Non-Compliance of Emergency Care's Hygiene Standards - Case Study Example

Title - Code Blue- Emergency Care Introduction In any medical hospital it is essential to maintain cleanliness, proper functioning of the infrastructure in the patient’s room, timely availability of medicines, physicians and nurses (Bullock & Coppola, 2008, p. 505). This paper would address the case where a 15 bed emergency wards in a hospital had to face severe criticisms from the patients. The hospital faced brick bats because of its poor maintenance in the emergency room and poor staff behavior. It also faced problems in dealing with special emergency room patients and unprofessionalism its resident doctors and nurses. Diagnosis of the Problems The emergency ward of Christian Medical Hospital in Wales faced severe criticisms from the patients over the last one year. The annual report submitted this year in the general meeting of the board showed that there were several flaws and inadequacies in the functioning of the emergency ward. These have been listed below: 1. Poor maintenance of the emergency room: the emergency ward of the hospital contains 15 beds for the patients with 3 attached washrooms to be used by the patients. It was found that there were mainly problems in its hygiene, cleaning of the floor, changing of the sheets in the patient bed, disrupted functioning of the air conditioners and lack of dustbins. On inspection by the medical officer, it was found that it was mainly due to negligence of the hospital staff that resulted in these problems. The hospital group D workers were mostly on strike last one year claiming the increase in their remuneration. They were joined by nurses in the hospital, some of whom were posted in the emergency wards for the night shifts. As there were inadequate group D workers, the bed sheets and dresses of the patients remained unchanged for more than two days. The floors were not swept and washed. The same condition was seen in the bathrooms and toilets. The air conditioners were not serviced by the people on regular basis because of which it often went without functioning. The water purifier was also not cleaned regularly. These were serious problems as it would directly increase the spread of germs in the emergency ward. 2. Lack of specialized doctors for the emergency patients: the hospital did not have sufficient number of doctors for attending the critical patients. Most of the doctors were either junior resident doctors or were on leave last year. The doctors present in the wards were not equipped with the adequate expertise or knowledge to handle critically injured patients. Also it was found that the majority of the senior doctors were either unavailable because of leave or had been shifted to other hospitals in the city. The patients in the emergency rooms are different in nature and it is important to have their attending doctors by their sides at all times. But it was not seen in the hospital last year. 3. Poor patient care: it was also seen that the patients and their relatives in the emergency rooms were not treated properly by the nurses. For 15 bed emergency rooms, the hospital management had assigned one nurse and attendant for every three emergency patients. As the majority of the nurses went on strike this number reduced considerably. The result was that there was no coordination between the patients, attending nurses and doctors. There were also incidents where the health of two patients in the room had deteriorated late at night and there was no nurse to attend them. This was partially a result of the staff strikes, but these strikes compromised with the health of the patients severely. 4. Patients turned away: the emergency ward was not able to admit patients above 15 as there were no facilities and beds for more than 15 patients. Also the lack of physicians and staff in the hospital compelled the authorities to send away many of the patients. There were instances when Christian Medical’s ambulances were provided to send the patients to a different hospital. A Strategic Plan to Overcome the Problems A systematic strategy can be formed to overcome these above problems in maintenance and patient care. Firstly, the hospital needs to ensure that there are adequate doctors available in the hospital throughout the year. There must be sufficient nurses and attendants to fulfill their duties in case of vacancies and in availability such as taking leave by the attendants. The hospital should maintain that the servicing of the air conditioners and water purifiers are done within regular intervals. They should hire proper authorities who would be given the charge in these departments. The hospital can tie up with reputed manufacturing companies who would provide them with these machines at a reduced cost and also provide for their maintenance. The hospital should ensure that physicians are available round the clock in the emergency ward and when required. The patients and their relatives should not be made to wait in long queues to avail the service. Most importantly, the emergency rooms should increase the number of their beds and facilities to at least 50. This would call for increase in every other facility as well which should be noted carefully by the hospital management group. The hospital should frame strict measures so that to prevent the occurrences of strikes and boycotts by the staff. It needs to make sure that there is no discipline or misconduct from the side of the administrations as well. The four levels of emergency cares, namely, basic, intermediate, transfer and trauma, should be prioritized while forming the strategic plans as no form and techniques involved in it are similar with the one other. The medical attendants and the physicians should be trained in all these levels according to the laid guidelines. Firstly, the nurses should be trained in the basic or emergency medical trainings at the basic level. This is typically the first training a person would be taking in order to begin their service in the emergency medical departments either as a volunteer or as a paid provider. After the training the person would be able to handle life-threatening conditions which can be in the form of problems in the airway, cardiac arrest, profuse internal or external bleeding and shocks. These trained personnel can also manage less severe situations like treating wounds and fractures, dealing with childbirth for normal patients and addressing emotional crisis of the patients. The people at the basic level of emergency care trainings should also be trained to apply special skills which can include driving in emergency situations, maintenance of the critical equipment as well as the supplies, keeping track of the emergency records etc (International Association of Fire Chiefs, 2008, p.256). The next level is the intermediate level in the training session. The person who passes the training in the basic level can go to the intermediate level. The intermediate emergency training course would include special training courses in intravenous therapy, administration of medicines properly, trainings in advanced airway care procedure, critical monitoring for cardiac arrests etc (American Academy of Orthopedic Surgeons, 2006, p. 4). The EMT-Intermediate training would provide an excellent way for a basic level EMT personnel to hone his or her knowledge while preparing for a course in paramedical care. It would also help the person to build stronger skills, while assessing critical patients. The next level in emergency care training is dealing with transfer patients. The hospital often gets patients who are referenced from nearby hospitals but in majority of the cases is not able to either accommodate them or give them proper attention. Also the staffs have been found to be lacking in skills while dealing with emergency patients with internal bleeding, complications in child birth and critical surgery. The emergency medical care unit must provide training to its staff members in these forms of intensive care. The patients must be trained to handle critical emergency patient care such as providing oxygen supply as early as possible, delivering the right amount of anesthesia for surgery patients and providing blood for the patients suffering from severe bleeding. The last level in emergency care training is trauma.. For this a definitive trauma unit would have to be constructed in the hospital. The trauma care unit in the hospital would be chain of particular medical care facilities that would provide a wide availability of medical care for the injured patients. A fully equipped trauma care system would include all the features which are identified for the optimal trauma care that would include preventing panic, accessing the unit, providing acute hospital care, rehabilitating the patients, and its related research activities. In addition, the trauma system in the hospital would emphasize on the need for developing different levels in trauma centers for coordinating with the care for the injured patients so as to avoid the wastage of costly medical resources (Norton et.al., 2008, p. 403). Trauma units need to have doctors and nurses who are trained to handle trauma related cases. Trauma is not similar to an emergency situation. Its symptoms and its treatments are significantly different. Good Samaritan Law Good Samaritan laws are the legal laws that oblige people to provide reasonable help or assistance to the people, who might be injured, could be ill, or in peril, or in some cases, otherwise incapacitated. The aim of this act is to provide assistance to the people against any form of legal action who offer their hand and provide medical assistance to these needy people (MacBeth, 1999, p. 4). Good Samaritan law was initially aimed at the physicians who would be available to an ailing patient or a victim outside a hospital premises and also making the physician immune against all sorts of penalties and legal jurisdictions (Mulheron, 2010, p. 222). In such situations, the total years of medical experience and the expertise of the attending physicians often does not match with the specific medical needs of distressed and sick individuals. Likewise, the medical equipments needed in such conditions would be very limited, and sanitary conditions would not be in accordance with the required levels of cleanliness. It would not comply with the standard of hospital facilities as well. But in case of emergency units, the Good Samaritan law can have some relaxations. As in the hospital, there have been incidents last year where the health condition of the patients in the emergency unit had deteriorated late at night as there were no helper to attend to the patients at that time, allowing the law to function in these cases can also help in saving somebody’s life. The emergency unit patients need to be monitored constantly. There can be chance accidents where the attendant might not be available. As we are dealing with emergency care patients even a lapse of a few minutes can lead to the death of the patient specially the ones on life support systems. This law would enable any passer by t o help the patient in these chance situations. As the law provides protection to the person providing help in need, the hospital should make the employees of the hospital aware of this facility so as to remove any fear or inhibition from their minds. The hospital needs to encourage the staffs to help the patients in case of emergency. They also need to take some measures regarding the relatives of the patients to help any patient they have in the hospital in case of an acute situation. Treating Adults, Minor, Emancipated Minors, or Incompetent Adults in ER There can be some patients who can be normal adults or incompetent adults, normal minor patients and emancipated minors in the emergency ward. These patients need to be treated in very sensitive manner as they may often retaliate to treatment procedure. The hospital staff will have to be patient and sympathetic toward them. They must be trained to understand the behavior and temperament of these patients. The staff should be trained to engage in friendly small conversations with the patients to make them feel at home. A ratio of 3:1 must be maintained between the patient and the attendant. Special emphasis must be given to the minor section. These young patients might feel lonely and scared in such conditions. It thus becomes the responsibility of the hospital staffs to make them feel comfortable. Treating Patients Who Refuse to Give Consent to Treatment The final person to decide on whether a patient shall continue with his treatments depends on and his relatives the doctor treating the patient. In some cases the patient can have a say here as well. However, there can be situations where a patient in the emergency room might refuse further treatments arising out of fears or family pressures. In such situations the physician and the nurses should convince the patient about the treatment. They need to handle such matters very carefully so as not to create any mental pressure for the patient which would be certainly not beneficial for the patient. Also, the hospital staffs need to talk with the relatives of the patient in the emergency ward to explain them all the risks that could arise for not availing the treatments. Conclusion Every patient needs to be attended with love and care but it intensifies for the patient in the emergency units. The emergency ward at Christian Medical Hospital has been defamed because of the presence of many loopholes that arose because of the lapses in the working staff of the hospital. The hospital must also keep in mind its cost structure while establishing these plans and strategies. The hospital has to ensure that all of its medical staff and physicians are properly trained to handle the emergency patients. A proper ration mentioned in the strategy must be followed as well. The hospital can follow the above mentioned strategy to correct threes defects in its emergency unit. It must frame the four different levels of addressing the emergency situations so as to develop an efficient system. References American Academy of Orthopedic Surgeons. (2006). Emergency care and transportation of the sick and injured. Jones & Bartlett Publishers. Bullock, J., A. & Coppola, D., P. (2008). Introduction to homeland security: Principles of all-hazards response. Butterworth-Heinemann. International Association of Fire Chiefs, National Fire Protection Association. (2008). Fundamentals of fire fighter skills. Jones & Bartlett Publishers. MacBeth, J., E. (1999). Legal and risk management issues in the practice of psychiatry. American Psychiatric Publishing. Mulheron, R. (2010). Medical negligence: Non-patient and third party claims. Ashgate Publishing, Ltd. Norton, J., A. et. al. (2008). Surgery: Basic science and clinical evidence. Springer. Read More