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Clinical Handover - Importance and Elements

Discuss about the Lower Risk Of Readmission For Recurrent Stroke.

The practise of nursing involves activities that help in facilitating the patients in receiving improved quality of health care. There is a constant effort shown by the Nursing and Midwifery Board of Australia (NMBA) to effectively manage and guide the nurses in their practice. The paper reflects nursing interventions that are required for provision of proper care to patients especially in the emergency wards. It discusses the hand hygiene interventions, involving the 5 moments of hand hygiene. Additionally the paper reports regarding the vitals status of the patient Mr. Sharman and shows his Q-ADD score along with his progress report. The aim of this report is to highlight the conditions of the patient Mr. Sharman who is under rehabilitation and illustrate the nature of care that is provided to him. The report also puts forward the various documentations that are involved in provision of care of the patient Mr. Sharman which entails all the information regarding him. This details help to influence the clinical practise that is provided by the health personnel.

Clinical handover refers to the process of transfer of the patient from one particular team to another, along with the transfer of the patient’s responsibilities and the accountability. It also refers to the patient’s information communication process (Sujan et al., 2014). It aims to mentor the staff members who are juniors, providing them with a platform for group cohesion. The elements of clinical handover includes teaching and training of the staff members. It also provides opportunities to the newcomers of the field to interact with the medical culture. Situational analysis is one major part of clinical handover. The situations are needed to be interpreted, which can be conducted in different levels. The first level refers to perceiving the critical factors that exists in the environment. The factors which exists needs to be properly understood and comprehended and finally the happenings of the future could be predicted through situational analysis. This can be related to Standard 6 that is ‘Communication for Safety’ in ways by developing and implementing the systems in order to bring about documentation of the significant healthcare records (Rolfs et al., 2013). Additionally opportunities will be provided for the responsible workforce to identify their job roles and responsibilities that is required for documentation.

The cornerstone of prevention of infection and control refers to the heath hygiene. There is a huge impact of these infections on the morbidity of the patients admitted in the emergency wards. Hand health hygiene is one of the effective tools that can be used to prevent the prevalence of these infections. The five moments of health hygiene is related to the approaches that is involved in describing the major moments that needs to be followed by the healthcare personnel while performing hand hygiene (Sunkesula et al., 2015). The key moments that are suggested by the World Health Organization (WHO) includes the moments that is included before touching a patient, prior to cleaning and aseptic procedures, after body fluid exposure/risk, after touching a patient and after touching patient surroundings (Tomas et al., 2015). When entering the cabin of the patient, I immediately sanitize my hands in case there is a need to touch the patient or the surroundings of the patient. After touching the patient I make sure to sanitize my hands once again. While leaving the patient’s cabin after every requirement regarding the patient has been met, again I sanitize my hands. The sanitization process helps me to disinfect my hands before I make any contact with the patient. The contact might make the patient Mr. Sharman susceptible to the healthcare associated infections since he is already very weak and had been recovering from cerebrovascular accident.

Hand Hygiene - Five Moments Approach

Mr. Sharman had an episode of cerebrovascular accidents or stroke causes conditions which led to muscle weakness, hypoglycaemia, hypotension. These are the main reasons which increases the risk of falling in such patients. Reduction in the muscular tone along with paralysis are involved in the risk of falling of the patient along with the factors of hypoethesia (Andersen & Olsen, 2015).

The patient Mr. Sharman has been detected with weakness on the left side of his body. He even suffers from problems of proper speech due to the occurrence of cerebrovascular accident. This has deteriorated his physical conditions and impaired his motility which makes him susceptible to the risk of fall (Cho, Yu & Rhee, 2015). He is administered with various drugs which helps to manage his conditions can have adverse effects on his health especially his muscles which will increase the amount of risk of falling. Additionally few other factors tend to work within the patient that contribute to increasing of the fall risk prevalence. These includes the fear of falling, impairment of balance and dysfunction of the cognitive functions.

Nurses have an important role to play in the processes of transfer. It is the nurse’s duty to conduct a careful planning of the transfer process in order to minimize the effect on the events that are unintentional. The prime objective should be to maintain satisfaction on the part of the patient along with the stable oxygen circulation and perfusion in the body tissues (van Sluisveld et al., 2015). Appropriate use of equipment is required while the process of transfer along with a vigilant monitoring of the condition of the patient during the transfer conditions needs to be done by the nurses. In certain cases there are issues regarding the patient transfer to the departments where scanning is done or in situations where there is a post-arrest while transferring to the critical care unit (Kudavidnange et al., 2015). Often there is opportunity for training courses for nurses to train in the process of transferring the patients. There are certain principles of transfer that is needed to be considered by the patients such as competence compassion, care and lastly communication.

The Queensland Adult Deterioration Detection System (QADDS) helps in identification of the deteriorating conditions of the patient especially for those who are placed in the emergency department. For determination of the score the vitals that needs to be checked upon includes the respiratory rate, blood pressure, oxygen saturation, the state of consciousness along with the pulse rate and condition of pain. Respiration rate was 20 therefore was scored 0, pulse was 120, blood pressure was 120/90 (usual BP 110/70), temperature was 39.5 therefore scored 2, oxygen saturation was 97% therefore scored 0 and conscious state – Alert therefore scored 0 and oxygen flow rate was in room temperature therefore scored 2. The total score hence accounted to a total of 4

Risk of Fall of the Patient

 The total score calculated from the Q-ADDS table came up to 4. In accordance to this obtained score, it suggests that he patient had significant escalation however this was an acceptable frequency.

In order to conduct urinalysis, the nurses must instruct the patient to void into a container that is clean and dry. The nurses should recommend containers that are disposable. The urine samples should be free from any sort of contaminations like feces, any discharges and vaginal secretions or menstrual blood (Free, 2018). On the basis of the hospital policy, the specimen container that was used for collecting the urine was transferred. In situations when the urine is needed to be collected from the indwelling catheter, clamping is required for about 15-30 minutes, prior to the sample collection. The antiseptic port needs to be cleaned using an antiseptic prior to the aspiration of the sample of the urine using a syringe and a needle. In cases where the sample is not possible to be delivered to the laboratory or tested within an hour, refrigeration is required along with addition of preservatives.

The personal protective equipment (PPE) needs to be administered in the workplaces especially in medical wards. This includes proper training and supervision in addition with the instructions and procedures (Tomas et al., 2015). The types of PPE that can be used while urinalysis includes hands and arms. The hazards that are related to hands includes abrasions, any cuts or punctures, certain chemicals and radiations along with vibrations and prolonged immersion. Options to avoid this involves use of gloves, or gloves along with cuffs and gauntlets that help to cover the part of the arm or the full arm.

In accordance to this framework the communication conducted is given as follows:

I am a first year student and currently I am on my first clinical placement. I am placed in the Rehabilitation ward in the CQ University Hospital. This communication was conducted with the doctor who was in charge of the emergency unit where my patient Mr. Reginald Sharman is currently placed. I had been assigned with the duty to look after him during the morning shift hours.

The current situation with Mr. Sharman is that is vitals are escalated and when I last checked up upon him, he looked flushed and red. He also complained that when during passing out urine, he got burning sensation and the urine smelled.

Nurse's Responsibility in Safely Transferring Patients

According to my perception, Mr Sharman might be having urine infection. Therefore there is a need for constant monitoring especially of the fluid balance (De Meester et al., 2013).  He has some difficulty expressing himself verbally as a result of the CVA. He is high risk for pressure injuries and falls and uses a rollator with assistance to mobilise. He has full swallowing reflex but does require assistance with meals. He is currently scoring 4 on the ADDS chart. Mr Sharman states his pain is 0 at rest and a 3 on movement.

Recommendations that I suggested in terms of providing standard precautions include the constant monitoring of the fluid balance chart. The input and output of the patient should be constantly monitored. The vital signs of the patient should also be monitored at a 24 hour basis in order to understand whether his conditions are deteriorating further or not (Cho,Yu & Rhee, 2015). Mr. Sharman’s blood glucose level needs to be taken care of. The patient has been recovering from the condition of stroke therefore he is currently at a heightened risk of fall. Therefore he should be given all round the day assistance while any mobility to inhibit the fall and implement injury prevention care.

Conclusion

In order to conclude it can be stated that the current environment and the task at hand needs to be addressed for provision of awareness to the individuals and for their proper understanding of the situation. This will help to address the rehabilitation of the patient through clinical handover. The patient was attended and his vitals were recorded which helped to generate the Q-ADDS score. This presented his deteriorating condition according to which significant care was provided to the patient. Being a nurse, it is a job of high responsibility as it involves provision of care to the patients who are quite sensitive. There should be a proper communication between the nurse and the doctor who is in charge of the respective patient. The paper evidently highlights that while communicating with the doctor, the implementation of the ISBAR communication framework is quite helpful as it covers all the aspects that are required for providing a detailed report of the conditions of the patient to the doctor. Recommendations are provided in reference to the current condition of the patient.

References

Andersen, K. K., & Olsen, T. S. (2015). The obesity paradox in stroke: lower mortality and lower risk of readmission for recurrent stroke in obese stroke patients. International Journal of Stroke, 10(1), 99-104. Retrieved from:  https://onlinelibrary.wiley.com/doi/abs/10.1111/ijs.12016

Q-ADD Score Calculation and Action to be Taken

Anderson, J., Malone, L., Shanahan, K., & Manning, J. (2015). Nursing bedside clinical handover–an integrated review of issues and tools. Journal of Clinical Nursing, 24(5-6), 662-671. Retrieved from:  https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.12706

Breisinger, T. P., Skidmore, E. R., Niyonkuru, C., Terhorst, L., & Campbell, G. B. (2014). The Stroke Assessment of Fall Risk (SAFR): predictive validity in inpatient stroke rehabilitation. Clinical rehabilitation, 28(12), 1218-1224. Retrieved from: https://journals.sagepub.com/doi/abs/10.1177/0269215514534276

Cho, K., Yu, J., & Rhee, H. (2015). Risk factors related to falling in stroke patients: a cross-sectional study. Journal of physical therapy science, 27(6), 1751-1753. Retrieved from: https://www.jstage.jst.go.jp/article/jpts/27/6/27_jpts-2015-028/_article/-char/ja/

De Meester, K., Verspuy, M., Monsieurs, K. G., & Van Bogaert, P. (2013). SBAR improves nurse–physician communication and reduces unexpected death: A pre and post intervention study. Resuscitation, 84(9), 1192-1196. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0300957213001688

Free, H. M. (2018). Urinalysis in Clinical Laboratory Practice: 0. Crc Press. Retrieved from: ttps://content.taylorfrancis.com/books/download?dac=C2017-0-67157-6&isbn=9781351085915&format=googlePreviewPdf

Kostoff, M., Burkhardt, C., Winter, A., & Shrader, S. (2016). An interprofessional simulation using the SBAR communication tool. American Journal of Pharmaceutical Education, 80(9), 157. Retrieved from: https://www.ajpe.org/doi/abs/10.5688/ajpe809157

Kudavidnange, B. P., Gunasekara, T. D. C. P., & Hapuarachchi, S. (2015). Knowledge, attitudes and practices on hand hygiene among ICU staff in Anuradhapura Teaching hospital. Retrieved from: https://dr.lib.sjp.ac.lk/handle/123456789/1853

Kulshrestha, A., & Singh, J. (2016). Inter-hospital and intra-hospital patient transfer: Recent concepts. Indian journal of anaesthesia, 60(7), 451. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4966347/

Peltier, T. R. (2016). Information Security Policies, Procedures, and Standards: guidelines for effective information security management. Auerbach Publications. Retrieved from: https://www.taylorfrancis.com/books/9780849390326

Randmaa, M., Mårtensson, G., Swenne, C. L., & Engström, M. (2014). SBAR improves communication and safety climate and decreases incident reports due to communication errors in an anaesthetic clinic: a prospective intervention study. BMJ open, 4(1), e004268. Retrieved from: mjopen.bmj.com/content/4/1/e004268?itm_content=consumer&itm_medium=cpc&itm_source=trendmd

Rolfs, A., Fazekas, F., Grittner, U., Dichgans, M., Martus, P., Holzhausen, M., ... & Jungehulsing, G. J. (2013). Acute cerebrovascular disease in the young: the Stroke in Young Fabry Patients study. Stroke, 44(2), 340-349. Retrieved from: https://stroke.ahajournals.org/content/44/2/340.short

Sethi, D., & Subramanian, S. (2014). When place and time matter: how to conduct safe inter-hospital transfer of patients. Saudi journal of anaesthesia, 8(1), 104. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3950432/

Strasinger, S. K., & Di Lorenzo, M. S. (2014). Urinalysis and body fluids. FA Davis. Retrieved from: https://books.google.co.in/books

Tomas, M. E., Kundrapu, S., Thota, P., Sunkesula, V. C., Cadnum, J. L., Mana, T. S. C., ... & Ray, A. J. (2015). Contamination of health care personnel during removal of personal protective equipment. JAMA internal medicine, 175(12), 1904-1910. Retrieved from: https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2457400

van Sluisveld, N., Hesselink, G., van der Hoeven, J. G., Westert, G., Wollersheim, H., & Zegers, M. (2015). Improving clinical handover between intensive care unit and general ward professionals at intensive care unit discharge. Intensive care medicine, 41(4), 589-604. Retrieved from: https://link.springer.com/article/10.1007/s00134-015-3666-8

Sujan, M., Spurgeon, P., Inada-Kim, M., Rudd, M., Fitton, L., Horniblow, S., ... & Cooke, M. W. (2014). Clinical handover within the emergency care pathway and the potential risks of clinical handover failure (ECHO): primary research.

Sunkesula, V. C., Meranda, D., Kundrapu, S., Zabarsky, T. F., McKee, M., Macinga, D. R., & Donskey, C. J. (2015). Comparison of hand hygiene monitoring using the 5 Moments for Hand Hygiene method versus a wash in–wash out method. American journal of infection control, 43(1), 16-19.

Davalos, P., Au, K. W., Bedros, S. J., & Venkatesha, S. (2015). U.S. Patent No. 9,207,468. Washington, DC: U.S. Patent and Trademark Office.

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