Changes in the Respiratory Care Services Department - Essay Example

?Proposal for respiratory care services department Work place: King Fahad Medical Complex (Dammam) Proposal: Changes in the Respiratory Care ServicesDepartment General goal of the project: This project seeks to propose changes in the respiratory care services department, mostly in relation to the collaboration of the different health professionals and the establishment of a short term plan for the next six months, and a long term and strategic plan to follow. Aim 1: Collaborative work between the neonatal, pediatric, adult and cardiac unit representatives. Proposed changes: To update and review policies and procedures in respiratory care, clarifying the rules for respiratory therapy and preventing or minimizing any untoward incidents in the future. The review process for hospital policies and procedures are measures which are meant to ensure the quality of hospital work in most departments and units. Reviewing the hospital policies and procedures are akin to the work carried out by external and internal quality assurance agencies. Brown (1999) discusses that hospitals are an essential element of the healthcare system as they provide services which seek to improve and extend the lives of people. They are however also places where inadequate or inappropriate treatment can cause harm. In the past, studies have indicated that incidents of negligence have led to unfavorable events for patients (Brown, 1999). Negligence can occur in the hospitals and these incidents can often be fatal for patients. Reviewing hospital policies is an important addition to the hospitals because it helps prevent incidents of neglect (Brown, 1999). Hospitals are often dependent on internal quality control mechanisms which include physician functions, peer reviews, and staff competence assessments in order to prevent instances of neglect and to secure quality care in the different hospital services (Brown, 1999). These policies ultimately help to secure improved patient care and help prevent medical errors. Corsbie (2010) also discusses the importance of review in terms of establishing tools which help enable the medical staff and the hospital board in evaluating the professional competence and performance of all the members of the medical and health team. Professional practice evaluations can help establish results on assessments and evaluations in improving professional competence, practice and patient care (Corsbie, 2010). Reviewing hospital policies and procedures also help provide a monitoring process for clinical performance among health providers (Corsbie, 2010). Reviewing policies can also help the hospitals monitor the trends in performance, assessing overall data and case findings as well as using comparative data where available. Through the review of policies, it is also possible to identify any possible opportunities in the practice improvement of individual practitioners, through feedback and through the development of plans for improvement, correction and improved quality care (Corsbie, 2010). Through review processes, it is also possible to ensure that professional practice evaluations are clearly established, and that they are objective, timely, as well as appropriate. Reviewing the policies and procedures of the hospital, especially the respiratory care unit is important in order to establish gaps in the delivery of services as well as issues in the coordination and collaboration of the health professionals. In identifying these gaps and issues, possible improvements in relation to coordination and collaborative working within the unit can be implemented. Changes can therefore be implemented in terms of the overall goals, as well as the individual adjustments that each health professional would have to make in order to improve his practice and his collaboration with other health professionals. Aim 2: To improve competency of the regular staff, newly hired staff, trainees, and interns. Proposed changes: Establish competency forms for the regular staff, newly hired staff, trainees, and interns. In order to support the general competence of all health professionals in the unit, an educational file has to be established for each staff. Such file shall help prove that the staff is eligible for the position and has the adequate and appropriate competence for the position he is occupying. Such file shall also indicate that he or she can competently carry out the procedures or work assigned to him. A competency file is needed on the staff in order to help establish a clear picture on the performance of the staff members. Knowing how each staff performs would provide a greater sense of management ability because the manager is better informed about the competency of all his staff and that he can easily identify who can be assigned to which job and who is not performing well in the particular work assigned. Competencies among health professionals are important in the healthcare profession. Gibson and Heartfield (2005) discuss that changes in healthcare delivery and in the role of health professionals indicate global socio-economic and political trends and issues. More significant competition in the market and in multi-skilling has affected health delivery, shifting emphasis on cost effectiveness and on being able to work within disciplinary bounds. Trends are often not consistent in terms of the emphasis and on competence frameworks where some areas are able to gain greater control and other areas have less control (Gibson and Heatfield, 2005). Health reforms are being implemented in different parts of the world and the trend is not based on high-cost in-patient care, but more towards primary care services based on finite resources (Gibson and Heartfield, 2005). In order to ensure these health reforms, competency standards have to be established for the various health professionals working in hospitals and in various health units. The initial means by which competence is established is through licensure examinations. Licensure examinations are carried out on graduating students in various professions and degrees, distinguishing those who have met the sufficient standards of the practice in terms of theory and clinical competence (USAID, 2012). Licensure examinations for the various health professions are standard requirements and for hospitals, it is important for them to sift through their applicants and their health staff in order to determine which have passed the licensure examinations. Licensing is considered a statutory method which helps the government grant permission for an individual to engage in an occupation (USAID, 2012). Licensing is a process which helps governments protect public health and safety and helps them manage health professionals and facilities. Licensing also helps guarantee that the various facilities offering health services are complying with the minimum and legal standards of care (Vandewater, 2004). In reviewing the competency standards of the health staff within the respiratory care unit, it would therefore be important for the managers to review all the qualifications of the health staff, establishing their competency, their licensure examination compliance, and other elements of their competence. Licensing is considered a mandatory requirement in maintaining competence. Its requisites and compliance are also based on a certain time-frame where continuing education requirements are needed at various points in the practice (Vandewater, 2004). Renewal of licenses often requires compliance with minimum standards of the practice where health education as well as revival of competency skills is often required. In securing the competence of my staff, I would also need to ensure that they are complying with continuing education activities required based on their profession (Vandewater, 2004). Continuing education is an essential part of licensing as well as of securing competency among professionals (Fletcher, 2007). Although these professionals have already passed the licensure examinations, continuing education would help update their skills and introduce updates to the practice which may have been recently established by the board of professionals (Fletcher, 2007). With each year, new technologies are being introduced in the health practice. Each health professional has to be made aware of these new technologies in order to ensure that the patients are being given access to the latest technologies as well as the latest procedures which can help them achieve improved health outcomes (Fletcher, 2007). In effect, it is important to ensure that the health staff members within the respiratory care unit have the necessary licenses as well as the continuing education updates on their knowledge and skills. Licensing standards are often set at minimum standards, based on government policies founded on the need to secure health and safety of the country and of the general population (USAID, 2012). Among individual health providers, licensing standards are often based on training, completion of a degree from a competent training school and technical competence based on passing of licensure examination (Vandewater, 2004). Licensure exams are the most common examples of regulation via licensing; however other regulatory programs include the reciprocal grant of licenses to professionals of other states, securing standards in the professional practice, and establishing systems to evaluate and punish professions who violate the professional license standards (USAID, 2012). Licensing is a necessary part of competency because without such license, one cannot be deemed competent in the legal and professional sense (USAID, 2012). Moreover, without such competence, one cannot adequately deliver the essential health services needed by the patients placed under the professional’s care (Vandewater, 2004). Once the competence of each health professional is established, the competence of the entire medical unit or department can also be guaranteed (USAID, 2012). A unit or department is only as good or as competent as its members. Through a well-reviewed and well-supported portfolio, the overall professional competence of the respiratory health care department can be ensured. Aim 3: Logistics Proposed Activity: Improve logistics of the department Collaborative work is needed between the respiratory care department and the biomed department. The biomed department is involved in maintenance and collaboration with them is needed in order to secure preventive maintenance of the machines. Instances have been noted where measurements in the machines were not accurate, or where they fluctuated, and where there was damage to some of the machines. A study by O Wear (2003) states that, technology changes in hospitals, and so do maintenance requirements. Technology is often dependent on time and the life span of each product is becoming shorter and shorter with technologies being used 20-30 years ago, no longer existent today. Health care facilities must be prepared to accommodate the challenges which technologies entail. Changes in health care facilities will also impact on maintenance (O Wear, 2003). As individuals consider the effect of technology on health facilities, they are also considering the latest developments in medical equipment. Current technological improvements now include high-tech methods in disposal of wastes in hospitals as well as in homes (Ministry of Health and Family Welfare, 2010). The area where technology is most apparent in hospitals is the medical equipment. Medical equipment impacts on the infrastructure as well as the environment of hospitals (WHO, n.d). One of the major changes in hospital technology includes the miniaturization of technology where smaller and handier versions of hospital equipment are now made available to the hospitals (WHO, n.d). The miniaturization of hospital equipment has proven to be both beneficial and disadvantageous in terms of medical equipment because maintenance has been reduced as operators can easily handle the equipment; however, dropping these equipment have also been more frequent due to their diminutive size. In some cases also, the equipment is often so small as to preclude repair; as a result, replacements seem to be the more viable option for these medical machines (WHO, n.d). Regardless of the size and the advancements in medical machines, the importance of maintaining such equipment is an imperative concern in the health care field, one which has to be a major concern among health managers. The World Health Organization (n.d) has also established a checklist by which the maintenance of equipment and of the hospital itself can be secured by managers. First and foremost, the WHO declares that there has to be a hospital maintenance plan where such plan would establish whether or not the building is in good shape, where there are no inoperable equipment in the hospital, and where the electrical, water, and waste system works (WHO, n.d). Secondly, there also has to be a hospital maintenance system where there are repair and maintenance manuals for all hospital equipment available in one location, where there are master records of maintenance of equipment, and where there is an inventory of all equipment in all rooms of the hospital (WHO, n.d). Thirdly, there must also be an action record which indicates the scheduled maintenance to be performed on all hospital equipment based on a regular basis and schedule (Ministry of Health and Family Welfare, 2010). Action records must be indicated on all equipments and for each month a maintenance check shall be made on all equipments (WHO, n.d). Fourthly, there must also be a system of reports to indicate the state of the equipment during each inspection and during each scheduled as well as unscheduled maintenance and equipment check (WHO, n.d). Possible follow-up actions on the equipment shall also be recorded in said action records. The WHO (n.d) also indicates the importance of checking the electrical systems of the equipment. This may also involve the process of oiling or replacing defective parts of the electrical systems. An annual plan for inspection and replacement of defective parts must also be set in place (WHO, n.d). A routine inspection of the mechanical parts of the equipment must also be carried out in order to replace defective parts where necessary and to ensure an annual inspection of the equipment (WHO, n.d). Technology and hospital equipment go through the normal process of wear and tear and it is therefore important to ensure that the equipment is functioning at their utmost efficiency in order to avoid any medical errors and to avoid endangering the patients. Hospital equipment may also be used by various individuals of varying infectious potentials. Most of these equipments cannot be disposable after use by one patient, hence, they are often reused by other patients (Ducel, et.al., 2002). The challenge therefore is on preventing the transmission of pathogens from one patient to another. This is where decontamination becomes an essential part of hospital equipment care. This process includes cleaning, disinfection, and sterilization (EMS, n.d). All hospitals therefore have to have a decontamination policy in order to assist staff members in establishing what decontamination processes would be used for the items of equipment. The process of decontamination and sterilization is based on the pathogens possibly present in the equipment and these processes must be applied on the equipment in order to prevent transmission of infection (Ducel, et.al., 2002). It is important to ensure adequate cleaning of equipment because there are various risks of infection for each patient using the equipment (EMS, n.d). The risks may be classified into three types and these types indicate various types of cleaning or sterilization. Firstly, low risk infections or infections involving non-critical items are those which come into contact with normal or intact skin (EMS, n.d). This may include the stethoscope, or inanimate objects like the walls, floors, ceilings, and furniture. For low risk equipment, cleaning with detergent and drying is usually sufficient. For stethoscopes used on highly infectious patients, they are often cleaned more thoroughly (EMS, n.d). Secondly there is the intermediate risk equipment. These are also known as semi-critical items or those which do not penetrate the skin or do not enter sterile areas, but are in close contact with mucous membranes or non-intact skin. In cleaning these equipments, cleaning with HLD is often adequate (EMS, n.d). Examples of these equipments include: respiratory equipment, flexible endoscopes, laryngoscopes, specula, endotracheal tubes, thermometers, and similar equipment. Finally, high risk or critical items are those which penetrate sterile tissues including body cavities and the blood vessels. There is a high risk of infection and contamination involved in these equipments (EMS, n.d). Cleaning and sterilization is often needed. High-level disinfection may also be needed in cases where sterilization is not possible. Examples of high risk equipments are: surgical tools, intrauterine devices, vascular catheters, implants, and similar tools (EMS, n.d). For single use items, these are often used on critical, semi-critical, and noncritical areas. However, these equipments are often prepackaged with their disinfection and sterilization processes already in place prior to use. They are disposed after single use. These equipments include gloves, needles, syringes, and tongue depressors (EMS, n.d). As was mentioned above, the bigger concern is on the use of equipment which has to be reused. The risk of infection is high with these equipments. Within the respiratory care unit, it is therefore important to set in place firm policies on maintenance, including sterilization, cleaning, and decontamination of equipment. Establishing clear and written policies on equipment use and maintenance is therefore important in the respiratory care unit. Coordinating these plans and policies with the biomed department would help ensure compliance with these policies and prevention of issues in equipment use. Aim 4: Empowerment Proposed changes: In order to maintain synchronization of activities and functions within the department, there would be three senior therapists or in-charge respiratory care givers who will be assigned based on their experiences and educational background. One of the caregivers shall be in charge of the adult intensive care and cardiac intensive care unit, another would be in charge of the neonatal and pediatric intensive care units, and the last one would be in charge of the ____. These caregivers shall follow the following rules: 1. Distribute work load equally. Teamwork helps to achieve equal work load. Where all members have an equal workload, the appearance of any unfair treatment on the part of any member would be dispelled (Davila, 2012). Favoritism or unfair treatment would be prevented and the work would be performed by competent members of the team (Davila, 2012). Distributing work load would also ensure equal and appropriate delegation and in the end would also ensure that the all the duties would be fulfilled and coordinated with other members of the team. 2. Respond to the code blue. There are various hospital emergency codes all of which help determine the level of response and urgency attributed to any incident or patient. In general, a Code Blue in the US refers to a patient needing resuscitation or emergency medical attention in possible cases of respiratory or cardiac arrest (Colby, 2007). A code blue would alert the resuscitation team, likely coming from the respiratory care unit (Colby, 2007). In general, any health professional may respond to a code blue however, in practice, the hospital often has a team on standby in order to adequately respond to such codes (Colby, 2007). 3. Monitor the staff during the work and checking for any uncompleted work. Monitoring the staff during their work is also an important function for most managers (Leka and Griffiths, 2003). Monitoring work helps ensure that the health staff is adequately functioning at the peak of their skills and expertise. Moreover, the monitoring process would also provide clues on possible gaps in the practice, including issues on the implementation of procedure (Leka and Griffiths, 2003). It can help note who the lazy employees are, including those who are diligent, temperamental, persistent, kind, engaging, or possibly abusive. 4. Annually evaluate the staff. Annual evaluation can help provide a yearly evaluation or assessment of hospital staff. Such evaluation would assess performance and eventually identify strengths and points of improvement for each employee. The evaluation would also establish how each employee works within the team, and how well the unit works as a team. Issues in team working would be established and various points of improvement can then be implemented. 5. Ensure continuous education and competency for the staff. Continuing education has to be secured for the staff in order to improve and maintain competence. 6. Help and assist in case of extra work. In instances where the team is short-staffed or overwhelmed in terms of work load. It is the responsibility of the team, including its leaders to assist in the extra workload. This is part of the cooperation and coordination of services which eventually help reduce work stress, reduce medical errors, and ensure quality health services. 7. Check for the stock and equipments in their unit, ensuring that all these are functioning properly and all units are properly stocked. Checking the stock and equipment would ensure that hospital equipment and supplies are available at all times, and without any delays and risks on the patient. Empowerment is an important element of leadership. Being made a leader is by itself already empowering because the role of leader implies various functions which would necessary include the exercise and manifestation of power in some shape of form (Population Health Futures, n.d). Leadership is associated with authority and authority cannot be manifested, nor can it be successfully manifested without power. As a leader takes on authoritative roles, he would also likely feel more empowered and even more encouraged to perform well as a leader (Population Health Futures, n.d). He would also be empowered to then encourage his team to carry out their functions well and to work together in order to produce better team results. Empowerment in leadership brings various benefits (WHO, 2006). For the patient, it helps promote self-worth and it helps support the client in choosing health lifestyle options (Population Health Futures, n.d). As far as the organization is concerned, empowerment supports development and the establishment of a shared vision in the organization’s success. It also supports the units in aligning visions for the organization. Empowerment also facilitates the process of establishing the organization’s mission and core values; moreover, it also helps secure the mission of the organization within the unit scope of work (Population Health Futures, n.d). Empowerment supports the contribution of agency programs in relation to the achievement of health vision and mission. The above points shall be important goals and activities which have to be implemented and achieved in the first six months of my office. Immediately upon taking over the position, I shall be implementing changes in the respiratory care department in order to make way for the goals and aims which I want to achieve for the unit and ultimately, for the hospital in general. Long term plan In order to implement a long-term plan for the unity, I shall be participating in respiratory, pulmonary, and cardiac conferences and these conferences shall be spread out in the next year. I shall be representing our own health organization and I would also be choosing some health staff in our unit to participate in such trainings and conferences in order to update their knowledge and skills. Within the next year, I hope that each staff member in the unit shall have attended at least one of these conferences. The knowledge and the skills learned and imparted through these conferences shall then be shared with the other staff members in order to ensure that their knowledge and skills are also updated. Possible trainings within the unit shall also be carried out in order to ensure that all our skills and competence is at par with the minimum legal and professional standards of care. Aside from conferences, asthma days can also be arranged in order to ensure proper and adequate care for the asthmatic patients. Assigning asthma days would also prevent any issues on the delivery of care, especially among patients who need quality respiratory care for prolonged periods of time. Another long-term care plan would also involve the establishment of a home care clinic for patients who need mechanical ventilation for the duration of their life. These home care clinics would ensure that the patients have access to quality health services and most importantly, competent respiratory care. Mechanical ventilations patients also require monitoring and with the assistance of the respiratory care department, their health outcomes may improve and the quality of their life may also be changed. It is important for health professionals to be involved in educational activities and medical conferences because educational activities help provide updates in the theories and knowledge currently available to the practice (Wentz, 2011). Educational activities arm the health professionals with the tools they can use in order to be effective health professionals. These activities also prevent the practice itself from stagnating, helping make the practice be more dynamic as a profession in general, especially in relation to the delivery of health services and in the improvement of the patient’s life (Wentz, 2011). Medical conferences provide new technologies, new knowledge, updates, as well as new options in the care of patients. These conferences also allow for the dynamic and engaging discussion of health professionals, ensuring the exchange of ideas and experiences in the practice (Wentz, 2011). These exchanges also provide basis for change in the practice, as well as for the introduction of more innovative and dynamic goals. Home care ventilation is also one of the options for respiratory care. According to the Weinmann Symposium at DGP Congress (2011), non-invasive home ventilation improves the prognosis and the quality of life for patients experiencing severe COPD. In Hamburg, home care ventilation has helped treat patients with COPD, helping improve blood gas levels and pulmonary functions as well as improve the long-term survival rates and quality of life of these COPD patients (Weinmann Symposium at DGP Congress, 2011). COPD patients often need a multi-dimensional assessment, especially in relation to the complexity and the severity of their disease and where home health care specialists are available to carry out monitoring practices. The monitoring can also be carried out on nutritional status as well as lung hyperinflation which without home health care cannot be monitored or detected (Weinmann Symposium at DGP Congress, 2011). In the end, these are factors which can worsen patient status. Summary Aim 1: To improve coordination and collaborative working between the different health professionals in the unit, including the neonatal, pediatric, adult and cardiac unit representatives. Actions: To update and review policies and procedures in respiratory care, clarifying the rules for respiratory therapy and preventing or minimizing any untoward incidents in the future. Aim 2: To improve competency of the regular staff, newly hired staff, trainees, and interns. Action: Establish competency forms for the regular staff, newly hired staff, trainees, and interns. Aim 3: Logistics Action: Improve logistics of the department. Improve maintenance of equipment. Aim 4: Empowerment Action: In order to maintain synchronization of activities and functions within the department, there would be three senior therapists or in-charge respiratory care givers who will be assigned based on their experiences and educational background. Long term plan In order to implement a long-term plan for the unity, I shall be participating in respiratory, pulmonary, and cardiac conferences and these conferences shall be spread out in the next year. References Brown, J., 1999. The external review of hospital quality the role of accreditation [online] Available at: http://oig.hhs.gov/oei/reports/oei-01-97-00051.pdf [Accessed 25 June 2012]. Colby, W., 2007. Unplugged: reclaiming our right to die in America. New York: AMACOM Div American Mgmt Assn. Corsbie, C., 2010. 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Business Briefing: Hospital Engineering and Facilities [online] Available at: http://www.touchbriefings.com/pdf/13/hosp031_r_wear.PDF [Accessed 25 June 2012]. Population Health Futures, (n.d). Visionary leadership/empowerment [online] Available at: http://www.populationhealthfutures.com/pdf/part2/VisionaryLeadership.pdf [Accessed 25 June 2012]. United States Agency for International Development, 2012. Licensing [online] Available at: http://www.hciproject.org/improvement_tools/improvement_methods/approaches/licensing [Accessed 25 June 2012]. Vandewater, D., 2004. Best practices in competence assessment of health professionals: background policy paper. College of Registered Nurses of Nova Scotia [online] Available at: http://www.crnns.ca/documents/competenceassessmentpaper2004.pdf [Accessed 25 June 2012]. Weinmann Symposium at DGP Congress, 2011. Improving the quality of life for COPD patients [online] Available at: http://www.weinmann.de/fileadmin/wm_de/website/company/presse/pressetexte/20110407_Improve_quality_of_life_for_COPD_patients.pdf [Accessed 24 June 2012]. Wentz, D., 2011. Continuing medical education: looking back, planning ahead. New York: UPNE. World Health Organization, 2006. What is the evidence on effectiveness of empowerment to improve health? [online] Available at: http://www.euro.who.int/__data/assets/pdf_file/0010/74656/E88086.pdf [Accessed 25 June 2012]. World Health Organization, (n.d). Administration and management maintenance of hospital facilities and equipment. WHO [online]. Available at: http://www.who.int/management/facility/hospital/Hosp_Standards_Maintenance.pdf [Accessed 25 June 2012]. Read More