Quality and Safety has been recognized as important issues in creating the delivery of effective and responsive health care. To improve Quality and Safety the leader must analyze data and interpret the information to develop a system for clinical performance by motivating, supervising, and develop a problem solving approach to deal with system of medical errors. The purpose of this paper is to inform the reader of the role of the leader in evaluating data to improve Quality and Safety issues.
Data Overview The data shows that sixty eight percent of the falls were women, who are more likely to develop osteoarthritis because bone mass declines faster in women than in men due to hormonal changes, sedimentary lifestyles and poor nutrition are therefore at increased risk of falls. Peripheral sensations decrease with aging and loss of foot tactile sense in the elderly contributes to postural instability (Wickremaratchi, 2006). Postural stability is a skill dependent on the coordination of motor and sensory systems to control body movements. As part of the aging process people cannot see, hear, feel, taste or smell as well as they once could.
The statistics showed forty-five falls during the four-month period occurred from seven in the evening to eleven in the morning. Confusion in the elderly that occurs late in the evening is referred to as sundowner’s syndrome and is increased confusion, disorientation and is common in hospitalized patients (Khachiyants, 2010). Data shows that falls during the eleven pm shift to the seven am shift were twenty one falls, and on the three to eleven shift there were nine falls, the nursing assistant provides additional support for the nurses and patients and would have been beneficial in prevention of falls.
Private rooms help reduce hospital-acquired infections, help prevent falls, and provide healthcare professionals private discussions with patient and family leading to greater emotional comfort, however they also isolate the patient and increases the risk of injury (Geller, 2012). The data shows that ninety four percent of the falls reported were patients prescribed diuretics. Diuretics have the capacity to cause dehydration by fluid volume depletion, increase the urge to void, potentially causes dizziness and cause postural hypotension therefore increasing the risk of falls in all patients but is increased in older women (Lim, 2009).
Telemetry unit have more patients with arrhythmias and other cardiac related problems and are often prescribed diuretic, anticoagulants, antihypertensive and other cardiac medications, which can increase the risk of falls (Carey, 2001). Quality Improvement Plan The quality management process involves review of the data that tracks activities and outcomes. Six sigma is a quality management program that focuses on the patient, the data collected provides evidence of the results and the emphasis is on the processes used within the system (Sullivan, 2013).
A risk management plan would identify risk for injuries, accidents and financial losses, it would review the monitoring system, analyze the data and identify ways to eliminate or reduce the risks. A continuous quality improvement plan for fall prevention needs to be established because falls are the leading cause of fatal and nonfatal injuries in persons over the age of sixty five, falls are expensive and the risk of falls increase with age.
A fall risk assessment is helpful because it reviews the patient’s psychological status, identifies the need for assistive personnel, ability to performs activities of daily living and general physical status, including incontinence, and pain assessment needs to be done on every patient admitted to the hospital. The assessment would include four levels of risk factors, level one would deal with confusion, and sedation, level two would address altered elimination, and history of falls, level three risk factor is mobility and level four deals with dizziness and vertigo.
Risk factor points will be assigned to each level and then a plan for those that score a three or higher will be implemented. Bed alarms are designed to signal nursing staff that a patient is getting out of bed and has been used as a tool to prevent falls (Hubbartt, 2011). Bed alarm types include systems built into hospital beds, portable systems that include use of a sensor pad and a monitor alarm. Bed alarms work well for patients with cognitive impairments and those who cannot be constantly supervised and can reduce the use of physical restraints.
Staff needs education about the importance of not relying on one intervention to prevent falls and training on fall prevention assessment and bed alarms. Staff can prevent falls by familiarizing the patient with the environment, demonstrating the use of the call light and stressing the important of having the call light within reach, keep hospital beds in low position, and use of supplemental lighting at night. Leadership Characteristics Leadership is an important element in a successful patient safety programs and leaders can directly influence their organization commitment to improvement of systems that cause harm to patients.
Leadership skills needed includes the ability to take responsibility for failures, ability to give recognition to others for their success and one who encourages and motivates others, they have good honest communication skills, is able to analysis data, create a plan and have a vision. A leader needs to develop a culture that supports the discussion of errors so that lessons can be learned; they need to align risk management, quality assurance, improvements, credentials and resources aimed at patient safety.
A leader is someone who is able to teach, mentor and reinforce good practices among staff, who spends time talking with staff about safety issues, they have self confidence, courage, and communicates honestly and openly and has an appreciation for all members of their staff. Successful leaders need to inspire and motivate others in order to achieve their goals, they must have commitment to excellence, be passionate about their work and have a clear vision with a deliberate focus, they must be trustworthy, be respectful of others, be accessible by all staff, be empathetic and caring and have a commitment to their staff.
Summary Quality and Safety is an important issue in health care, to provide a service that does not harm a patient or health care provider, which increases people’s trust and confidence in the service, and involves organizing resources in the most successful way to meet health care needs safely without waste. The leader must analyze data and interpret the information to develop a system for clinical performance by motivating, supervising, and develop a problem solving approach to deal with system of medical errors.
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