Quality Nursing Care: Risk Management Plan in the Context of Healthcare Settings - Term Paper Example

Quality Nursing Care Executive summary The relationship between quality healthcare and patient outcome is well established through various studies that have been able to establish a causal-association between the two. However, few studies have delved into the issues of developing monitoring and evaluation frameworks of the various indicators of interest that are key in assessing levels of quality health in hospital settings. Development of an M&E framework that identifies key indicators of interest is essential since it forms the basis for development of another key process in establishing high levels of quality healthcare which is a Risk Management Plan. This paper will discuss the aspects of M&E framework and Risk management plan in the context of healthcare settings for purposes of establishing quality healthcare. Introduction The relationship between patient and healthcare providers is a significant factor of not only quality healthcare, but patient recovery as well. Thus, quality healthcare is increasingly becoming a significant metric of interest among policy makers and other stakeholders in the health sector given the level of growing evidence indicating its impact on all aspects of healthcare. Quality health care is described as “excellence in the ability to provide high-quality care which is safe, effective, person-centred, timely, efficient and equitable” (Baid and Hargreaves, 2015). In this regard, quality health care is identified as a critical factor of skilled personnel, among other determinants (Bender et al., 2016). The implications of quality in healthcare is a well-researched area in current studies and there is overwhelming evidence that indicates it has far reaching implications not only within the health sector settings but also more significantly for patient outcome, including patient safety. This paper will review evidence for quality healthcare in general, and discuss existing models and related factors revolving on quality of nursing care such as monitoring of quality, measure of indicators, risk management plans and interactions between quality care and other actors. Quality nursing care The nursing profession sector is probably one of the most overstretched sectors in healthcare industry because of the increasing number of people requiring specialized as well as general care. The emergence of diseases such as lifestyle related, chronic and cancerous conditions in the last few decades, has significantly strained the nursing healthcare providers at levels unprecedented. This coupled by a liberalization of healthcare industry focused on profit-making and cost cutting, has further aggravated the issues of quality in healthcare. However, the recognition of importance of quality in nursing care has not only began in recent times but as early as 1850 when Florence Nightingale documented in a study an evaluation of nursing care (Cohen, 1984). Since then, numerous studies have demonstrated that quality nursing care has tremendous impact on patient recovery and overall healthcare quality in a hospital setting. One study established that ‘nursing practise environment’, is a major determinant of nursing quality care which is dependent on other crucial factors such as nurses outcomes (job satisfaction, skills etc), patient outcomes and organizational variables (Anzai et al, 2014). In addition, it was found that “nursing shortages compromise the safety and quality of patient care”; a clear demonstration of the association between quality of care and patient recovery (Anzai et al, 2014). Another study by Vryonides et al (2015) concluded that inadequate nursing staff in healthcare settings “contribute to poor practice and substandard patient care with neglect, unnecessary suffering, adverse patient outcomes, and higher mortality rates”. Thus, it can be argued that patients’ recovery is significantly influenced by quality of care. The concept of quality nursing care has remained centre stage because of the research evidence that demonstrates the positive association between quality care vis a vis patient recovery/wellbeing. For this reason, various models and metrics have been developed to evaluate and measure the concept of quality nursing care as described in healthcare. The resulting criteria of quality nursing care must be effectively measured from both the perspective of the patient and the nurse caregiver. Some of the various criteria used in assessing nursing quality are discussed below. (i) Patient safety This is an effective criteria that can be applied in assessing the level of healthcare quality existing in a facility. Patient safety is a general criteria that is assessed through a variety of various specific measurable indicators namely; (a) falls resulting to harm in hospital, (b) healthcare associated infections, (c) measures of surgical harm, (d) measure of safe medication management and (e) pressure injury acquired in hospitals (Yankovsky et al., 2016). A measure of these indicators will provide a true reflection of the safety level in a facility. (ii) Effectiveness This criteria attempts to measure the efficacy of healthcare in a facility through proxies. It therefore assesses the rate of amenable mortality, and healthcare interventions leading to positive patient outcome. To measure this one will need to utilize data related to hospital readmissions, day cases turning into overnight stays, measure of cardiovascular disease management and occupied bed-days aged 75+ among others. (iii) Access to care This is a measure of patients’ access to healthcare services in a given locality. It depicts the level of access to healthcare and consequently is a measure of nursing care (Yankovsky et al, 2016). It utilizes data such as, age appropriate vaccinations for 2-year olds and eligible population for cervical screening. (iv) Efficiency This is simply a measure of cost-benefit analysis i.e. the cost of the healthcare services provisions vis a vis patient derived benefit based on cost. It is usually assessed through survey where hospital days during the last six months of life are measured (Yankovsky et al, 2016). In measuring the efficiency of healthcare, stakeholders and policymakers attempt to answer the question of whether the expenditure on healthcare is justified. (v) Equity This is an indicator that measures the standards of healthcare across various segments of the population. This factor attempts to assess how healthcare services standards varies across different groups. In all the above mentioned indicators of quality nursing care, the nursing professionals can directly influence the outcome and level of each. They are therefore an outcome of medical professionals’ actions that can be qualitatively measured and analysed. Most notably, nurses comprise the largest proportion of healthcare professionals, thus their input significantly impacts on quality of care. This is especially so in the backdrop of various studies suggesting very “high prevalence of burnout among nurses globally” (Nantsupawat et al., 2016). Nurse burnout is found to be directly related to adverse outcome in patient care and safety according to a recent study by Nantsupawat et al (2016) Measures of Healthcare quality tools There are several approaches that can be applied in assessing the level of healthcare quality in a given facility. The Donabedian model is one of the most commonly used framework in measure of healthcare quality level through three broad perspectives; structure, process and outcomes (Gardner et al., 2014). The Donabedian is described as a “model of Structure, Process and Outcome (SPO) is a construct whereby each component is influenced by the previous, making the components interdependent” (Gardner et al., 2014). Within the facility in which I work this is the model that is applied in measure of healthcare quality. Some of the aspects that are tracked through this model in my facility include; cost efficiency, critical pathways, patient outcome and clinical practise guideline. The cost efficiency is a measure of whether the benefits of healthcare service exceeds cost implications. It is a measure of quality in that it informs on overutilization or underutilization of healthcare, both of which impacts on quality. Some of the data collected in order to measure this indicator are the number of patients attending the facility monthly, comparison of the patient turnover vis a vis number of healthcare, and review of funds used in providing healthcare over a certain duration. This data is collected through routine hospital documentation records and analysed to inform on the cost efficiency of the facility. In the facility that I work this data indicates that the component of cost efficiency is within acceptable limits. Critical pathways are basically guidelines offered to healthcare professionals that list the intended goal of the care by charting the most efficient optimal interventions leading to the desirable outcome. It is a measure of healthcare quality in that it is known to significantly boost efficiency and limit errors in healthcare settings (Leino-Kilpi et al., 2015). This indicator is usually assessed through surveys, key informant interview and observation. The data is then analysed to determine how closely the healthcare professionals apply critical pathways in their workplace and recommendations are written. The assessment of this indicator showed that compliance of critical pathways by healthcare professionals was at 89%. Compliance to critical pathways is mostly affected by healthcare professional skills and training on critical pathways. Patient outcome is a measure of change in health. It is a useful indicator of healthcare quality because it can assess the rate at which desirable patient outcome/health is achieved which is the overall objective of healthcare (Rahman et al., 2016). In our facility this indicator is measured through data collected from patient admission, patient discharge, outpatient and inpatient records and mortality records among. The analysis of this data will indicate the level of patient outcome and consequently quality of healthcare. The patient outcome assessment in my facility indicates that it is above average. This indicator is usually affected by nurse skills and experience, as well as by staffing levels of the facility and patient expectations. Clinical practise guideline is a strategy of healthcare that emphasizes application of best practise throughout the process of case management. It is described as “the extent to which a health professional conformed to the best practices established by medical guidelines” (Lubbe and Roets, 2014). The measure of this indicator is through observation and patient case reviews that usually assess the caregiver compliance to clinical guidelines regardless of patient outcome. This model requires healthcare professionals to adhere as much as possible to recommended case management guidelines in order to minimize cases of malpractices and practitioner human error. Adoption of this strategy can directly influence the issues of health quality in health setting in that it is able to significantly peg patient outcome on proven best practise health systems. It also reduces human error incidence which is the major factor that leads to medical litigations (Shan et al, 20146). A study by Rahman et al., (2016) observed that “experts have viewed nursing quality indicators, particularly those reflecting patient safety, as an appropriate gauge of efficiency”. Risk Management plan is an approach that is commonly used in enhancing quality healthcare. This is basically a plan of preventing and managing adverse events and potential accidents/injuries from happening within a healthcare setting. Measurement of the of the Risk Management components is one of the ways that quality of healthcare can be assessed. Risk management plan Risk management is defined as a “strategy of improving the quality and safety of health care by identifying circumstances that put patients, staff and organisations at risk and acting to prevent or control those risks” (Yankovsky et al., 2016). A risk management plan should include all of the following aspects; (i) Evidence-based guidelines such as NICE, RCOG, WHO medical eligibility etc (ii) Risk management committee (iiI) Establish context (iv) Risk identification (v) Risk assessment (analysis) (vi) Risk control eg avoidance, avoidance, transfer etc An example of a risk management plan can be demonstrated below. Risk management plan for accidents and injuries 1. Patient monitoring 2. Ensure areas of potential hazards are clearly marked 3. Physical design of the facility to mitigate and reduce accidents or falls 4. Guidelines on use of equipment’s at hospital by patients, e.g wheel chair, stretcher 5. Pre-use guideline for use of equipment’s by healthcare professionals 6. Adequate subordinate staff to assist and provide guidelines within the hospital 7. Ensure compliance to critical pathways by health professionals to reduce risk of injury to patients 8. Ensure written guidelines in various areas of facility are documented and well displayed 9. Adequate staffing in facility to reduce unintentional injury due to exhaustion 10. Guidelines on reducing patient/staff radiation exposure 11. Ergonomics Recommendation Given the significant impact that quality healthcare has on patient outcome, as well as among healthcare professionals, it is necessary for policy makers and stakeholders to develop guidelines for improving quality in healthcare facilities. In addition, a risk management plan should be developed for every potential harm that exists in a given facility. Adoption of these recommendations in health facilities will significantly improve patient outcome in the facility that I am currently working in. Conclusion Current literature demonstrates the importance of quality in healthcare facilities which is underpinned by evidence-based research. It is on this backdrop that issues of quality in healthcare are pegged. As demonstrated throughout this paper, there is need to ensure quality in healthcare services is achieved since it is inherently linked to risk management in the healthcare setting. Indeed, the very process of risk management in healthcare settings usually involve aspects of improving quality healthcare. Therefore, healthcare quality is best achieved through implementation of risk management plans at minimum. 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