The Type of Health Care Delivered in Hospitals
The type of health care delivered in hospitals does not satisfy the highest safety standards. A high number of deaths and injuries are caused by medical errors. Countless Americans have fallen victim to such errors. According to statistics, the number of Americans killed by medical errors outnumbers those killed by AIDS, car accidents, or breast cancer. The nature of the errors varies. The most common are prescription errors. Incorrect dosages account for 37% of all preventable pharmaceutical mistakes. Hazardous drug interactions or drug allergies are responsible for 11% of all preventable pharmaceutical mistakes. Medication reconciliation errors that are preventable take place in all the care phases. An estimated 100 dispensing errors that are undetected may occur daily due to the dispensation of a considerable amount of medications.
Significance of the Problem
The cost of the deaths is astronomical. When one loses their life, there is no remedy that can help restore it. The costs range from disability, lost income and lost household production among others. Some children may be orphaned as a result. Parents may lose their most pressured children. A given field may lose a talented worker with impeccable skills that are hard to find resulting to a stagnation of developments in the affected field. The persons responsible for the medical errors may also feel depressed, a situation that may affect their mental health. The annual figures for the national cost of medical errors currently stand at about $ 17.1 billion. Serious errors affect 3.8 million of the patients admitted to hospitals and about 3.3 million of outpatient visitors. The errors which are preventable account for 7000 U.S. deaths annually. Physicians and healthcare facilities place patients and their families in unwarranted pain.
Current Practice Related to the Problem
Healthcare facilities are incorporating technology into their service provision measures to help improve service delivery while minimizing on the occurrence of errors. Such initiatives include electronic medication reconciliation, barcode medication administration, and computerized order entry by physicians. There is also increased use and maintenance of personal records. Such records are seen as vital in tracing a patient's medical history to help in determining the appropriate care to accord them. For instance, some medication for a given condition may have been taken a while back and may call for a break that has to last for a certain amount of time before a repeat of the same may take place.
Impact of the Problem on the Patient's Cultural Background and/or Organization
Avoidable harm tends to erode the confidence of patients in the affected institution. Human beings place a high value on an individual's life and his or her health. Medical errors tend to cast doubts about the credibility of the physicians providing care to patients. The doubts tend to affect the perception of the public towards the affected health facility. High cases of medical errors on a general level have the potential of discouraging individuals from visiting health facilities opting instead for alternative care and other home remedies. Such alternatives pose a risk to the patients' health as they are not well-versed on the right dosages and kind of medication that meets their unique needs. There is also the possibility of problems that arise when patients mix hospital medication with other alternatives as such actions may result in an unfavorable drug interaction that may serve to worsen their conditions.
Elements of PICO
Patient Problem
The population covered includes patients of all ages. They are spread in different parts of the state. Given the size of the hospital and the reputation for dealing with some of the worst cases of illnesses, it tends to attract many patients. 80% of the patients are Caucasian, with the rest being from the minority communities. The specific problem they face that is currently under investigation is that of cases of medical errors.
Intervention
The possible solution revolves around the improvement of the kind of care being accorded to patients. The not intervention is not a form of medication, but a change in the way service delivery is carried out to ensure that there is an exercise of caution on the part of the medical staff so that they do not continue with practices that put the patients' life at risk. There will computerized patient record monitoring. A follow-up of the kind of medication that the patient received will also be a critical factor. The monitoring will cover a sample of patients served within a given week and will enable a different team of personnel to ascertain the quality of care given to those involved and if there may have been any errors.
Control/Comparison
The health facility to provide a platform through which patients will be able to fill in surveys intended to determine their experience with the hospital. The survey will help reach out to some of the patients who may have been left out of the follow-up exercise. The target is to get the feedback of patients who might be too afraid to speak out or unable to access the hospital.
Outcome
The desired effect is a more than 50% reduction in the cases of all medical errors reported. The achievement of a more than 50% reduction in errors will boost patient confidence in the healthcare system's commitment to minimizing medical error.
PICO Question
Does electronic monitoring of patient records help reduce the reported cases of medical errors?
Search Strategy
Keywords
Natural language Key word mapped to database
Medical Errors Medical Error; Mistake, medical [MeSh]
Diagnostic errors
Computerized patient record monitoring Computerized patient records
Evidence Sources
There were four articles for consideration. They were mainly reports of previous studies conducted on the issue of medical errors.
Article I
The first research evidence is in the article "A new, evidence-based estimate of patient harms associated with hospital care," by John James (2013). According to the author, any individual is susceptible to mistakes. The same applies to the healthcare system and at the national level. Due to constant developments in the healthcare field, a medical practitioner may be overwhelmed with new knowledge and end up making mistakes. The research found out that mistakes are almost impossible to avoid. However, the study recommended that owning up to mistakes and taking steps to avoid a repeat was the best approach in ensuring the best quality of care. The study had its focus on the healthcare errors in the USA, with the researchers saying that the outcome of the survey points to a situation that is common the world over. The relevant stakeholders within the respective jurisdictions have a duty to implement corrective measures determined through lessons learnt from previous mistakes (James, 2013).
Article II
Another study given consideration was, "Medical errors in primary care clinics-a cross-sectional study," which sought to determine the magnitude of the problem of diagnostic inaccuracies (Khoo et al., 2013). The decision to conduct the study was informed by a lack of adequate research on the subject of medical errors. The focus of the study was on primary care clinics that are publicly funded. The study found serious issues with documentation with about 98% of the records having issues with the way they were managed. There was also 3.6% diagnostic error. 93.5% of the errors were preventable while 39.9% of the errors considered as having the possibility of causing harm.
Article III
"Reducing diagnostic errors-why now?" is another article on medical errors considered in this paper (Khullar, Jha & Jena, 2015). It takes an interest in the reason for increased interest on the subject of medical errors. The authors argue that the reason for such interest is in increased cost of the errors. The costs are currently at their highest levels. As such, there is a need to pay greater attention to the issue to ensure that possible solutions are sought to the errors recorded.
Article IV
The fourth article that I considered in the paper was "Evidence-Based Medication Safety Quality Improvement Programs and Strategies for Critical Access Hospitals." The source explores some of the nursing practices that put patient's lives at risk (Klingner & Prasad, 2013). It goes on to propose measures that are vital in improving the quality of care accorded to patients to guarantee their safety.
Recommended Practice Change that Addresses the PICO Question
One of the recommended practices is prompt entering of patient data into the data that will be created after the installation of the computer system. Nurses should be encouraged to take advantage of the services offered by the data entry and library management staff to ensure they keep updated data on client records. In future, the practitioners should first check the patient's records before recommending any further medication to ensure that they do not offer the same approach for a recurring condition or one that has persisted.
Ascertainment of the quality of care should form a part of the core activities for the health facility's management
Each life is invaluable calling for a proactive approach to the handling of any issues related patients. When a life is lost due to preventable errors, any measures taken following such incidents cannot be in restoring back the hospital's reputation. To ensure the quality of inspections, there is need for a coordinated effort among different facilities that will help to bring about sharing of information and lessons on previous experiences that may be helpful in informing future decisions. Lessons from mistakes done in one institution can help avert a mistake in another.
There is also need for stakeholders to set in place rules that will guide the quality checks
For instance, such checks should be done by officers from a different health facility. A facility's staffs may express bias when inspecting their own facilities and colleagues. Using inspectors from a different facility will help offer an objective view as opposed to one that may be subjective and as such counterproductive in nature. With all the measures set in place, there is bound to be a considerable drop in the cases of medical errors in the future.
Process for Implementing the Recommendation
How to Involve Three Key Stakeholders
In applying the recommendations, the participation of the relevant stakeholders will be vital in ensuring the success of the changes. The key stakeholders will include healthcare facilities, the department of health, and the professional body for all nurses. I will design a program that will equip managers of healthcare facilities with skills that will be vital in enabling them to drive change in the institutions that they run. As for the nursing professionals body, I will present it with a proposal containing the strategies and show them the kind of impact it will have on the profession given past successes in some of the top performing hospitals. Goodwill from the government will also be necessary. The plan is to show the relevant officers some of the benefits that the government stands to reap from having the suggested strategies implemented.
Potential Barriers in the Application of Evidence Practice changes in the nursing practice setting
One of the major issues that may encounter efforts aimed at applying evidence-based practice in the context of nursing practice is a lack of willingness among a significant portion of the nurses to integrate evidence into practice. Discipline surveys conducted in the past to assess the implementation of suggested changes showed reluctance on the part of some of the practitioners to adopt new changes and adjust their way of doing things. Some have even been known to try and sabotage progress. Given the fact most of the current nurses working with the healthcare system have many years of experience, they may view changes with suspicion as it will deem their prior experience with the previous of way of doing things as irrelevant.
There may also be challenges in the initial stages of implementing evidence-based practice due to a variation in the people's ability to learn things. The speed with which the nurses learn new skills will vary. Some of them may need to be provided with mentors who will assess their learning behavior and guide them successfully into the new way doing things. There are also those who may find the challenge of learning new skills as being too much for them and they might opt out of training programs meant to enhance their abilities at the workplace. Such tendency does not, however, reflect an unwillingness to learn and acquire new skills. The difficulty they face a given training experience is attributable to the technicalities involved. There are also those who are overwhelmed with responsibilities and may find it difficult to adopt the training and have it on their schedule.
Some hospitals may also be struggling with the problem of inadequate staffing. Fitting a training program within the hospitals' plans may prove difficult. In such facilities, there is a tendency by the management teams to put pressure on the nurses to perform and meet the set targets. The nurses may also face significant resistance from such managers, a process that may strain relationships and as such further complicate the efforts to integrate evidence into practice.
Strategies for Overcoming the Barriers
Promoting a positive attitude in employees towards change will require proper communication about the benefits that employees stand to reap from the adoption of the practice. The management needs to make the employees understand that the nursing industry is fast changing and that without the integration of the new practice, their skills may drop in terms of relevance. They need to understand that without the new skills, their experience in the healthcare profession may not count much. There is also a need to provide the staffs with examples of cases where evidence-based practice brought about tremendous improvements in the quality of care delivered at the affected health facility.
Another strategy is ensuring a widespread change in the culture of the healthcare setting, and enacting a new direction for healthcare education. The integration of newly researched methods needs to move away from a trend in which emphasis is on the teaching of rigorous research methods coupled with a critique of current research to one where research findings are made use of in the clinical practice settings. The consumers of health care services also need to feel empowered to provide their feedback on whether they feel they are receiving the services. Through such feedback, the managers of health care services will determine whether the nurses are implementing the evidence practice. Care that is not based on evidence is easy for consumers to detect.
Health care institutions also need to determine if the profession is ready for certain changes. Sometimes, it may be necessary to wait until such a time when the implementation of evidence-practice is bound to work. If the practitioners are not ready to adopt new ways of doing things, any investment in the implementation of such new practice may prove to be an exercise in futility.
A good point to start in getting the profession ready for the adoption of evidence-practice is by getting leaders who can drive the nursing profession in the direction of change. Some of the leaders are not committed to ensuring that the integration of evidence practice in nursing takes of successfully and that it is sustained. They have the power to promote a culture that promotes the adoption of new techniques. Without the creating the necessary conditions for change, they cannot claim to be doing their work in ensuring the adoption of evidence-based practice. Research indicates that about 75% of nursing practitioners find it necessary to impart the intended implementers of evidence-based practice with more skills in the practice to put them in a position where they can feel confident and motivated to adopt them. Mentors within the healthcare setting will be vital in helping many of them to adopt many of the practices.
The strategies identified have been seen to work in various health facilities that are associated with stellar performance in the provision of core services. Nurses working at the facilities that have received multiple awards attest to the role of evidence-based practice in their success. However, they opine that its implementation requires a complete shift in the mindset of nursing professionals.
Understaffing may have the effect of making educational programs counterproductive and needs to be dealt with promptly. The relevant bodies tasked with checking up on issues related to staffing need to take relevant steps to ensure the nurse to patient ratio is at the recommended levels in all the healthcare facilities. With the right number of staff, it is possible to improve care even with the current methods. With enough staffs, it will be possible to free up some time for other skill training activities such as those necessary in educating the affected on evidence in practice.
Indicator for Measuring Outcome
The indicator that will determine the outcome is the number of medical errors reported per week.
References
James, J. T. (2013). A new, evidence-based estimate of patient harms associated with hospital care. Journal of Patient Safety, 9(3), 122-128.
Khoo, E. M., Lee, W. K., Sararaks, S., Samad, A. A., Liew, S. M., Cheong, A. T., & Ismail, R. (2012). Medical errors in primary care clinics-a cross sectional study. BMC family practice, 13(1), 127.
Khullar, D., Jha, A. K., & Jena, A. B. (2015). Reducing diagnostic errors-why now?. The New England Journal of Medicine, 373(26), 2491.
Klingner, J., & Prasad, S. (2013). Evidence-based medication safety quality improvement programs and strategies for critical access hospitals.
