The Mortality of Patients That Experience a Hospital-Acquired Complication - Essay Example

This is a case study involving Mr Smith who is a 52 years old green grocer with a wife and two children. His life medical history in the report started while he was playing rugby in his young days. He had several injuries that have led to arthritic problems. He also suffers from chronic obstruction of the pulmonary disease whose symptoms include difficulty in breathing, chest pains as a result of the inflammation of the lungs, and heart problems. He is so unfortunate to be suffering from hypertension and hypercholesterolemia which have symptoms of difficulty in breathing and continued heart failure and which by coincidence happens to affect him concurrently. He is in a very complex situation that if not handled properly can be very fatal. It is a case that needs to be handled by a multi-disciplinary team of professionals to contain this situation. The mortality rate of patients that experience a hospital acquired complication has been indicated to be directly correlated to the quality of the nursing care and nursing skills. Out of the outcomes of failure to rescue, dominant causes to mortality have been linked to misdiagnosis, failure to administer the proper treatment and the inappropriate management of complications. This may be due to judgment made on incomplete information. ‘Cues refer to information that can be accessed in the form of handed over reports, patient history charts, history, results of lab examinations and assessment data also instinctively by recall of knowledge’ (Woodhall et al 2008, pp 316). It calls for deep understanding of physiology, pharmacology, epidemiology, culture and therapeutics. Early warning sign use the physiological measurements to identify patients who can develop critical illnesses especially those with serious occurrences of cardiac arrest, severe respiratory problems. Unresponsiveness to verbal communication, oliguria, hypoxia and interference with the blood gasses are warning sign that signal patients at risk. This has to be conducted and monitored closely to make a follow up of the changes as they occur. Early warning signs parameters include the soluble partial oxygen pressure of the range between 50-60 mm Hg, a drop of the Glasgow coma Scale the range between 9-11 and a fall by a value greater than 2, systolic blood pressure of between 80-100 mm Hg and a pulse rate of the range of 40-49 or 120 beats per minute. Serious conditions such as the chest pain, poor peripheral blood circulation greater fluid loss and finally uncontrolled pain are early sign also termed the early cues. Late cues on the other hand will present serious situation such as unresponsive verbal commands, air waves obstruction, breathing rate greater than 40. Smith has clear late cues suggested from his discomfort and complains. Failure to rescue involves the identification of quality service providers in health care by examining the outcomes in the patient care. It is determined by calculating the proportion of those who suffice to death among those who have complications. It is reflected on the availability of resources in different institutions in order to bring back lives. Successful outcomes have basically been attributed to good efforts of the nurses and the physicians. This has really played a good role in those patients experiencing better outcomes by doing very well out of their own strength regardless of the nurse’s skills and actions. Two phases of rescuing patients have been identified. There is constant surveillance and timely identification of complications on one hand and mounting an effective rescue response on the other hand. However, this has been indicated to differ from hospital to hospital in terms of the availability of staff and the quality of the working environment. This seems to be the guiding factor in the motivation of the nurses in providing good services. ‘The model of care that can be applied in terms of the nature of the patient care assignments, supportive services also influence greatly whether a nurse will apply her technique for rescue of the patients’ (Clarke & Aiken 2003,pp 69). Social aspect of the nurse care also has a significant role to play. The authority vested in them in the clinical care of patients has influence over their responsibilities as on their approach to their patients and their work. Interaction with other nurses and physicians also influence their timely management, identification and resolution of the patient problems. Investing into these factors is actually a costly affair that can only be accomplished with sufficient resources. A survey of the situation, background, assessment, recommendation (SBAR) to aid communication of nurses at the Magee Women’s Hospital started with the initial resistance. Basic templates such as ‘R’ to indicate that something was wrong were introduced and assessment was required by saying it wholly. Similar application has been applied by the nurse taking care of Mr Smith. She directs the pharmacist to conduct a pharmaceutical review of Mr Smith. This is practical example of SBAR as a tool for proper communication. A Pharmaceutical review may not be of any help considering it may be a late remedy to his situation as he is already suffering from the same effect of misdiagnosis. ‘This has proved that break down of verbal and written communication between clinicians and other health care worker is a vital concern’ (Haig, Sutton and Whittington 2006, pp 168). Efforts to ensure this is well taken have been conducted to improve communication using the SBAR technique. This involves the use of laminate papers or posters displayed on the units, speakers are also placed on each phone at the units. Observation of the use of SBAR was also assessed apart from the monthly quizzes. All this are done to ensure that timely and accurate communication between nurses and pharmacists and other medical physicians take place to enhance medical reconciliation. ‘Contrast in medical list can lead to duplication, omissions, wrong doses and even accidental poisoning of patients’ (Jones & Higgs1991, pp 18). This SBAR technique is that mental model to unify the thought of all medical assistants. More so, it should improve the efficiency of service delivery and enhance team work which will result in a reduction of all failure of patient rescue. ‘Clinical reasoning is the most significant element in the practice of nursing especially because it has been demonstrated easily by the experienced nurses; the cognitive instincts that comes with professionalism’ (Banning 2008, p 179). The nurses need to employ several judgemental criteria. There are several rights in clinical reasoning; First, having the right cues include collecting an updated patient history that may involve using the patients chart and results of investigation that have been conducted on various occasions. ‘A proper patient history should be the base line in finding out the proper techniques and ways to administer also considering the hazards associated with the misdiagnosis’ (Levette-Jones, et al 2010, pp 518). Caution should be exercised especially in discerning only the details that are relevant to the particular diagnosis. This is because the right cues collection processes may include prejudices and stereo types while making assumptions at the same time. Secondly, the right patient includes those that are critically ill and have symptoms that correlate with the necessity for the need for the critical care. These includes; difficulty in breathing, fainting, low blood glucose levels, pulse rate and other critical parameters indicative of the need for immediate attentions. Best practice has it that patients should be prioritised basing on their need for their immediate care. Both the early and late right cues need to need to be determined early in time. Thirdly, the right time principle consist a complex and often unpredictable situations, multiple clinical reasoning for every patient in their care usually has to be conducted at all times. Identifying clinically risk patients in a time and administering interventions at the right time and procedure is very vital. Late recognition of critical patients and wrong interventions has been the key cause of failure rescue. Mr Smith is most likely a case of negligence and arrogance. Moreover, the right action involves making radical judgement as per the professional ethics demands; it includes practical skills, intellectual skills and proper communication. Planning is the best practice which is a guideline for easier interpretation. This plan must have information on who takes the action, over what procedures and what policies are involved in the process and finally who should be notified in case of an emergency. Finally, right reasoning is an aspect of the right clinical reasoning according to the ethos, legal standards and professionalism. ‘It is the motive or the guiding rational. It is a complex of planning, evaluating and making a follow up’ (Hoffman, et al 2009, pp1337). The confidence of the decision maker determines the accuracy of process. Personal attributes, orientation of roles, education and culture also play a supporting function. The right reasoning should also be compatible with the values and beliefs of the patient. ‘Clinical reasoning, problem solving or making judgements are pertinent issues in discussing issues with patients care with emphasis to nursing practice’ (Ryan, Brown and Esdaile 2003, pp 157). Standards help maintain any system and individual nurses and clinicians have an obligation of accepting responsibility and devising appropriate environment that will enhance the nursing practice. The entire medical physician’s in general including the Nurses and novices need to up hold best practice at all times. Research has already been done in this field and further research should be allowed to be conducted on these issues to help discover new ways of making these professions better and more efficient now and the future. The already available information should be interpreted with care and the motive that they deserve. Similar occurrences just like what happened on Mr Smith may not occur again if nurses will terminate their notions of tasks being routine and independent of skills instead of concentrating on efficiency on nursing practice. Read More