Improving Patient Safety Using Donabedian Model - Essay Example

? Improving patient safety using Donabedian model Handoffs play a critical role in exchanging accurate information that maintain the continuity of patient care in the care facility or transfer to another hospital. In this paper, we will consider a handoff improvement using Donabedian model of quality health care. The paper will adjust the structure and process in order to eliminate risks associated with injuries or adverse events that affect the outcomes. The paper shall provide for opportunities for improvement to patient handoff when patients need admission for psychiatric treatment. Improving patient safety using Donabedian model Introduction Handoffs occur across the health care system in all the settings (Wachter, 2007). There are different types of patient handoffs since some involve transfer of the patient form one health service provider to another or to a different location but by the same health service provider. Interdisciplinary handoffs may occur between the nurses and physicians while intra-disciplinary handoffs occur between the physicians (Wachter, 2007). Patient handoffs are critical to patient safety and occur when the responsibility of attending a patient is transferred from one caregiver to another or from the one department to another within the same hospital. The overall objective of the patient handoffs is to provide accurate, complete and timely information since incomplete and untimely information may put the health of the patient at risk (Wachter, 2007). One of the leading causes of inadequate patient handoffs is unclear communication. Patient handoff may include transferring the patient from the labor unit to delivery unit and then to a rapid response department within the same hospital facility (Wallace & Fitzpatrick, 2006). Factors contributing to poor handoff There are numerous factors that can lead to poor transfers of patient information like limited time and patient information confidentiality issues. Language barriers, noise and caregiver’s fatigue may adversely affect the patient handoffs (Wachter, 2007). (source: White & Byers 2004) Donabedian model of quality of health care provides for three factors in assessing the quality of health care. The dimensions are the structure, the process and the outcomes. The structure deals with the attributes of the setting or hospitals where the health care is provided. The process deals with the medical practices being followed while the outcomes deal with impact of the health care on the health status. The structure is the physical and organizational attributes. The model provides the patient safety framework and helps in analyzing how hazards and risks within the structure may cause injury and harm to the patients (Wallace & Fitzpatrick, 2006). According to the model, the more time and resources are spent on improving the structure of the care facility, the more the staff will have a positive attitudes towards their duties (process), therefore the likelihood of goal accomplishments are high (outcome). The patient safety indicators (PSIs) can provide information on adverse events after surgeries or childbirth (Wachter, 2007). Barriers Some of the barriers to effective handoffs that put the patient at risk include lack of financial resources to implement documented handoffs standards and language barriers between the health workers and the patients (Wallace & Fitzpatrick, 2006). Lack of time for handoffs and caregiver’s stress may compromise the quality of handoffs. The structure of the health facility like the physical set up may present numerous barriers to effective communication. Some of the barriers that may be inherent in the facility include noise and lighting or high temperatures that hinder staff coordination and communication (Wallace & Fitzpatrick, 2006). Donabedian model The structure is identifiable and includes human resources aspects. The number, quality and variety of health care professionals should be sufficient in order to ensure quality health care (White & Byers, 2004). The record keeping should ensure quick retrieval and access of medical information. Health facilities should keep separate medical registries for each type of disease or department visited by the patient (White & Byers, 2004). The hospital should also integrate the medical records of the patient and store the information in a computerized database that allows for timely and accurate retrieval of the information. The health facility should provide electronic copies of the health records upon their request in a timely manner. The medical facility should be able to exchange critical patient information with other care providers in a timely manner upon the request (White & Byers, 2004). The care facility should have enough staff; therefore enough nursing hours should be allocated to each patient in a day. The staff should not be overworked since this may lead to stress and fatigue that may adversely impact on the patient handoffs. Another structural measure could be the number of surgical cases that are postponed or delayed beyond the allocated schedule time (White & Byers, 2004). The percentage of errors in medical orders and number of pieces of equipments like computers in the care facility and lab report errors are some of the structural measures of the quality of health care. The presence of noise and other distracters in the care facility will also affect the communication between the care giver and the patient, therefore adversely impacting on the handoffs process (White & Byers, 2004). The process consists of all activities that take place between the patient and health care provider. It includes both the technical and interpersonal processes. The technical processes seek to improve the individual health without increasing the risk while the interpersonal processes aim at the psychological and social interactions between the patient and caregiver (White & Byers, 2004). The process reflects the procedures, surgeries and medical tests that are performed to the patient. An efficient procedure or process indicates the ability of the physician to screen, diagnosed and treat the medical condition. A wrong procedure may lead to further complications and mishaps during the diagnosis and treatment phase. For instance, caregivers should monitor pneumonia patients’ reception of blood cultures before antibiotic injections in order to prevent distortion of the blood cultures (White & Byers, 2004). The process also encompasses how the limited resources are utilized, therefore the care facility should ensure time and equipment are utilized efficiently. The process should ensure minimum wastage of needles and bandages (Wallace & Fitzpatrick, 2006). The care should be focused on the needs of the patient thus consultations should be done prior to handoffs like transfer of the patient to a different department or facility. The caregiver should have effective communication and interpersonal skills that are critical in delivering patient information to either the other physician or the patient. Transparency and accountability of the health care worker will help in improving the health care delivery process (Wallace & Fitzpatrick, 2006). The effectiveness of the structure of the health care facility and administration together with the service delivery process, will lead to better health care outcomes (White & Byers, 2004). Proper structures and efficient processes will improve the population health through reduction in the patient waiting time. Proper processes lead to cost-effectiveness of health care since expensive and urgent medical attentions are avoided through proper planning and communicating (Wallace & Fitzpatrick, 2006). The number of patient falls will reduce while the number of C-sections will also decline. Unexpected returns for further surgery will decline if patient scheduling improves due to a reduction in a number of days between the call for appointment and the actual first appointment (Croskerry, 2009).. Another critical outcome of excellent structures and efficient processes is a reduction in employee turnover and increase in the average years of employment in the health care facility (Savage & Ford, 2008). The documentation of patient medical history will be enhanced by implementation of modern electronic medical records which is critical in dealing with errors in medical orders. The patient satisfaction index will be high while the number of patient referrals to other patient will increase thus improving the revenues of the health care facility (Savage & Ford, 2008). Inpatient psychiatric admissions and hand off to ER staff Over a few years, inpatient psychiatric admissions have aimed at promoting patient recovery and expanding peer support. Inpatient admissions are aimed at reducing stress and allow the patient to concentrate on recovery. The patient should undergo a medical examination to determine the state of his overall health. Patients are assigned therapists and numerous psychiatric medicines depending on their medical condition. During therapy, the patient is able to learn about his or her emotional and mental functioning and the effect on his relationships with others. Handoffs to ER staff may lead to psychiatric emergency due to disturbance of patient thoughts. Economic hardships and increased patient stress levels have increased the need of inpatient psychiatric care. Common psychiatric emergencies that occur include suicidal thoughts, aggressive behaviour, mood swings and substance abuse (White & Byers, 2004). During handoff to the ER staff, the patient should be provided with medication from the general Emergency Department nursing staff while the inpatient psychiatric staff should evaluate the patient symptoms thoroughly. Monitoring of symptom changes is the responsibility of the ER staff. The emergency department should provide 24/7 medical attention to the patient. Diagnosis of the mental conditions can be done with information from the clinical interviews, mental status examinations, lab tests including drug screening, brain imaging where necessary, electronic medical records and psychological tests. The physician should develop the treatment plan according to the nature of the medical condition. The physician should justify the need for inpatient treatment in his recommendations and provide any crisis intervention mechanisms that may be needed in future (White & Byers, 2004). The physician should also formulate the risk reduction plan and identify mechanisms of assessing the progress of recovery through feedback information. The risk management plan should include suicidal thoughts reduction and depression reduction. Medical means should be provided to deal with acute psychosis and acute intoxication of substances abuse. Support services like counselling should aim at reducing the patient anxiety. The physician should also consider the side effects that may occur due to the use of particular medication. Delirium or impaired concentration is one of the medical conditions that may lead to inpatient admissions. The patients suffering from this mental condition can hardly memorize three words. The patient is usually confused and his body cannot regulate the body temperature thus there is a high risk of collapse due to dehydration. Visual hallucinations may also be experienced (White & Byers, 2004). There are opportunities for improvement in the Emergency room. Due to the emergency nature of the patient condition, the staff must aim at providing treatment for injuries that are life-threatening and require immediate response (Savage & Ford, 2008). Handoffs can be a source of medical errors and liability claims but also an opportunity for preventing and recovery from adverse effects in the psychiatric treatment. The first step is the pre-turnover time where the physician prepares for the handoff to the ER staff (White & Byers, 2004). The initial physician should then arrange for a meeting with the ER staff where information about the patient mental condition is exchanged. A patient handoff to ER staff should be safe, timely and efficient (Savage & Ford, 2008). The handoff should also be patient centered and equitable. Areas of improvement according to Donabedian model include the structure and process factors. The handoff should utilize technology like electronic health records due to emergency of the care. Patient factors that should be catered for include the language barrier, the pain level and knowledge of own illness. The physical facility should be designed in a manner that creates patient safety. For instance, natural light, wide corridors and outdoor green space are essential in minimizing instances of patient aggressive behaviour (Savage & Ford, 2008). Unbreakable windows and doors with limited opening are essential in improving patient safety since they reduce chances of the patient hanging themselves. Most mental patients being at a greater risk of aggressive and violent behaviour to other patients, the handoff should allow for separation of the mentally oil patient from the rest of patients within the care facility (Savage & Ford, 2008). The documents and systems should have memory aids of the history of the patient medication and drugs administered in the past (Croskerry, 2009). Language barriers that are created by ambiguity in patient records, non-medical terminologies and second language issues should be avoided since the ER staff may perceive the patient needs differently. Nurses and physicians have different medical terminologies that they use to communicate; therefore terminologies used during the handoff to ER staff should be clear and easily understandable. Time pressure and length of handoff may put the patient at risk. The handoff should consider the demands of the caregiver’s time like the time allocated to other duties (White & Byers, 2004). Standardization of time allocated for the handoffs is necessary due to emergency of the care required by patients in emergency room (Savage & Ford, 2008). Numerous forms of communication media such as recorded telephone communications and face to face meetings should be used. The communication media should allow the receiving ER staff to make clarifications of the information in a timely manner. Confidentiality information should be safeguarded by the communication media; therefore documented information should be properly filled and accessed only by the responsible staff in the health facility (Wallace & Fitzpatrick, 2006). According to the “pass the baton” model of handoffs, the handoff will include provision of patient information and roles of the previous caregiver. The patient name, residence and sex will be highlighted during the handoff. The ER staff together with the previous staff will conduct an assessment of the vital symptoms and signs of the patient. The previous caregiver will give details of the current situation of the patient, the recent changes and response to the previous treatment whether certain or uncertain symptoms and signs have been noted. For instance, he should outline whether the drugs administered have been able to control the situation or not and if further actions are necessary (Savage & Ford, 2008). The previous caregiver will hand over report of the patient safety concerns like allergies and isolations that the psychiatric patient has experienced. The safety concerns are critical since the information will highlight any potential triggers that may adversely affect the care to the psychiatric patient (Croskerry, 2009). The nurse will provide information on the background history of the mental illness like the recent episodes, current medication and the family disease history (Savage & Ford, 2008). The background information will assist in determining other needs of the patient like the need of isolation or the nutritional requirements in the diets and how the mental condition should be monitored. The nurse will also pass information on the actions that were taken in previous treatment and the required treatment depending on the patient current condition (Savage & Ford, 2008). Timing is also essential therefore treatment actions should be prioritized according to the level of urgency. The handoff should outline the responsibilities of the family members, the patient and the psychiatrist in delivering the treatment. The handoff should consider the next actions or the anticipated patient response to the treatment therefore a contingency plan should be put in place (Croskerry, 2009). Conclusion Health workers should ensure two-way communication by using both verbal and written communications. The hospital management should involve the health workers in developing the handoffs standards and enough time should be accorded for handoffs. If possible, handoffs should be conducted at the patient bedside by involving the patients and families in the handoffs process. The health care facility should implement modern technology like electronic medical records in order to enhance the accuracy and timely exchange of information between the health personnel. References: Croskerry, P. (2009). Patient safety in emergency medicine. Philadelphia. Kluwer. Savage, G & Ford, E. (2008). Patient safety and health care management. Bingley. Emerald. Wachter, R. (2007). Understanding patient safety. London. McGraw-Hill. Wallace, M & Fitzpatrick, J. (2006). Encyclopedia of nursing research. New York. Springer. White, S & Byers, J. (2004). Patient safety: principles and practice. New York. Springer. Read More