Knowledge of the increased risk for pressure ulcers and the need for frequent turning and off-loading of pressure points could have allowed the staff to prevent the one forming along Mr. J’s spine. Proper education of all staff, nurses and aides alike, could have helped the CNA assisting the patient to identify the redness earlier and begin appropriate interventions. Another issue that could have been prevented through knowledge of indicators is the unnecessary use of restraints. If Mr. J’s mental status was such that he required additional safety measures, the need to adjust staffing to allow more direct care and observation of the patient could have been identified. Both the pressure ulcer
Nurses need to be educated on these indicators to understand the care they provide directly affects patient outcomes. The American Nurses Association (ANA) recognized areas of patient care and developed nursing-sensitive indicators to improve care of patients. Nursing-sensitive indicators reflect three aspects of nursing care: structure, process and outcomes. (American Sentinel University, 2011, para. 2) They identify structures of care and care processes, which influence patient care outcomes.
Placing patients close to nurse’s station or offering frequent toileting can also help reduce potential injuries. If falls continue to occur with precautions in place, incidents need to be reviewed to identify where improvements can be made. Educational opportunities can be offered to staff on the importance of enforcing fall precautions on at-risk patients. Many different nursing-sensitive indicators can be tracked in the same fashion. The important element here is to continuously monitor standardized performance measures and assess the extent to which nursing interventions have an impact on patient safety, quality, and the work
Lastly, key roles nurses would play in improving the quality of care in the Mr. B scenario will be discussed.A. Root Cause AnalysisA root cause analysis (RCA) is “a process for identifying the basic or causal factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event” (Cherry & Jacob, 2011, p. 442). The participants during the root cause analysis would be the emergency room physician (Dr. T.), the Mr. B’s LPN and RN (Nurse J) during the time of the sentinel event, the emergency room nurse manager, and the chief nursing officer (CNO) of the hospital. These members would meet in a root cause analysis meeting to discuss the causative factors that created Mr. B’s sentinel event. The first step in a root cause analysis on the sentinel event that caused Mr. B’s death is to gather the data surrounding the situation.
insertion is done unsuccessfully or when the I.V. is taken out. This is why pressure is applied to the insertion site, to try and make the hematoma as small as possible. It is very important that nurses are properly trained on the techniques of starting an I.V. Purpose is importance of proper technique to administer and I.V.
Change theory will be utilized to implement the plan. A failure mode and effects analysis (FMEA) will project the likelihood that the process improvement plan suggested will not fail. Additionally the role of the professional nurse in functioning as a leader in promoting quality care and influencing quality improvement activities will be discussed. A.Root Cause Analysis A root cause analysis (RCA) is “a process for identifying the basic or causal factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event” (Cherry & Jacob, 2011, p. 442). The people involved in the RCA should be the people involved in the scenario: the RN (Nurse J), the LPN, the physician (Dr. T.), the emergency room manager, and a figure from administration (Chief Nursing Officer?).
Nurses need to review the disaster history of their community, as well as how past disasters have affected the community’s health care delivery system (Stanhope & Lancaster, 2008). It is important for nurses to understand and gain the competencies necessary to respond in times of disasters before disaster strikes. The preparedness competencies should focus on personal preparedness, understanding roles, becoming acquainted with the health department’s disaster plan and communication equipment appropriate for disaster situations (Stanhope & Lancaster, 2008). Disaster and mass casualty drills and exercises are extremely valuable components of preparedness that can give nurses and other personnel opportunities to improve plans. Nurses should also identify limits to their own knowledge/skill/authority and identify key resources for referring situations that exceed those limits.
Additionally, “The health belief model and social learning theory assist the nurse in formulating an action plan that meets the needs and capabilities of the individual making health behavior changes” (Edelman & Mandle, 2010, p. 248). This model states important points that serve as guidelines for nurses to help enable them to determine an individuals’’ willingness to change health behaviors and to understand the factors that contribute to their state of health (Edleman & Mandle, 2010). They are as follows: • Individual perceptions or readiness for change • The value of health to the individual compared with other aspects of living • Perceived susceptibility to a health problem, disease, or complications • Perceived seriousness of the disease level threatening the achievement of certain goals or aims • Risk factors to a disease attributed to heredity, race or culture, medical history, or other causes • Perceived benefits of health action • Perceived barriers to promotion action As nurses, we must always act on the opportunity to educate and recognize those opportunities as they arise. We must be able to evaluate the willingness of individuals to learn and to accept new ways that they can improve their health. We do have such a large amount of face-to-face contact with people that it is only in our benefit to take advantage of educational situations.
In Monitor Alarm Fatigue: An Integrative Review, research evidence was broken down into themes including: effect of excessive alarms on staff, nurse’s response to alarms, alarm sounds and audibility, technology to reduce false alarms, and alarm notification systems. Non-research evidence revealed strategies to reduce alarm desensitization. Cvach concluded the article with evidence-based practice recommendations for technology manufacturers, hospitals, and caregivers. One nursing intervention recommended was to adjust alarm parameters so that they are customized to each individual’s actual needs. This intervention ensures that the alarms are valid and that they will provide and early warning to potential critical situations.
Safety Techniques Nurses need to know and apply proper hand washing techniques, wear gloves during patient care, and use anti-bacterial hand lotion or soap. Nurses need to know the location of the bio-hazard containers and when to use them so as to limit the spread of infection. Nurses need to apply the 3 reads and 5 rights when administering medication to avoid any form of error. (The unintended). Nurses need to apply safety during patient transfer.