Hospital Following Diagnosis Of Pneumonia †Myassignmenthelp.Com

Question: Discuss About The Hospital Following Diagnosis Of Pneumonia? Answer: Introducation The case study proceedings revealed that Betty, an 85 year old woman was admitted to the emergency department (ED) of the hospital following diagnosis of pneumonia. She was put on medications and therapeutic interventions. After that, on the same day she was transferred to a 4 bedded respiratory ward that was located some distant away from the nurse station. Further, it was stated that Betty did not possess any Advanced Care Plan, although medical power of attorney lied with her daughter, Jane. Jane pointed out to the attending nurse whether her mother was given her usual morning medications that upon verification by the staff was found out that her usual medications was not recorded in her medication chart. Considering the medical history of Betty it is imperative for her to bide by her prescribed medications to improve clinical outcomes. It is the duty of the nurse to conform to the standards code of practice and engage in critical thinking for understanding the difficulties and at risk condition of the patient that was breached in this case (Kong et al., 2014). Nurses did not make a note of her prescribed medications that might thwart her condition. Empirical evidences suggest that adherence to medications hold the potential for improving the benefits of prescribed medications (Nieuwlaat et al., 2014). However, non-compliance to medications in Bettys case due to lack of proper prudence and conformance to the expected duties by the nursing professionals might have thwarted her condition. She is likely to exhibit symptoms of illness and difficulties due to skipping of her usual medications. Positive perceptions of care through medication adherence have been indicated in patients through valid research study (Tinelli et al., 2015). Further, while leaving from the hospital Jane informed the nurse in charge of the shift that her mother was a bit confused and quite not herself as opposed to her alert and oriented self. She gave out her necessary contact details to the nurse in case she was required to be approached. On the same night, Betty was just once attended by the concerned nurse who left to address other patients in later hours. A lack of clinical supervision round the clock for Betty was clearly evident as she was left all by herself in the ward alongside other patients. It has been referred to in literature that adequate supervision is indispensable for patients who has recently been hospitalized due to significant physical ailment and is crucial in determining the signs and symptoms for either improvement or deterioration as applicable to the patient situation (White, 2017). On that night itself, Betty sustained injuries due to fracture of the neck of femur because of fall and had laceration in her forehead. This was reported under the alacrity of a fellow patient who rang the bell and call out for help to make the nurse aware of her condition. Following this discovery, Betty was put under subsequent treatment and reviewed by ortho pedic team and was suggested for a surgery a week later. Infection developed due to defective wound healing at the site of hip wound. Impaired wound healing following improper care and intervention might lead to adverse outcomes in concerned patients (Dreifke, Jayasuriya Jayasuriya, 2015). Thus, these were the identified clinical practice issues of concern relevant to Bettys care during hospitalization where negligence of the nursing staff to carefully acknowledge her condition and working in conformity to the established standards of practice were noted. The Australian Commission on Safety and Quality in Health Care (ACSQHC) has laid down propositions pertaining to National Safety and Quality Health Service (NSQHS) standards. The Standards aim to address the following areas encompassing governance for safety and quality in health service organizations, partnering with consumers, preventing and controlling healthcare associated infections, medication safety as well as patient identification and procedure matching. Other standards catered to the needs relevant to clinical handover, blood and blood products, preventing and managing pressure injuries, recognizing and responding to clinical deterioration in acute health care in addition preventing falls and harm from falls. All these standards have been suggested in order to render protection from possible harm thereby enhancing the quality of health service provision. A total of 10 Standards have been proposed in this context that is to be abided by the concerned healthcare professionals and the organization to harbor holistic outcomes (Safetyandquality.gov.au, 2017). However, pertinent to Bettys case, a serious breach of certain standards were evident that threatened the clinical outcome of the service recipient due to medical negligence and violation. A breach of Standard 2 that stated for partnering with consumers was noted. It has been mentioned that a medical power of attorney rested with Bettys daughter Jane who gave out her necessary contact details in case of any medical emergency. However, the nurses failed to inform her on account of her fall on the night of hospitalization that resulted in fracture of the neck of femur. Consumer participation has been identified as a vital factor that drives the efficacy of nursing intervention (Happell et al., 2015). Standard 4 related to medication safety were also violated as nurses did not make a note of Bettys usual medications until pointed out be her daughter. Moreover, a clear lack of nursing diagnosis and undert aking of prudent nursing interventions was noted following transfer of Betty to the respiratory ward where she was left all by herself without any nurse to supervise her condition all the time. A round the clock lack of monitoring of the patient condition might lead to adverse consequences in patient because of dearth of acknowledging the crisis symptoms and carrying out prudent interventions likewise (Park, 2014). In this regard, breach of Standard 9 is observed as the nurses failed to recognize and respond to clinical deterioration in acute healthcare that lead to her injuries related to fracture of the neck of femur due to fall. Thus the Standard 10 was also breached as prevention from falls and harm from falls could not be mitigated by the nursing professional. Moreover, breach of Standard 3 was also noted in case of Betty whereby occurrence of post-operative infections due to impaired wound healing at the site of hip was observed thus confirming the lack of measures to prevent and control healthcare associated infections. Wound assessment and consecutive measures to control the wound has been identified vital in nursing vocation to offer quicker recovery and pragmatic interventions for generating positive outcomes relevant to the patient (Greatrex?White Moxey, 2015). Hence, it may be said that violations pertinent to Standard, 2, 3, 4, 9 and 10 was recorded in case of Betty during her hospitalization. The review of Mrs. Betty case and the type of care given to her during hospitalization revealed many breaches in care according to the National Health and Safety Standards of Australia. According to the negligence and attitude of staffs towards caring for Betty, the main standards that were violated included the following: Standard 2: Partnering with consumers Standard 3: Preventing and controlling healthcare associated infection Standard 4: Medication safety Standard 9: Recognizing and responding to clinical deterioration in acute health care Standard 10: Preventing fall and harm from falls (National Safety and Quality Health Service Standards, (2012) Among the above mentioned standards, the main standards that lead to clinical practices issues includes standards 2 and standards 9. Standard 2 is related to partnering with consumers. This means that health service organization should have a system in place to support patients and carers to improve the quality of care. It also means that patients as well as other family members of patient must be involved in the well-being of patient. The patient and their relative must receive all information related to progress of patients or any issues during treatment (National Safety and Quality Health Service Standards. (2012). However, in case of Betty, this standard was not followed. Although Bettys daughter has asked the nursing staff to call immediately if there was any change in Bettys condition, but they did not informed her when she fell down and had a laceration in her forehead. The health care staff could have maintained standard 2 of quality and safety by the following steps: The hospital staff should have engaged in partnership with patient and their family members by sharing information in an ongoing manner and informing them about any untoward incidents immediately. They could have informed Bettys daughter when she had fallen immediately. In the absence of Jane, her mother Betty sustained a fall and fractured her hip. In this situation, the hospital staff should have called Jane immediately and involved her in decision making about safety and quality of care. Carman et al., (2013) mentions that patient and family engagement creates a pathway for high quality and efficient care. Different forms of engagement related to consultation, information and partnership for health care decision making promotes health and well-being of patient. This could have prevented Jane from raising a complaint with the Patient Advocate Officer. The health care staff should have implemented patient and family centered care by responding to all concerns of health consumers. Consumers should have direct access to patients record and entire experience during care. This form of patient centered care promotes recognition, respect, dignity and individualization in care (Michael et al., 2014). Interprofessional collaboration should have occurred in a professional manner so that patient like Betty do not have negative experience during hospital stay. In Bettys case, staff lacked knowledge about medications and did not communicated in response to symptoms of disorientation in patient. However, they could have maintained a positive relationship with patients and family members by having knowledge about patients history and frequently communicating about patients condition (Reeves et al., 2015). Active response in relation to Janes concern of disorientation symptoms found in her mother could have prevented fracture in the neck of femur. Another standard that was seriously breached in Bettys case included standard 9 which is recognizing and responding to clinical deterioration in acute health care. The health care staff looking after Betty could have maintained standard 9 by taking the following initiative and actions: In case of Betty who was admitted following episode of high temperature and chest congestion, her daughter Jane repeatedly told that her mother was not her usual self in hospital and was disoriented. But, the staff did not took any responsive step. This could have been corrected by following standard 9 of National Health and Safety. Firstly, it is important that all staffs be aware of the need to recognize and respond to clinical deterioration in health care. The main protocol that they should follow includes regular measurement and documentation of patient observations, escalation of care and clear communication about clinical deterioration (National Safety and Quality Health Service Standards, 2012). When Jane reported about the disoriented state of her mother, the action that the staffs should have taken as part of standard 9 was to engage in mechanism and process for recording physiological observations. The nursing staff should measure respiratory rate, oxygen saturation, heart rate, BP and level of consciousness in patient to detect specific physiological abnormalities and plan accordingly to address them. Bogossian et al., (2014) has also reported that early recognition and situation awareness is necessary for timely response and safety of patient. It is also necessary for health care organization to refine the recognition and response skill of health care staff. This will enable appropriate response to patient deterioration and improve clinical performance too. The next step after identifying clinical deterioration through physical observation is to communicate effectively with other clinicians and care staffs. According to the patients condition, the nursing staffs can escalate the frequency of observation and modify nursing interventions at staff level too. If the finanacial examination reveals any extra attention and care for patients, then immediate action should be taken at the early stages of deterioration. This can help avoid negative incidences like fall, injuries or deterioration of clinical condition of patients (Fisher King, 2013). Another critical step that all nursing staff should follow is that they must adhere to the escalation protocol during emergency cases. An appropriate clinical protocol is one which clearly outlines the following process to staffs: Frequency of observations needed Possible interventions during different types of clinical deterioration Communicating and collaborating with staffs for emergency action Transferring the patient to higher level of care (Stayt et al., 2015) A common issue seen in hospital is that treatment is delayed even after reports from patients or their family members. However, staffs must pay attention to concern of family members as they are familiar with patients and their normal attitudes and feelings. Janes concern for her mothers unsual state of mind was also not taken seriously by health care staffs. Hence, appropriate process and response to prevent adverse event is important to maintain the continuity of care. Ward rounds, handover system and communicating patients and family members about signs of deterioration is important for safe and ethical delivery of care. Based on standard 2 and standard 9, the recommendations to make changes to health care practice at the ward level includes the following: At ward level, all nursing staffs must change their way of communication. They must regularly communicate with health care consumers regarding the progress of patient and care planning. The partnership should be such that both consumer and nursing staff are aware about their role in health and safety of patient. It is also necessary to establish new rules and creative methods for communication so that no conflicts arise (Loghmani et al., 2014). To achieve standard 9 at ward level, it is necessary to change the system for responsive action of clinical deterioration. Full guidance and training is needed in the areas of documentation of care, escalation of care, clinical communication, inter-professional collaboration, rapid response system and improving the technological systems. 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