Clinical Governance in H Ward at Jakarta Hospital - Case Study Example

Clinical Governance Name Institution Instructor Course Date of Submission Introduction H ward is an orthopedic ward with a bed capacity of 30 patients. In order to manage the ward effectively ensuring quality services to both the patients and the workers there has to be some guidelines and policies which stipulate the expectation of the hospital from both the patients and the nurses. The policies of this ward are in line with the goals of the hospital and therefore there is need to follow them to the latter. They are stipulated in line with the clinical governance principal and therefore believed to be the best. However, any contributions which are aimed towards improving the quality of services provided to the patient are welcomed. All members of the staff must work as a team despite their different professional backgrounds. Policies Risk management Responsibilities of different staff in risk management The support staff To begin with, the staff responsible for cleanliness of the ward should be available at all times when required to clean any fluid spillage or wastes. They should report on duty on time and ensure that before that ward rounds begin everything is clean and the corridors are clear. This is because large equipment and dirt around the working area increases the chances of falls for the patient, working staff and relatives coming to visit the patient (Skelton & Todd, 2005). In addition things like blood spillages increase the risks of transmission of nosocomialinfections to both the staff and the other patients as well as to relative Secondly at all times during the process of cleaning, all the staff should be in their rightful protective uniform; which includes an apron, gumboots, a face mask and gloves. This is to ensure that the worker is fully protected from getting any form of infection during their working time Thirdly, during cleaning, the worker should begin with the cleaner areas before moving to the dirtier area. It is advisable to begin with dump dusting of the window seals and the patient cabinets before moving on to cleaning of the floor. The worker should change gloves when moving to a new zone of cleaning, in other words they should avoid using the same glove they used during cleaning of the windows while cleaning the patient’s cabinet. They should also not sweep the floor rather they should wash with water and soap. All these are infection control measures and also to increase the patients comfort. The person cleaning the floor should ensure that there is no soap left on the floor after the cleaning of the floor. This is because soapy floors increase the chances of falls and fractures in the working area (Skelton&Todd, 2005). After every shift the staff should remove their work uniform, leave them at the sluice room for cleaning and disinfection and take a shower prior to going home. This is a health protective measure. During the exchange of shifts, the cleaning staff should ensure that they receive the machines from the person in the previous shift, and ensure that the machines are in good working condition. In case the machines are not in good working condition then this should be reported to the ward in charge immediately for repair or replacement. This is because faulty machines can be a health hazard to both the staffs and the patients. During the cleaning process, the cleaner should not tamper with any machines connected to the patient or move and bed accessories connected to the patient. This is because it may interfere with the treatment therapy, making it less effective, slowing down the healing process or even leading to the increase of patients’ mortality rate (Hirsch, et.al, 2001). During the cleaning of any body fluids, the cleaner should first of all disinfect the fluid for at least twenty minutes using a strong disinfectant such as citadel, jik or Dettol or any other disinfectant available. This is because most body fluids are infectious and should be handled with care. Therefore this is a measure to reduce the risk of infection to different people (Douglas, et.al 2001). The porter on duty should always be available at all times when required to work with the rest of the staff to transport the patient to the required area, for instance to the x-ray department, to the ambulance for referral to name but a few. This is because there may be an urgent need to transfer a patient from one area to another for emergency intervention. The porter should never transport a patient alone from one destination to another. They should always be accompanied by either a nurse or a medical officer or even a doctor. This is because a patient may develop complications along the way and need urgent intervention, which only a medical practioner can provide. In addition, the porter may not know how to best handle the patient while transporting them and may end up interfering with treatment therefore leading to more complications. This is therefore as a measure to void complication of the patient’s condition as well as for accountability (British Orthopaedic Association, 2006). The cleaner should ensure that the fire exit door is free of obstacles and that it is in a good functioning state. The cleaner in the morning shift should work in collaboration with the ward in charge to check the door. This is to take precaution in case of a fire outbreak within the ward (Neale,et.al, 2003). The nursing staff The nursing staff should always be on time to report at his/her working station during their shift. This is a measure to ensure that the nurse receives a comprehensive report about the patients in the ward, as well as the patient they are managing as the primary nurse. This helps in the prevention of mismanagement of patients in the ward. As well as serve as a basis of proper planning of the patient care. During change of shifts, the nurse should ensure that they receive the equipment in the ward and ensure that the equipment is in a good working condition. In case any equipment is not in a good working condition the technical staff responsible for repair should be informed and incase the machine is not in a state that can be rectified then it should be replaced though the administrator. This is because faulty machines within the ward can be a health risk for the patients as well as the staff (Hirsch, et.al, 2001). Before starting any work, the nurse should be well groomed and in full working nursing uniform, which is inclusive of a nametag, at least two pairs of scissors, a second hand watch and the regular nursing uniform. This is because it increases the efficiency and also to avoid misidentification of nurses by the patient and also for accountability purposes (Royal College of Surgeons of England, 1990). Prior to admitting any patient into the ward, there is need to take a thorough history of the patient in order to understand the patient’s condition as an individual and also to identify their patient’s health risks in order to avoid any complications. It is advisable to do a thorough head to toes assessment or assessment using the Gordon’s health pattern in order to be able to manage any patient’s health risks in a timely manner (Gates, et.al, 2008). Immobile patients should be turned at least four hourly and this should be done with a lot of caution in order to avoid making the condition of the patient worse, for instance in case of a fracture patient, to avoid destabilizing the fracture and hence making it worse. The turning should at all times be done by at least two nurses and not one nurse. The turning is done in order to prevent the development of bed sores and the nurses should do the turning as a team in order to avoid harming their back as well as harming the patient during the turning process (British Orthopaedic Association, 2006). The nurse should be in constant assessment of her environment to ensure that the environment she is working in is clean and obstacle free for efficient and effective moving around the ward. In case of any body fluid spillage the nurse should first of all decontaminate the body fluid and the call the cleaner on duty to do the cleaning. This is as an infection prevention measure. And also an environment which is free of obstacles reduces the chances of falls and fractures within the ward (Neale,et.al, 2003). The nurse should use different pairs of gloves while handling different patients and should ensure that they wash their hands prior to moving from one patient to another. The proper procedure of hand washing should be followed in order to ensure that the hands are thoroughly cleaned. This is as a precaution to ensure that there is minimal transmission of infection from one patient to another. During wound dressing the ideal sterile procedure should be followed. A sterile field must be maintained throughout the procedure and contamination should be avoided by all standards. The wound should be cleaned starting from the cleaner area moving to the more infected area. The best cleaning agent should be used for the cleaning of the wound. This is all to avoid infection of wounds within the ward making them septic (Douglas, et.al 2001). All the equipment should be well decontaminated prior to being taken to the sterilization machine. The nurse should put the used equipment perhaps dressing pack in the rightful decontaminant for it to be decontaminated by the nurse in charge of the equipment. This is done in order to avoid infection of the patients and to ensure safety of the equipment to the person packing them. Proper management of waste should be done to ensure that the wastes are put in their rightful places. There should not be mixing of different types of wastes. The non-infectious wastes such as uncontaminated papers should be put in the bin with black lining, the infectious wastes such as contaminated cotton wools and gauzes should be put in the bin with yellow lining and the very infectious wastes such as those having body fluids should be disposed in the bin with a red lining. This is an infection control measure. The medicine cupboard should be well labeled and all medicine put in their rightful containers which should also be well labeled. The name of the medication, its date of manufacturing, its date of expiry and the amount should be a part of the label. This is to avoid giving the wrong treatments to patients and for easy access of the medicines by the staff (Laura& Kerry, 2003). The Doctors Medications prescribed to the patient if hand written should be written in a handwriting which is legible and clear. This is to enable the nurse dispensing the medication to the patient to be able to dispense the correct medication, to the right patient, during the proper time and through the right route. If the prescription is written in a bad handwriting then it would be impossible for a new nurse in the field to identify and give the right treatment to patients. Otherwise all the prescriptions should be done in a typed manner. Before admitting a patient into the ward the Doctor should do a thorough history taking and physical assessment and ensure that they get the correct diagnosis for the patient. This is because misdiagnosis of the patient’s condition has in many cases led to improper management of the patients in the past (Gates, et.al, 2008).. Clinical audit Clinical auditing will be carried out quarter annually. The clinical auditors will be determined by the hospital management team. Some of the people expected to carry out the audit are the members of the management board, the national medical services auditing body or even the ward in charge. Prior to the audits it is imperative that all the nurses ensure that they maintain proper documentation of all the documents in the ward throughout their nursing practice. These include the patient’s notes, antibiotics book, the equipment books, the patient’s record book to name but a few (Royal College of Surgeons of England, 2000). All the staff should also try their level best to ensure that all the equipment in the ward is always in their proper location and well maintained. Patients’ needs should be well met where possible and where not possible it should be explained to the patients. The audit is important as it will enable the management as well as the other staff to be able to identify areas which need to be improved and ensure the improvement of the areas (Laura& Kerry, 2003). Education and continuous professional growth It is the role of the ward in charge to monitor his/her staff constantly and be able to identify the areas they need more education on. Then they can forward the identified area to the hospital body responsible for continuous medical education to conduct training on the same. The in charge should also consult with the rest of the staff on areas they feel that they need more training on (Hospital Doctors, 2003). The in chargealso has the responsibility to bargain for any person who would like to go back to school to increase their level of education. The in charge should also ensure that he/she identifies seminars which are meant to update patients on health related issue and allow his/her staff to attend such seminars. All these are important because it will help the staff to keep abreast with the extremely dynamic medical field. It is also aimed to ensure the best quality of healthcare services are delivered to the patients. Evidence-based care All the nurses and Doctors should ensure that they are giving care that is scientifically sound to the patient. For the nurses, as they write their nursing care plan for the patients they have to ensure that they write a column of the nursing diagnosis, its intervention and the scientific rationale for considering the intervention. This will help in giving scientifically sound nursing care, (Royal College of Nursing, 2000). Patient and relatives involvement during care During the care, nurses and Doctors should involve the patient and the relatives. They should be communicating to the patient on the clinical findings, the treatment modality and the importance to undergo such treatment. They should also render any physical or psychological assistance that may be needed or which may be as a result of the ailment. This is very imperative in improving the quick healing of the patient (Fuller, 2000). References Skelton, A. and Todd, C. (2005).“Thoughts on effective falls prevention intervention on a population basis,” Journal of Public Health, vol. 13, no. 4, pp. 196–202. Gates, J. D. Fisher, M. W. Cooke, Y. H. Carter, and S. E. Lamb. (2008). “Multifactorial assessment and targeted intervention for preventing falls and injuries in a care settings: systematic review and meta-analysis,” The British Medical Journal, vol. 336, no. 7636, pp. 130–133. Fuller,J.(2000) “Falls in the elderly,” American Family Physician, vol. 61, no. 7, pp. 2159–2168. Royal College of Surgeons of England.(2000). Guidelines for Clinicians on Medical Records and Notes.. White Paper 2007.Trust Assurance and Safety. The Regulation of Health Professionals in the 21st Century. ttp://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Publications PolicyAndGuidance/DH_065946 The Initial Care and Transfer of Patients with Spinal Cord Injuries.British Orthopaedic Association. January 2006. A Framework for Casting Standards.Royal College of Nursing/Society of Orthopaedic Nursing. London RCN Publications. 1999. The Effect of Dedicated Emergency Theatre Facility on Emergency Operating Patterns.Journal of the Royal College of Surgeons of Edinburgh 1998; 43:17-19. “Improving Orthopaedic Services- A guide for Clinicians,Managers and Service Commissioners”. NHS Modernisation Agency. December 2002. House of Commons Health Committee.Health Service Committee Report.Independent Treatment Centres. Fourth Report of Session 2005-06. (HC934- 1) July 2006. “Hospital Doctors: Training for the Future”. Report of the Working Group on Specialist Medical Training. (Chairman: Dr.KennethCalman).Department of Health. April 2003 Hirsch,C.,Sommers,L.,Olsen, A., Mullen,L. and Winograd, H.(2001). “The natural history of functional morbidity in hospitalized older patients,” Journal of the American Geriatrics Society, vol. 38, no. 12, pp. 1296–1303, Laura Bragato, Azienda ULSS 12 Veneziana, Venezia, Venito, Kerry Jacobs.(2003). Care pathways: the road to better health services .University of Edinburgh, Edinburgh, UK. Laura Bragato, Kerry Jacobs, (2003) "Care pathways: the road to better health services?", Journal of health Organization and Management, Vol. 17 Iss: 3, pp.164 - 180Keywords:Health authorities, Health services, Process management, Publisher:MCB UP Ltd. Audit, guidelines and standards: Clinical governance for hip fracture care in Scotland 2005, Vol. 27, No. 18-19 , Pages 1099-1105 (doi:10.1080/09638280500056329) Douglas,P., Margo A.,Swan,J., Spigelman,A.,( 2002). Prevention of orthopaedic wound infections: A quality improvement project Neale,G., Woloshynowych, M.,Vincent, C.(2005).Exploring the causes of adverse events in NHS hospital practice.Clinical Risk Unit, Department of Psychology, University College London, London WC1E 6BT, UK Read More