Risk Management - The Management of Hospital-Acquired Infections - Assignment Example

?Risk Management Paper Introduction The risk management issue under review by my facility is hospital acquired infections or nosocomial infections. It is defined as any infection obtained from a health institution that is separate and distinct from the one for which the patient was admitted. Sometimes these infections could appear after discharge or during the patient’s hospital stay. They also refer to occupational infections among healthcare providers. MedWest Haywood Hospice and Palliative Care is my respective institution. It offers both post acute (home and hospice health) as well as inpatient services. The institution has a bed capacity of 112 and a home care program. Currently, MedWest has identified catheter associated urinary infections as their most significant hospital acquired infection even though other infections are also under review. Steps that have been put in place to address the issue The hospice has dealt with this problem by first tackling patient identification. Samples and specimens from and for patients must be labeled correctly. This ensures that if they are eligible for blood transfusions, they get the correct ones. Furthermore, identification is done in the patient’s presence in order to ensure accuracy. MedWest Haywood also has a communication policy for caregivers. This means that test results and other documentations must be delivered to the right medical personnel within the appropriate time. Furthermore documentation of that communication ought to be recorded. The institution has also established a standardized communication format that members of the institution are supposed to follow. These formats include SBAR and Ticket Ride (MedWest Carolinas Health Care, 2011). Aside from communication and patient labeling, the company has also worked on medicine administration. MedWest has procedures for labeling all medications. Persons under anticoagulant therapy are more likely than others to be harmed. Therefore, specific procedures must be adhered to when dealing with these patients. The institution has standards and procedures for reducing the quantity of drug concentrations in its environs. It strictly adheres to the five principles of medical administration that focus on giving patients the right medication at the right time, to the right person, in the correct dosage, using the appropriate route. Particular emphasis is given on medicines that sound or look alike as these are likely to cause errors. Medication containers with syringes or other apparatus are labeled. Care is taken during preoperative settings as well as other procedural environments. A protocol for reconciling medication throughout the care continuum exists in the Hospice. Direct infections brought on by medical practitioners are controlled through adherence to national standards for hand hygiene. Medical professionals must wash hands prior to and after contact with patients. They are also expected to follow rules for isolation of patients who may be at risk of infecting others. MedWest expects its staff to adhere to national guidelines concerning difficult to treat infections. It also follows similar procedures for control of infections after surgery as well as prevention of catheter associated urinary tract infections. In surgery, MedWest Haywood prevents infections by having a time out procedure. Here, all the professionals involved in the surgery will identity the correct time out. Additionally, they must mark the surgical site but do this in accordance to preset rules. They are also supposed to surgically pause before starting the procedure in order to ensure that the right patient, site and procedure have been identified. How the agency developed a path to remedy the problem First, the organization identified the impact of health problems and the amount of risk that patients are exposed. By showing these challenges, it would be possible to get buy in from the professionals responsible for risk exposure as well as risk mitigation. This would also ensure that management and other stakeholders of the institution understood the need for such safety procedures. The organization realized that these infections increase patient disabilities and could even create conditions which diminish the quality of the person’s life. Some nosocomial infections have led to death. It is unacceptable for patients to die due to preventable reasons, from the institutions that were meant to prolong their lives. The economic costs of hospital acquired infections were identified as problematic for the patients. Length of stay increases tremendously when nosocomial infections arise. The hospice found that consumers’ stay increased by between 3 days to 20 days, depending on the nature of the infection. Indirect costs arose due to missed working days. MedWest Haywood also found that the infections were straining the institution’s resources by causing it to allocate them to preventable conditions. Additionally, because the hospice dealt with aging patients, chronic diseases were highly prevalent. These groups were quite susceptible to infections. After coming up with a case for risk management of hospital diseases, the company carried out a risk analysis of all the potential sources of hospital acquired infections. It came up with five key areas that were contributing to the problem. It realized that poor coordination between medical practitioners was a leading cause. There were no procedures for creating seamless communication across the care continuum and this led to problems. Furthermore, documentation of communication between members of the care group was absent. The group also realized that certain procedures were highly risk-prone and these included catheters as well as surgeries. Although national guidelines existed for the same, few protocols were there to ensure that the guidelines were followed. It was also likely for professionals to start on a procedure before confirming certain details as they would largely focus on the work ahead of them. Catheter associated infections were also found to be a serious problem for the institution. 80% of the infections acquired from the hospice originated from this group. Bacteria from the institution led to the prevalence of the problem and had to be handled. MedWest also established that medication administration and specimen handling were a key area of susceptibility. They realized that most confusion in the hospice arose when professionals mixed up intended interventions. No method existed to ascertain that these mix ups did not arise. Further, they established that sometimes excessive quantities of medication were contributing to the problem. After identification of the causes, the risk management team then established procedures and standards for dealing with each area of concern. In communication, they created standard communication formats and outlined the manner and occasions that professionals needed to communicate as well as procedures for documentation. They also created the surgical pause for surgery-related infections as well as other routines for hazards in this segment. Matters of medical labeling were also streamlined through set protocols. It was also stated that strict adherence to the national guidelines for prevention of health acquired infections would be followed without compromise (MedWest Carolinas Health Care, 2011). Valid methods adopted by other facilities to address the problem Some institutions start by establishing infection control committees which consist of a myriad of professionals from various disciplines. The group needs to have a direct reporting associating with administrators and should have certain procedures that govern their program. They usually create a work plan that is time bound thereby allowing staff to have direct instructions on how to minimize infection risks. This group also ensures that training occurs on a regular basis for the staff. Many healthcare facilities also choose to establish infection control manuals. Here, the infection control team will establish the rules, standards of procedure as well as the processes that are needed in order to prevent infections. They often update the information and distribute it among healthcare professionals. This shows that the institution takes nosocomial infections seriously and will not compromise on them. Some institutions also allocate specific roles to hospital staff concerning infection management. Technical components of hospital hygiene are delegated to nursing staff, clinical microbiology, maintenance or housekeeping. Once these roles have been delegated then regular check up of the interventions will be assessed. In the event that an outbreak occurs, investigation will be done by the infection control committee. Physicians often play a critical role in control of nosocomial infections. They usually interact with patients directly so their practice must be in tandem with this aspect. They have a role to play in hygiene practices as well as in administrative roles in the control committees (Raymond & Aujard, 2000). There are several other strategies used by facilities to deal with infections. Some of them limit the amount of exposure from equipments, visitors and staff. Others prevent contamination of equipment and materials that will come into contact with the patient. Some focus on good nursing practice which others revolve around hygiene and isolation. Some streamline their reporting procedures involving the primary caregivers around a certain patient. Institutions may also work with consultants in health that deal with these infections (Carlet, 2009). Comparison with what the agency established MedWest had an infection control committee but the rigor with which peer facilities control their activities is nonexistent in this hospice (Inweregbu et. al., 2005). It does not have a plan for surveillance of outcomes and also lacks the visibility that is necessary in order to make the program effective. Training may also be an issue of concern to the institution. It places a lot of emphasis on individual preceptor or mentorship programs which may not have a holistic approach to infections controls. An infections manual also exists at MedWest. However, the ease of availability of this document may be put into question. The hospice seems to have laid out nurses’, physicians’ and other professional’s tasks in infection control. Many practitioners seem to know what they are expected to do in order to deal with these issues. However, too much emphasis seems to be given to the usual or technical aspects of infection control. The organization seems to downplay the administrative role that can be played by medical practitioners when handling these issues. MedWest appears to embrace some of the common methods of infection control like reporting protocols, isolation and hand hygiene. However, it has done little to consult with external experts. Issues of consistent review are also a problem. On the other hand, compliance with national policies and regulations has been done promptly. Conclusion The facility appears to have a head start in management of hospital acquired infections. It has done a good job of complying with national standards, establishing a manual for infections control and having a team in charge of this. However, improvement in organization wide training is necessary and so is increased visibility of the infection control committee. References Carlet, J. (2009). The zero risk concept for hospital acquired infections. Clinical Infectious Diseases, 49(5), 747-749. Inweregbu, K., Dave, J., & Pittard, A. (2005). Nosocomial infections. Continuing education in Anaesthesia, Critical Care and Pain Journal, 5(1), 14-17. MedWest Carolinas Health Care (2011). Medwest Academic affiliate clinical orientation manual. Retrieved from http://www.medwesthealth.org/sites/www/Uploads/images/2011%2011-04%20MedWest%20Academic%20Affiliate%20Clinical%20Orientation%20Manual%20Revision.pdf Raymond, J. & Aujard, Y. (2000). Nosocomial infections in pediatric patients. Infection Control Hospital Epidemiology, 21, 260-263. Read More