).
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The use of restraints spills over into another area of nursing-sensitive indicators, that of assessment. The patient developed a skin ulcer not only due to the use of restraints, but they would have played a large roll in the processes of the ulcer developing. Our patient was admitted for a hip fracture that would require to be in bed for most parts of the day, turning the patient, washing the patient and releasing restraints are all indicators to me that the assessments were not a focus of the staff and may have been delegated to the CNA, and by the explanation provided by the CNA I believe that further education on skin ulcer development and prevention should be recommended.
Patient satisfaction is an area that should be addressed. From the scenario it is clear that patient satisfaction does not rate highly in importance to the staff, this is clear from the top of management all the way down to the people in the kitchen. The disrespect that is shown to the patients preferred diet due to his religious believes are concerning. Patient outcomes are related to trust between care providers, the patient and their family. Mistakes happen every day in every care setting; the poor decision to withhold the mistake was made worse when a staff member apologized for the error. Patient satisfaction directly impacts facilities reimbursement by Medicare and Medicaid, as directed by HCAHPS (n.d). The negative impact on reimbursement is one aspect, the combination of meal error, the withholding of the error, the skin ulcer and restraint use has all damaged trust between family and care givers, negatively affecting the potential positive outcome of the patients stay in the hospital.
Advancing Quality Patient Care
Data should be the driving force towards improved patient care, patient outcomes and satisfaction. Evidence based practice and unit protocols work towards the goal of quality and improved patient outcomes and care, data drives these tools that are available to nursing staff. Data can be collected on multiple ways, from the point of medical care and patient satisfaction. The scenario points to pressure ulcers and the use of restraints, in both situations I believe that there was a fundamental lack of knowledge by the staff and disconnect by management.
Data should be collected on pressure ulcers, this is easily provided by conducting audits and creating a Skin Champion position, as is the case in my hospital, that is filled by a nurse that creates educational documents, conducts audits on the use of Braden scale and following up with Wound Care staff. Changes in healthcare, as in any business, usually starts when there is a direct impact on financial reimbursement, and the formation of new pressure ulcers on inpatient care places the cost on the facility and not Medicare or Medicaid (Medscape, 2015). The audits should provide management with enough data to track ulcer...