Case Study Analysis: Breaches In Healthcare Standards And Guidelines Essay.

 1:

• Discussion includes relevance of clinical issues in the care of the patient in the case study.
• Predominantly well supported by relevant and credible references.
• Writing was coherent with logical development of key ideas

2:

• Detailed, excellent, identification, explanation and in depth discussion of all Safety Standards breached in the case study.
• Discussion was supported by professional literature.
• Writing was coherent with logical development of key ideas.

3:

• Excellent analysis and discussion of 2 identified National Health and Safety Standards.
• Analysis and discussion was supported by current professional literature.
• Writing was coherent with logical development of key ideas.

4:

• Recommendations for changes to health care practice identified and relevant
• Clearly identified rationales.
• Rationales supported by evidence-based literature
• Writing was coherent with logical development of key ideas.

Flaws in Healthcare Treatment Provided to the Patient

The following assignment would be based on a case study where breaches of several types standards and guidelines have taken place. All these had resulted in poor health and suffering of the patient along with increase of mental and emotional turmoil for the family members.

1: The case study shows a number of flaws in the healthcare treatment that had been provided by the professionals to the patients. The first hospital, where her third baby as delivered, her condition of cholelithiasis was diagnosed. However, the healthcare professionals who were in charge did not take any necessary interventions to help her overcome such clinical issue. When she approached the second hospital with the pain that she was experiencing due to her inflammation of the gall bladder, the professional only provided her some pain medication and did not assess her condition about the severity of the issue. Following this negligence, her condition had become severe leading her to suffer extensively.

The third hospital completely lacked a proper organizational culture that ensured safety and quality care of the patient. It was seen that no one tried to assess the seriousness of her issue and were continuously postponing her treatment telling her that patients that are more serious needs to be attended. This continuous postponing resulted in a severe condition when her gall bladder burst and the gallstones blocked the bile duct entry point (Pasternak et al., 2013). This situation of the patient was mainly due to negligence and the carelessness of the professionals that made the patient suffer largely. Another issue that was also noticed. It was seen that the patient was kept in fasting stage or a very light diet stage for surgery but the surgery was continued to be postponed and her period of fasting of light diet was also continued. This made the stomach of the patient being empty for a long time. This was not only an example of negligence at the work but also affected the human dignity and human rights as the situation resulted her to become weak and fragile.

Another issue that was also observed was the infection of the patient that took place when the patient came back home after being discharged. This might have been mainly because of the improper wound management of the professional who was caring for the patient as she might not have dressed the wound or not have maintained proper protocol during dressing of the wound (Hundal & Shaffer, 2014). There were infection at the drainage site. Moreover, the patient was at the risk for sepsis and therefore the nurse should have followed the dry wound dressing procedure for treatment of the wound. Moreover, situations should be such that the professionals should help in reducing the anxiety and stress of the patient before surgery but nothing such was done. The patient had an increase in blood pressure that could have been the reason of a barrier in the surgery (Triunfo et al., 2013).

National Health and Safety Standards Not Followed by Healthcare Professionals

2: This section would mainly be describing about the National Health and Safety Standards that the nursing professionals had failed to follow while providing care to Ysabel. Australian Commission on Safety and Quality in Health Care had proposed a number of important safety and quality standards which every nurses need to follow in order to maintain reliability, quality as well as safety in the healthcare interventions that they provide.

This case study shows that there was complete breach in the maintaining of the clinical governance that had exposed the patient to improper safety and quality system. It is indeed important for the nursing professionals to abide by these standards while providing care so that they do not become the cause of patient dissatisfaction and ensures good health of the patient. It was noticed that the patient was suffering a lot because she had already developed stones in the gall bladder and there was inflammation as well. She was immediately needed to be entered to the surgery room for conducting laparoscopy. However, this was not done as the nursing professionals on ward thought that they had more severe cases to attend and as a result, her surgery continued to be postponed. This resulted in a situation where she felt burning of the gall bladder. This resulted in multiplied suffering of the patient that gave her a very poor quality life (Chen et al., 2014).

One of the most important standards that the patient had breached is the “Preventing and Controlling of Healthcare Associated Infection”. This standard mainly helps in highlighting the different interventions that the nursing professionals need to take to ensure management of infection as well as prevention of any infection from wounds, sites of surgery and many others (Pillay, 2015). It describes the responsibility of anti-microbial stewardship that states the importance of limiting microbial infection through the proper use of anti-microbial agents, hand washing, proper dressing and many others. It was seen in this case study that the patient had been seen to suffer due to neglects from the healthcare professionals like utilization of unsterilized products while dressing, not following the protocols of dressing wounds or not maintaining proper hand hygiene (de la Serna-Higuera et al., 2013)

Another standard that was also breached is the Communicating for Safety for the patients who are under the care from healthcare professionals. This guideline mainly helps the professionals by guiding them through the different types of strategies and system significant for effective communication. Effective communication is extremely important among patients, multidisciplinary teams, clinicians, families and caregivers across the organization. A number of improper communication episodes took place with tom. Tom was in care of their three little children who could not be left at home alone but he constantly tried to be in touch with the hospital professionals to know about the status of his wife. However, the communication system of the hospital was not appropriate, for which he could not get any information about the present status of his wife (Poupon et al., 2013). This made me anxious, stressed as well as confused sitting at home. Moreover, the professional of the healthcare inquiry section also gave him wrong information stating that his wife was shifted to the ward but in reality, the patient had not yet been transferred from the recovery room. Moreover, the nursing professionals did not answer question of Tom as he was not herself aware about what was happening with the patient (Kroh, 2013).

Preventing and Controlling of Healthcare Associated Infection

Another standard that was also not followed by the professionals is the Recognizing and Responding to Acute Deterioration. This standard helps patients as well as their family members to be well aware of their mental, physical as well as cognitive deterioration of their conditions making them well informed. Although the professionals saw that the patient was suffering in pain due to inflammation of the gall bladders due to stones, they were still very casual with their approach and continued to postpone (Zing et al., 2015). They did not feel the importance to assess the condition of her gall bladder and neglected their practices creating bursting of gall bladders and blocking the bile duct with the stones.

One of the duties of the healthcare professionals is to provide care to the patients which would help them to be safe from any form of infection. Researchers are of the opinion that hospital acquired infection not only increases the suffering of the patients physically but also has innumerable impacts on the metal health conditions. Both the patients as well as the family members get anxious and stressed in such conditions as it leads to increased stay of the patient at the hospital, readmission to the hospitals, outflow of huge amount of finance and resources which lead to poor quality life for the patient as well as the family members. Different types of actions might impeded the professionals to ensure quality and safe care to patients like using under-sterilized products and improper hand hygiene resulting in hospital acquired infections (Otter et al., 2013). Moreover, many of the professionals are also not skilled enough to undertake proper dressing protocols as if they might not know when to apply dry dressing or wet dressing or might not follow the framework policy provided by the healthcare system. They might also fail miserably to assess the risks associated with different actions of the professionals and might not contribute enough to maintain the safe and hygienic environment for preventing infection or controlling them. Therefore, it is important for the nursing professionals to follow the standard of National Health and Safety Standard called the preventing and controlling if infections put forward by the authority and comply with best care services. Not only inappropriate following of these standards result in suffering of the patients and family members causing stress and financial flow but it also affects the healthcare organizations (De bono et al., 2014). They have to spend additional amount of healthcare resources to treat the person that they could have successfully utilized for treatment of other resources. Moreover, when the healthcare professionals conduct such mistakes, it engaged them in legal obligations and the organization tends to lose the reputation. Therefore, it becomes extremely important for healthcare professionals to ensure maintenance of guidelines for infection control and prevention.

Communicating for Safety

Therefore, it is important for the healthcare professionals to take up initiatives by which they can prevent the occurrence of infection while caring for patients and ensure better quality life and satisfaction for the patients. One of the most important initiatives that the healthcare professional should follow is to engage in proper training sessions where the mentors would be helping them to understand the strategies by which risk assessment should be done and infection can be prevented off controlled (Climo et al., 2013). Besides development of skill and knowledge, it also becomes important for the organizational culture to be such that it encouraged safety and quality through infection control strategies. The patient had been mainly seen to develop infection at her drainage sites because of negligence of the professionals to maintain hand hygiene or to adopt proper infection control framework. They might have done the dressing with non sterilize products or have provided wrong methods of dressing (Stone et al., 2014). This had resulted in increased suffering of the patient forcing her to suffer more. All these provided a very difficult time to the patient, her husband tom as well as to the children who required their mother. All these resulted in poor quality of health and life of the patients.

This paragraph would mainly be describing about another important guideline proposed for ensuring safe and quality care to the patients by the professionals are the effective communication among stakeholders. Development of therapeutic relationship with the patient is an important agenda and effective communication is an important tool that has the potential to establish the same. It becomes important for the professionals to communicate effectively among the members of the multi-disciplinary teams to ensure smooth flow of information and accordingly help in ensuring that all needs of the service users are met (Levin et al., 2013). Most importantly, ineffective communication results in medication errors as well as different forms of missed interventions increased waiting times of the patients, patient’s requirements not met and others. It might also result in inappropriate delegation, improper communication and increased chances of missed interventions. Therefore, it is important for the healthcare professionals to ensure that they are following the guidelines of effective communication to prevent such errors and to increase patient satisfaction (O’Halloren et al., 2015).

Effective communication helps professionals to develop a therapeutic relationship with the patients and their family members. It helps them to be kept in the centre of decision-making, thereby focuses in their prior requirements, and needs that need to be considered while planning the care interventions. When the patients feel that they are in the centre of decision-making, they feel empowered (Jackson et al., 2014). When professionals are seen to communicate with the patients in a compassionate as well as empathetic manner, it is seen that patients tend to develop bonding with the professionals. They start believing that the nursing professionals genuinely care for their health and suffering and hence it makes them feel secured and comfortable in the healthcare organization. Effective communication is one of the best ways to follow during seeking for informed consent. It is very important for the healthcare professional to communicate in details about the disorder to the patient and they should state the interventions that can help them overcome the disorder (Dryden et al., 2014). They communicate about the different positive and negative outcomes for the intervention giving total freedom to the patient to choose his or her own interventions and make appropriate decisions. These communication procedures help in preserving the autonomy and dignity of the patient making them feel empowered, honored and respected. This helps in the reduction of stress and anxiety among the patients reducing the chances of depression among the patients.

Recognizing and Responding to Acute Deterioration

The healthcare professionals in the case study have not followed any communication guidelines. For their ineffective communication procedures, tom had been highly anxious about the condition of his wife as he was not communicated about her present status, was given wrong information regarding her transformation to general ward and even her present health condition (Weller et al., 2014). This made him stressed and upset as he also had the responsibility of three young children on him. It was also seen that the communication among the different members of the departments were very poor and no one informed others about health of a particular patients. All these resulted in poor mental health making both the patient as well as the family members anxious and depressed (Joseph et al., 2014).

4: In order to develop skills and knowledge of the professionals regarding prevention and control of the infection, they can be proposed for training sessions where the mentor would be guiding them and enhancing them of the ways they can follow to ensure effective safety and quality through prevention of infection. The organizational culture should be such where the leaders would ensure a blame free environment where individuals can report about the improper practices they have done and thereby get suggestions abut how to prevent infection ad control them in future (Foronda et al., 2016). They should be conducting effective screening of the patients following infection control framework. They should be able to identify vulnerability of the person towards infection and thereby assess the risks for infection and thereby accordingly, they would be arranging suitable interventions for them that would help in reduction of the chances of infection. The training sessions should have detailed discussion and practical sessions for the enhancement of the proper hygienic maintenance as well as wound dressing management and even safety and quality care (Meuter et al., 2015).  

For development of effective communication, training sessions need to be held as well. Professionals can attend workshops for communication skill development and may undertake evidence based practices to develop ways to develop communication. Arrangement of the feedback sessions are also important where employees would state the difficulties they face during communication and the leaders should help accordingly (Thompson et al., 2015).  

Conclusion:

Effective communication, prevention of infection and control of it along with caring for the patient in a diligent way are important for ensuring health of the patient. Improper guidelines set as the National safety and the professionals should follow health standards. They should ensure patient satisfaction and quality of life of the patient.

Importance of Proper Infection Management in Healthcare

References:

Chen, Y. K., Yeh, J. H., Lin, C. L., Peng, C. L., Sung, F. C., Hwang, M., & Kao, C. H. (2014). Cancer risk in patients with cholelithiasis and after cholecystectomy: a nationwide cohort study. Journal of gastroenterology, 49(5), 923-931. https://doi.org/10.1007/s00535-013-0846-6

Climo, M. W., Yokoe, D. S., Warren, D. K., Perl, T. M., Bolon, M., Herwaldt, L. A., ... & Wong, E. S. (2013). Effect of daily chlorhexidine bathing on hospital-acquired infection. New England Journal of Medicine, 368(6), 533-542. DOI: 10.1056/NEJMoa1113849

De Bono, S., Heling, G., & Borg, M. A. (2014). Organizational culture and its implications for infection prevention and control in healthcare institutions. Journal of Hospital Infection, 86(1), 1-6. https://doi.org/10.1016/j.jhin.2013.10.007

de la Serna-Higuera, C., Pérez-Miranda, M., Gil-Simón, P., Ruiz-Zorrilla, R., Diez-Redondo, P., Alcaide, N., ... & Nuñez-Rodriguez, H. (2013). EUS-guided transenteric gallbladder drainage with a new fistula-forming, lumen-apposing metal stent. Gastrointestinal endoscopy, 77(2), 303-308. https://doi.org/10.1016/j.gie.2012.09.021

Dryden, M., Milward, G., & Saeed, K. (2014). Infection prevention in wounds with Surgihoney. Journal of Hospital Infection, 88(2), 121-122. https://doi.org/10.1016/j.jhin.2014.07.008

Foronda, C., MacWilliams, B., & McArthur, E. (2016). Interprofessional communication in healthcare: An integrative review. Nurse education in practice, 19, 36-40. https://doi.org/10.1016/j.nepr.2016.04.005

Hundal, R., & Shaffer, E. A. (2014). Gallbladder cancer: epidemiology and outcome. Clinical epidemiology, 6, 99. doi:  10.2147/CLEP.S37357

Jackson, C., Lowton, K., & Griffiths, P. (2014). Infection prevention as “a show”: A qualitative study of nurses’ infection prevention behaviours. International journal of nursing studies, 51(3), 400-408. https://doi.org/10.1016/j.ijnurstu.2013.07.002

Joseph-Williams, N., Elwyn, G., & Edwards, A. (2014). Knowledge is not power for patients: a systematic review and thematic synthesis of patient-reported barriers and facilitators to shared decision making. Patient education and counseling, 94(3), 291-309. https://doi.org/10.1016/j.pec.2013.10.031

Kroh, M., Chalikonda, S., Chand, B., & Walsh, R. M. (2013). Laparoscopic completion cholecystectomy and common bile duct exploration for retained gallbladder after single-incision cholecystectomy. JSLS: Journal of the Society of Laparoendoscopic Surgeons, 17(1), 143. doi:  10.4293/108680812X13517013317356

Levin, J., Riley, L. S., Parrish, C., English, D., & Ahn, S. (2013). The effect of portable pulsed xenon ultraviolet light after terminal cleaning on hospital-associated Clostridium difficile infection in a community hospital. American journal of infection control, 41(8), 746-748. https://doi.org/10.1016/j.ajic.2013.02.010

Meuter, R. F., Gallois, C., Segalowitz, N. S., Ryder, A. G., & Hocking, J. (2015). Overcoming language barriers in healthcare: A protocol for investigating safe and effective communication when patients or clinicians use a second language. BMC health services research, 15(1), 371. https://doi.org/10.1186/s12913-015-1024-8

O'Halloran, R., Worrall, L., & Hickson, L. (2015). Environmental factors that influence communication between patients and their healthcare providers in acute hospital stroke units: an observational study. International journal of language & communication disorders, 1-18. Retrieved from- https://www.tandfonline.com/doi/abs/10.3109/13682821003660380

Otter, J. A., Yezli, S., Perl, T. M., Barbut, F., & French, G. L. (2013). The role of ‘no-touch’automated room disinfection systems in infection prevention and control. Journal of Hospital Infection, 83(1), 1-13. https://doi.org/10.1016/j.jhin.2012.10.002

Pasternak, A., Gil, K., Matyja, A., Gajda, M., Sztefko, K., Walocha, J. A., ... & Thor, P. (2013). Loss of gallbladder interstitial Cajal?like cells in patients with cholelithiasis. Neurogastroenterology & Motility, 25(1), e17-e24. https://doi.org/10.1111/nmo.12037

Pillay, Y. (2015). Gallbladder duplication. International journal of surgery case reports, 11, 18-20. https://doi.org/10.1016/j.ijscr.2015.04.002

Poupon, R., Rosmorduc, O., Boëlle, P. Y., Chrétien, Y., Corpechot, C., Chazouillères, O., ... & Barbu, V. (2013). Genotype?phenotype relationships in the low?phospholipid?associated cholelithiasis syndrome: a study of 156 consecutive patients. Hepatology, 58(3), 1105-1110. https://doi.org/10.1002/hep.26424

Stone, P. W., Pogorzelska-Maziarz, M., Herzig, C. T., Weiner, L. M., Furuya, E. Y., Dick, A., & Larson, E. (2014). State of infection prevention in US hospitals enrolled in the National Health and Safety Network. American journal of infection control, 42(2), 94-99. https://doi.org/10.1016/j.ajic.2013.10.003

Thomson, K., Outram, S., Gilligan, C., & Levett-Jones, T. (2015). Interprofessional experiences of recent healthcare graduates: A social psychology perspective on the barriers to effective communication, teamwork, and patient-centred care. Journal of interprofessional care, 29(6), 634-640. https://doi.org/10.3109/13561820.2015.1040873

Triunfo, S., Rosati, P., Ferrara, P., Gatto, A., & Scambia, G. (2013). Fetal cholelithiasis: a diagnostic update and a literature review. Clinical Medicine Insights: Case Reports, 6, CCRep-S12273. https://doi.org/10.4137/CCRep.S12273

Weller, J., Boyd, M., & Cumin, D. (2014). Teams, tribes and patient safety: overcoming barriers to effective teamwork in healthcare. Postgraduate medical journal, 90(1061), 149-154. https://dx.doi.org/10.1136/postgradmedj-2012-131168

Zingg, W., Holmes, A., Dettenkofer, M., Goetting, T., Secci, F., Clack, L., ... & Pittet, D. (2015). Hospital organisation, management, and structure for prevention of health-care-associated infection: a systematic review and expert consensus. The Lancet Infectious Diseases, 15(2), 212-224. https://doi.org/10.1016/S1473-3099(14)70854-0