Reflect on your experiences as a health care professional. Compare and contrast your experiences in a current (or previous) workplace with current literature on health service design.
Answer
In today’s healthcare sector, it is imperative to abide by certain protocols and principles so that the optimal service delivery may be rendered to the healthcare recipients. Maintenance of quality and safety in healthcare is a crucial step to foster the quicker recovery and wellbeing of the patient. In this connection for allowing greater insight about the topic pertaining to quality and or safety of healthcare, a case study as appeared in a relevant literature may be cited. Gluyas and Morrison (2014) in their work have represented the incidence that described the death of a nursing home resident in addition to medication error that preceded the death. The article provided a sneak peek into the issue of cognitive functioning that is related with the thoughts and processing of information capability for the concerned person. The cause of death for the resident was attributed with the underlying pathogenesis of the disease rather than any involvement of any person. However, on closer examinations, it was revealed that the attending nurse who was in charge of the patient was responsible for a medication error occurring a few hours before the resident’s death in which 25mg of morphine instead of 2.5mg was subcutaneously administered.
The utility of applying a definite framework for analysis of the care and contextual factors in patient safety is of paramount importance in clinical sector. The London Protocol has been put in place to streamline the recognition of the patient safety issue in a suitable manner through root cause analysis (Ahmed et al. 2014). According to the propositions made in the London Protocol, clinical practice that might lead to causation of an incident in turn may be influence by certain contributing factors. The types of contributing factors might include patient factors, task and technology factors, individual factors, team factors, work environmental factors, organizational and management factors in addition to institutional context factors. Among these identified factors, individual, team and work environmental factors are of particular relevance in the give case scenario. The wrong dose of subcutaneous administration of morphine as performed by nurse may be stated as the individual factor that lead to the incident although the patient factor due to criticality of the underlying disease have been attributed to the ultimately cause in death. It has been reported that the nurse was a newly graduate nurse who was performing her duty as a registered nurse for the second time in that shift along with other three extended care assistants or nursing assistants. Despite the fact that these nursing assistants constantly reminded the nurse regarding the administration of the prescribed morphine medication as long overdue, it felt short of their sight as well when the nurse asked the one who was with her on duty while administering the medication to check the dosage of medication. Quality of work seems to be hampered often under the influence of nursing burnout because of workload (Van Bogaertet al. 2014). Thus, team factor contributed to the causation of the incident. Further, unfamiliarity with morphine administration, skipping of the orientation course for the new staff in nursing home beside the excessive workload due to large number of patients and need to collaborate extensively with other healthcare personnel outside the organization contributed to chaos and work pressure for the nursing professional. Thus, in this case the work environmental factor due to tremendous workload as opposed to meant for a newly appointed registered nurse resulted in causing the incident. Therefore, the patient experience of undergoing wrong dosage of medication as found on the second place while administering the medication may be identified to have occurred because of interaction of multiple factors that encompassed individual, team and work environment.
Clinical governance is a coveted concept in the modern healthcare sector where emphasis is laid on optimizing the healthcare delivery system. Enhancement of effectiveness and efficiency of service is falls under the primary objective of clinical governance through removal or restricting the unsafe practices or the ones that are of little benefits. Integral to this process, the participation of consumer has been acknowledged as a crucial factor. The measure has been considered as a progressive step by which resource allocation may be sustained and done properly by taking into consideration consumer views and preferences. Relevant literatures have shown that consumer participation is increasingly gaining prominence in the publicly funded health services and has been documented in standards and policies. Resource allocation process essentially catered to communication, consultation and participation for improving the provision of health service for the healthcare service recipients. Consumer values and perspectives are increasingly gaining prominence in the clinical governance sector to be included while undertaking vital decision-making ability (Harris et al. 2017). Patients who are considered as the potential service users are considered as the consumers. Therefore, understanding and support received from the patient might be indicative of enhancing the quality and safety of the service that is being delivered to them. The issue has been raised and incorporated in public health policy in an aim to foster the provision of most suitable healthcare service to the patient. Health data that has been procured takes into account the values and preferences of the patient so that the healthcare service delivery experience may be bettered to some extent (Hripcsak et al. 2014). In the given context, the principle of consumer participation do not hold true as there is no documented evidence whether the opinions and preferences of the patient was taken into consideration while framing the care regime. Moreover, medication error was the identified issue that might possibly have been a factor leading to death of the nursing home resident. Negligence of duty for nurses by not conforming to the preferences of the patient has not been stated in the case study so that we may infer that consumer participation was overlooked.
Clinical effectiveness is another vital component that is stressed upon in clinical setting so that optimal care service may be rendered to the patients in need. The healthcare practitioners and professionals must increasingly make efforts so that the efficacy of clinical care may be enhanced significantly. Clinical governance being indicative of a continuous learning environment focuses essentially on creation of safe, responsive and effective services. Commissioning of quality of care services remains at the pivot of the healthcare delivery system whereby evidence based practice has been emphasized to inform the healthcare personnel regarding the following of the most prudent methods to increase the efficacy of service (Hamer and Collinson 2014). Other relevant research has also laid emphasis on rendering safe and high quality healthcare service through ongoing research evidences and innovations. An integrated, continuous and coordinated healthcare delivery is useful in this regard (Jones and Killion 2017). In the given scenario, clinical effectiveness could have been improved and well addressed had there been a provision of a simulation-based strategy for implementation in clinical and educational sector. Knowledge based and rule-based errors might be well allayed by investing in such procedures and has been regarded as a crucial tool for abating error-prone situations like that of medication administration (Keers et al. 2013).
Improved workforce within the clinical healthcare team might allow for a better output in terms of facilitating the provision of adequate healthcare service to the patients. Modern interdisciplinary approaches are being increasingly emphasized in the clinical settings to harbor optimal outcomes. Management of clinical standards in an adept manner through increased collaboration with the healthcare workforce is fostered through abidance of a multi-professional healthcare framework (Kennedy et al. 2017). It has been recognized that facilitation of learning of evidence based practice principles is dependent upon the engagement of the related workforce within the clinical setting. Clinicians, nurses in addition to the inter-professional students have been suggested to play crucial role in maintaining effective workforce so that the clinical outcomes may be greatly improved (McKeever et al. 2016). In the given scenario, lack of on-site support as desirable from the nursing attendants also contributed to the emanation of medication error. Orientation of new staff members was also not done in the give context that added to the cause of medication error. The coalition, unity and adequate professional knowledge and training amongst the registered nurses and attending nurses might have helped n evading the situation to some extent.
Risk management is another aspect of clinical governance that attends to the conformance of various safety principles to ensure that the patients receives utmost care facility without posing threats or harms to their health. Governance roles as well as management and practice roles are essential in ensuring that the risk assessment and subsequent tasks are appropriately conducted (Brennan and Flynn 2014). Advocacy of a patient safety culture may be gained through training of the healthcare staff who are directly associated and responsible for conferring healthcare service to the patients depending upon their needs and circumstances (Sendlhofer et al. 2015). In the given scenario, the lack of adequate training and orientation course for the newly appointed registered nurse for increasing the familiarity with the near environment might have been beneficial in preventing the risk associated with medication administration.
The promotion of clinical excellence is directly related with the interaction of a plethora of factors such as those encompassing principles of consumer participation, clinical effectiveness, effective workforce and risk management that underlie the clinical governance aspect. Emphasis must be laid on each of these components to render safety and quality healthcare service to the patients.
References
Ahmed, M., Arora, S., Tiew, S., Hayden, J., Sevdalis, N., Vincent, C. and Baker, P., 2014. Building a safer foundation: the Lessons Learnt patient safety training programme. BMJ Qual Saf, 23(1), pp.78-86.
Brennan, N.M. and Flynn, M.A., 2013. Differentiating clinical governance, clinical management and clinical practice. Clinical Governance: An International Journal, 18(2), pp.114-131.
Gluyas, H. and Morrison, P., 2014. Human factors and medication errors: a case study. Nursing Standard, 29(15), pp.37-42.
Hamer, S. and Collinson, G., 2014. Achieving Evidence-Based Practice E-Book: A Handbook for Practitioners. Elsevier Health Sciences.
Harris, C., Ko, H., Waller, C., Sloss, P. and Williams, P., 2017. Sustainability in Health care by Allocating Resources Effectively (SHARE) 4: Exploring opportunities and methods for consumer engagement in resource allocation in a local healthcare setting. BMC health services research, 17(1), p.329.
Hripcsak, G., Bloomrosen, M., FlatelyBrennan, P., Chute, C.G., Cimino, J., Detmer, D.E., Edmunds, M., Embi, P.J., Goldstein, M.M., Hammond, W.E. and Keenan, G.M., 2014. Health data use, stewardship, and governance: ongoing gaps and challenges: a report from AMIA's 2012 Health Policy Meeting. Journal of the American Medical Informatics Association, 21(2), pp.204-211.
Jones, A. and Killion, S., 2017. title Clinical governance for Primary Health Networks.
Keers, R.N., Williams, S.D., Cooke, J. and Ashcroft, D.M., 2013. Prevalence and nature of medication administration errors in health care settings: a systematic review of direct observational evidence. Annals of Pharmacotherapy, 47(2), pp.237-256.
Kennedy, M., Elcock, M., Ellis, D. and Tall, G., 2017. Pre?hospital and retrieval medicine: Clinical governance and workforce models. Emergency Medicine Australasia.
McKeever, S., Twomey, B., Hawley, M., Lima, S., Kinney, S. and Newall, F., 2016. Engaging a Nursing Workforce in Evidence?Based Practice: Introduction of a Nursing Clinical Effectiveness Committee. Worldviews on Evidence?Based Nursing, 13(1), pp.85-88.
Sendlhofer, G., Brunner, G., Tax, C., Falzberger, G., Smolle, J., Leitgeb, K., Kober, B. and Kamolz, L.P., 2015. Systematic implementation of clinical risk management in a large university hospital: the impact of risk managers. Wiener klinische Wochenschrift, 127(1-2), pp.1-11.
Van Bogaert, P., Timmermans, O., Weeks, S.M., van Heusden, D., Wouters, K. and Franck, E., 2014. Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events—A cross-sectional survey. International journal of nursing studies, 51(8), pp.1123-1134.
