Factors Affecting Patient Safety in an Elderly Facility

Overview of Staff and Facility

In addition to Sarah, who is an experienced manager and clinician, a full-time geriatric nurse practitioner just joined the staff a week ago and is being oriented at the facility’s main offices across town. The facility ensures 24-hour coverage by registered nurses.

Licensed vocational nurses (LVNs) work 12-hour shifts as charge nurses. Most medications are administered by one of the LVNs. Certified nurse aides, chaplains, housekeepers, and dietary personnel compose the rest of the staff.

A medical director provides on-call services and visits the facility at least once a week for several hours. Additionally, the facility contracts for services from physical therapists, occupational therapists, and social workers.

One of the primary concerns that Sarah has is patient safety. In the past 2 months, the medication error rate has increased. The charts are kept at the nursing station in a secured area and are in paper format only.

The pharmacist reports that more than 700 different medications have been supplied to the facility during the past month.

Review of medication incident reports shows that most of the errors were caused by the interactions of, or adverse reactions to, medications that were prescribed by various physicians who have been seeing a large number of residents for the first time as the result of influenza complications.

Pharmacists from a contracted agency visit the facility once a week to review residents’ charts for the appropriateness of medications prescribed.

The facility has a quality review committee that meets every month to review events of the past month, including follow-up of any unusual incidents.

1.Is a change needed? What is the perceived problem? What standards will support and guide any change that may be needed?

2.If you were Sarah, what kind of assessment would you complete? What framework or strategy would you use initially to collect data comprehensively about the factors in the change situation? What questions would you ask?

3.At what point would you involve other individuals, and why? How would you apply systems thinking to this issue?

4.Would you consider this a low- or a high-complexity change situation? What change management approaches will probably be needed? Justify your selections.

5.Whom do you perceive as potential change agents who will champion patient safety measures associated with the medication administration system in the facility?

6.What is the role of staff followers in this situation?

7.How will you select appropriate strategies that will relate to the behavioral styles and responses of the staff and the major players and allow for optimal constructive participation in this situation?