Facility Structure and Process Factors †Free Samples to Students

Question: Discuss about the Facility Structure and Process Factors. Answer: Introduction: Patient safety is the main motto of all healthcare centers. However the same remains the most prominent issue in health policy and public debate. Different types of factors become responsible for adverse patient outcomes when they are not followed properly (Nezamodini et al. 2016). Different types of falls, wrong site surgery, drug transfusion reaction, post operative sepsis, development of pressure ulcer, and wound infection are some of the factors. Moreover catheter related infections, preventable deaths due to inappropriate caring, skin tears, hand hygiene compliance are also some others. However among the factors, the most important concern which had been noted in most of the healthcare centers of the nation is medication errors (Dolansky et al. 2013). Medication errors have various types of negative outcomes which not only affect the reputation of the hospitals and the career of the nurse but can lead to preventable patient deaths and poor quality lives of patients. In the prese nt working center, medication error has been identified as the main cause of concern for the organization. It is thereby used as an indicator which can be used to analyze the intensity of the patient safety adherence rules followed by healthcare professionals (Vaismoradi et al. 2015). This would be followed by a proper improvement plan for the development of the culture of maintenance of medication administration safety. An evaluation plan should also be proposed to monitor the change and improvement made by the healthcare professionals in their practices and efforts made by the organization for the development of patient safety after changes. All these would ensure development of the culture of safety in the healthcare center ensuring the best care for patients. Medication administration is the complex as well as a multistep process which involves a large number of activities. It encompasses prescribing, transcribing as well as dispensing and administering drugs and at the same time monitoring the patient response to ensure safety of the patients (Alenius and Graf, 2016). In any step, an error may take place which may affect the entire course of medication administration severely compromising the patient health. In busy shifts nowadays, different nurses are found in hurry as they have to handle multiple patients at the same time. Often their multitasking can lead to severe issues when they either miss out medication or administer wrong medication or follows improper procedures for medication. There has been also reported incidents like many of medication error occur at the prescribing state and also some are intercepted by pharmacists and other staffs beside nurses as well (Jun and Lee 2014). Administration errors are accounting for about 26 to 2% among different types of medication errors and these errors are seen to be conducted mostly by the nurses as they are the ones who are responsible for providing medication to patients. Therefore mostly the nurses should be most careful among the different healthcare professionals. Often large numbers of factors are responsible for the occurrence of the medication errors. One of the most important factors which are identified is inappropriate or incomplete patient information. Often nurses do not complete the patient information chart or the medical history of the patients is not taken completely (Lane et al. 2014). As a result, important information gets missed out which have significant effect on the health of the patient. A patients name, age, birthday, allergies, weight, current labs results, vital signs and others are very important as they might alter the medication procedure of the patients. When such information goes undocumented, it may harm the patients. Recent researchers are of the opinion that proper barcode scanning of the patients armbands help in patients identity and at the same time can confirm the reduction of the medication error related to patent information. However, several issues regarding barcode scanning has been noted as it increase m edication administration times. Moreover the system is also not completely fail proof (Hwang and Park 2014). Another factor that is also observed by researchers to cause medication errors are inaccurate drug information. Often accurate and current drug information is not advisable to caregivers or they do not develop their skills and knowledge to follow current information about drugs. This information can come from protocols, text references, order sets, medication administrations records and patient profiles (Karavasiliadou et al. 2014). Moreover computerized drug information systems are also important to follow properly. Researchers are of the opinion that nurses need to show patience and proper concentration while handling drugs so that they can avoid wring administration of drugs thereby preventing adverse events (Van Boggaert et al. 2014). Another issue that leads to medication errors is inadequate communication. Miscommunication among the physicians, nurses and pharmacists often act as barriers in effective drug information availability and therefore this should be verified. Improper communication mainly rises from power struggle, excessive burden from over work, lack of situation awareness and other all lead to improper information sharing for which ultimately the patients lives are compromised (Scott and Henneman 2017). Many researchers are of the opinion that in such cases SBAR method helps in minting patient safety by proper jotting down of information and passing of such information to different healthcare professionals which ensures safe practices. Another issue that also results in medication errors is drug packaging, labeling as well as nomenclature. Often it has been noted that different healthcare centers have incidences where nurses have delivered improper medicine to the patient mainly due to the medicines sounding alike or looking alike (Leufer and Claery-Holdforth 2013). Medications are not sometimes maintained in clearly labeled unit dosage packages for institutional use which result in confusion among the nurses. Moreover, in busy schedules nurse remain in hurry and in such situation, medication errors become common (Ignatavicius and Workman 2015). Proper methods need to be adopted to strategically handle such cases and reduce the medication errors. There are also many environmental factors which also remains responsible for different medication errors. These include inadequate lighting as well as different cluttered work environments. Moreover increased patient acuity as well as distractions during drug preparation and during drug administration is also a reason for medication error (Makary and Daniel 2016). Caregiver stress and fatigue also contribute to this. Heavier workloads, nursing shortage, burning outs and others also increases workloads which have physical and mental impacts on nurses. These result in medication errors. Another issue which is also noted to be contributing in medication errors are insufficient staff education and their competency. Continuing education of the nursing staffs is extremely important for the nursing staffs for reduction of the errors (Raymond et al. 2017). Medications which are new to the facility should be taken as the priority areas as well as teaching domains. Proper learning with the help of the medication related policies as well as the procedures and protocols should remain updated to very nursing professionals. Moreover nursing grand rounds are also ensured for proper adherence to medication guidelines (Lewis et al. 2013). The way about how medication error acts as indicator of health: The first way is to conduct medical reviews. It can be conducted manually as well as electronically using text mining and text words. This would mainly involve searching for notable events in electronic medical records, resources for performing reviews, monitoring the variability in the terms used to label adverse events, spelling mistakes and others. Moreover a Meta-analysis of the comparison rate of detection of non pharmacist as well as pharmacists reveal a high level of adverse event detection by pharmacists (Alenius and Graf 2016). The second way is the voluntary reporting of the adverse events which can be used to measure the rates of medical errors and also adverse events. This has been stated by researchers to be one of the most useful and beneficial method as adverse event reporting allows professionals as well as the monitoring committee to learn from errors and saves financial cost of reporting. The third way is by direct observation at the bedside of the patients. This helps in detection of errors made by omission. It helps to note errors in stages like prescription, delivery, dispensing, administration, and monitoring. This helps in noting errors which have been not reported by voluntary reporting The fourth way is the traditional method where narratives of patients are noted to measure whether ant medication error had taken place during their care in the hospital. Besides, the hospitals may also conduct closed ended survey or open ended interviews to patient, family members and also the nurses for quantitative measuring of the issue and taking steps accordingly (Jun and Lee 2014). It has been seen that in my recent working area, complaints are noted by the family members who have stated that the conditions of their patients have deteriorated over the stays. They have mainly resulted from wrong medications given. Moreover, the nursing leaders have also noticed that nurses are providing medication through wrong routes which are harming the conditions of patients. Following this, they wanted to research further on the error indicator more and therefore with the advice of the nursing leaders, the organization decided to implement an improvement planning procedure (Garrouste et al. 2015). They used medication error as an indicator for measuring the patient safety outcomes and wanted to implement proper guidelines and initiatives so that adverse outcomes of the patients due to medication error can be prevented. For this, they adopted the PDSA cycle which was made popular by DrW. Edwards Deming who is regarded by many as the father of the modern quality control. It i s mainly called the PLAN-DO-STUDY- ACT-CYCLE which is the four step model. The first step is called the PLAN step. In this step, the main issues need to be identified and accordingly plans are to be made. A research team was established with the main duty of observing the practices of the healthcare professionals and noting the discrepancies observed in the processes of the medication administrations. Secondly, they were also asked to note the patients narrative about their experiences of their stay in the hospitals and would be interviewed about what they perceive of the skills and methods of medication administration by the professionals. Thirdly, they were also appointed to check the documents which are administered by the nurses regarding patient information, medication charts and others to see how they are maintained and whether the nurses are following proper guidelines to do so. Fourthly, separate nursing interviews were conducted to understand their view, experiences, incidents and other that they want to discuss about regarding medication errors so that they could help the organization with better strategies. After thorough analysis, certain issues were noted. These included improper communication between the nurses to be one of the major factors. Both power struggle and absence of communication skills resulted in the contribution of medication issues. For this communication skills workshops needed to be arranged. For overcoming power struggles, individuals were planned to be summoned for a meeting to disclose their issue with others and resolve their distances resulting in proper relationship development. Secondly, another issue that came to light was inappropriate practices by the nurses which were not according to the modern guidelines. The old nurses were not accustomed with the new medications and did not know how to administer them. They were using random procedure as they have no idea about the correct routes of administration. For them, continuous professional development courses should be introduced so that the senio r nurses get the scope of developing ideas about the new medication incorporated in care practices which would ensure reduction in medication errors. Thirdly, another issue was observed by the researchers. They found that nurses were completely burned out. They were stressed and fatigued due to overtime as nurses to patient ratio was not justifiable to maintain patient safety (Noland and Carmack 2015). For all these, they were becoming distracted and cannot concentrate on their work. For this, the employers and the managers should conduct a meeting and introduce incentive schemes which would provide them enthusiasm to work hard. Moreover, more recruitment should be done so that nurse to patient ratio is just to maintain patient safety. Fourthly, all the cases which are reported would be discussed in a weeks meeting so that every nurse can understand the harmful effects that may occur and they would be also suggested with proper guidelines which would be taught to them by nurse leade rs so that they do not continue such practices. The next stage is called the Do stage. In this stage, small scale study needs to be conducted in order to understand the probable outcomes of the strategies. The communication workshops will be held thrice a week where mentors would help them learn communication skills which are important to avoid miscommunication. Proper developments of relationships are also important for overcoming the power struggle and for this meetings would be help bi weekly where nurses would be requested to clear out their concerns and provide valuable feedback to each other so that transparency is maintained between every individual (Roth et al. 2017). Moreover, the open-mindedness between the nurses, more effectively they will be able to interact and communicate for which medication errors will lessen. The next strategy that needs to be implemented is the introduction of training sessions for the continuous professional development for the senior nurses. They would be held thrice a week for 2 to 3 hours. T hese classes will be helping the nurses to accommodate themselves with the present set of medicines which had arrived in the market. This will also help the nurses gather knowledge about the recent discoveries made in the field of medicines and also help them to know the proper administration routes and dosages. The third strategy that would be implemented is the development of proper plans by the administrative system and financial departments. They would provide proper incentive systems which would be helping in developing enthusiasm in the nurses and would also motivate them to work beyond the organizational goals. Motivation by the leaders and also financial incentives will be helping in making them adhere to the rules of medication and make them dedicate themselves more. Moreover, the organizations human resource department should maintain proper nurse patient ratio and also allocate proper initiatives so that work overload does not occur. Physical and mental impacts on nurses have negative effects on patient safety and therefore human resource management should allocate more nurses so that work gets equally distributed and no nurses get burnt out. Moreover, lastly an open discussion forum can be arranged on weekends where the leaders would discuss their observations throughout the weeks and thereby discuss the incidents with the nurses helping them to identify their mistakes. They would also suggest the alternative action they could have taken in the scenario so that they can also learn the various ways they could have taken which would have prevented the adverse effects on the patients (Starmer et al. 2014). This discussion class would help them to learn from the mistakes already made. The next stage is called the Study phase. In this phase, the strategies which are implemented are reviewed. After reviewing the strategies, the results should be analyzed and initiatives should be taken about what is learnt by the participants. For proper evaluation of the result of the strategies, the hospital organization would be developing a monitoring committee which would be comprised of experienced personalities of healthcare who would be assessing the results. Firstly, the mentors of the communication workshop classes would be called for meeting weekly along with the reports of the nursing professionals. The reports would be containing the developments made by them in their communication skill which would help the experts to understand the response of the nurses and the enhancement of skills they made. Secondly, the training procedures of the continuous professional development would be monitored and the reports of the development would also be taken from the trainers. These would help the experts to understand whether the strategies are resulting in positive effects or are failing to meet the goals (Wright and Khatri 2015). The functioning of the human resource department in allocation of the nurses should also be judged over the quality of the skills of the nurses who are recruited. Moreover, they would also verify that the nurse patient ratio is maintained or not, so that overload of work or stress or fatigue is not experienced by them. Moreover, the qualities of the discussion forums will also be noted so that experts can be sure that evidence based solutions are provided by the nursing leaders and also taking part in development of their knowledge and skills. The most important part of the evaluation of the strategies is to conduct interviews of the nursing professionals with open ended questionnaires about the strategies taken for them. These would help to know their perceptions that whether they are really helping them or required further develop ment of modification of the plans (Noland et al. 2017). The next part of the cycle is the stage called ACT. This stage mainly helps to act over the evaluation results and implement any changes if required in the strategies. The experts of the monitoring committee will develop a file with the results if the evaluation. Following this data in the file, important strategies will then be altered if required. If no changes are required these strategies would be continued until the incidence of medical errors is reduced (Wright and Khatri 2015). Conclusion: From the entire discussion, it is quite clear that medical errors are one of the most important indicators for patient safety and hence the quality of care provided. With the rising incidence of patient mortality and poor quality life due to medication administration, researchers have become quite concerned. They have discovered many factors like inappropriate communication, improper trainings of nurses, lack of proper environmental surrounding, fatigue and stress, and many others result in wring medication administration. Hence, my organization (where I work) has used the PDSA cycle to implement strategies, test their results and alter the strategies when requited. With the help of the steps, the improvement plan can be successfully established which will bring out positive results. Conducting of continuous professional development classes for the senior nurses will give them scope to learn about correct procedures that need to be followed during medication administration. Also cond ucting of communication workshops will help in breaking the barriers faced by different professionals while communication. This will ensure reduction of medical errors that occur due to absence of proper communication or due to absence of communication skills. 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