Accreditation Audit Case
Accreditation Audit Case
Introduction
The accreditation process is designed to assist healthcare establishment to identify and enhance the patient’s safety and the quality of service delivery. This paper presents a review of the readiness Nightingale Community Hospital for accreditation audit. The paper comprises of a periodic performance review of the establishment. The review has focus of several priority areas. These areas include; assessment and care; quality improvement; patient safety, and staffing effectiveness. Trend within the hospital indicates the Nightingale has made significant progress towards fulfilling the standards of the Joint Review Commission. However, the trends in staffing effectiveness are limiting the organization’s compliance.
Periodic Performance Review (PPR)
The PPR is based on data collected in the Joint Commission Survey. The survey utilized the priority focus methodology to evaluate the compliance of Nightingale Community Hospital. The priority focus process is a methodology that makes use of data to establish priority areas for reviewing compliance. This process has utilized of both external and internal data to evaluate the compliance of Nightingale Community Hospital. This methodology identified five priority areas. These include; assessment and care services; quality improvement activities, and patient safety. This paper evaluates Nightingale’s compliance in these three priority areas.
- Assessment and Care/ Services
Assessment and care standards are mainly concerned with ensuring that the healthcare facilities align treatment and care plans to the patients needs. This means that the treatment plans need to match the severity of the disease, disability or any other condition of the patient. The survey reveals that Nightingale has an established collaborative process for delivery of care. However, the process does not generate interdisciplinary care plans. The survey points out that the process incapable of delivering care that is tailored to the requirements of each patient.
Nightingale also scored poorly in terms of pain assessment. The survey reveals that the pain assessment process does not indicate the severity of pain making treatment difficult. There was also limited evidence that the hospital offers the patients education and training. Providing education to the patient in order to enhance the patient ability to take care of own health is a vital standard that define quality care. The hospital medical record did not give evidence that the hospital provides education to its patients.
Screening criteria is also an essential element that defines quality assessment and care services. The joint commission survey indicates that Nightingale Hospital employees lack adequate knowledge of the hospitals functional screening criteria. The facility also scores poorly in terms of planning for high risk procedure. The survey reveals that some patients were not adequately evaluated before the administration of moderate sedation.
- Quality Improvement Activities
The PPR process has also focused on assess the activities that Nightingale has implemented in order to improve the quality of care. Nightingale has made significant improvements in various areas. One of these areas is patient identification. Establishing an efficient system for identifying patients is essential in determining the quality of care. An efficient system result in low quality services as patients’ records and specimens easily get lost. Nightingale hospital has made significant progress in terms of enhancing patient identification.
Effectiveness in communicating critical results is also a vital element in the delivery of care. Critical results are results that are outside the normal range and may present a life threatening situation (Khorasani, 2009). Hospital procedures need to ensure the communication of critical results in timely and responsible manner. The Joint Commission standards require hospitals to report critical results within 60 minutes. The survey reveals that Nightingale is 80% compliant with this standard, which is a noteworthy improvement from previous years. However, there is still room for further improvements.
Effectiveness in communicating other medication information is also an essential element in the delivery of care. In some cases, medical practitioners give verbal instructions to the patients (Alberta College of Pharmacists, 2007). These instructional are mainly in the form of prescriptions. Verbal communication of prescription is prone to error. Therefore, Joint Commission communication standards require practitioners to authenticate verbal orders within 48 hours. The endoscopy, surgical and CCU units have recorded significant standards in terms of adhering to this communication standard. However, a lot of development is required in the ortho unit (Alberta College of Pharmacists, 2007). Nightingale has also recorded significant improvements in communication by minimizing the use of unacceptable abbreviations and enhancing the labeling of containers.
Nightingale hospital has also made significant improvement in terms of reducing risks of healthcare associated infections (HAI). HAIs refer to infections that the patient acquires as a result of a medical procedure (WHO, 2010). These infections mainly originate from poor hygiene, inadequate infrastructure, inefficient procedures and understaffing (WHO, 2010). Thus, hospitals need to evaluate these areas in order to prevent these infections. Nightingale has made significant progress in terms of minimizing healthcare associated infections.
- Patient Safety
Nightingale has excelled in most areas that involve protecting the patient’s safety. The hospital has enhanced communication or critical results, reduce the use of verbal orders, enhanced labeling and hygiene. The only area in which the hospital has not made significant improvements is prevention of patient falls. Patient falls are significant threats to the safety of patient. According to Hitcho (2004), patient fall is the largest cause of non-fatal injury among old patients. Young people are also adversely affected by patients’ falls. Many falls occur within the patient room where the patient is unassisted. A small number of patient falls occur while the patient is being assisted by a practitioner.
The Survey indicates an increase in the number of hospital wide patients within the 12 month period. The number of inpatient falls increased from 2.8 to 4.2 falls per 1000 inpatient days. Four east recorded the largest number of falls. The number of falls in 4 east was 11.9 per 1000 patient days. The number of falls that resulting in injury within the same block was 3.8 falls per 1000 inpatient days. Patient falls originate from a number of factors. Intrinsic factors are some of the contributors to patient falls (Person, 2011). These include age of the patient, medication or the severity of illness. Patient fall may also originate from extrinsic factors. These include; slippery falls, lack of grab bars and inadequate patient assistance.
- Staffing Effectiveness
The staffing effectiveness component of PPR evaluates the institution number of staff, staff competency and skills. The number of staff, as well as, the staff competency and skills are essential determinants of the quality of care. The survey utilized clinical and human resource indicators to measure the level of staffing effectiveness. The clinical indicators include fall prevalence, falls with injuries and ventilator associated pneumonia. The human resource indicators include overtime and nursing care hours. There was evidence of reduced cases of falls and pressure ulcers in the oncology unit. The number of falls within this department reduced from 5.57 to 5.45 per 1000 inpatient days. This is an indication of improving the level of staff effectiveness.
However, 4 East Department recorded an increase in the number of cases of patient falls and pressure ulcers. The number of patient falls increased from 1.47 to 4.37. The increase in the number of falls appears to be in line with the increase in the number nursing care hours. The ICU also recorded an increase in the number of falls. Cases of patient falls increased from 0.41 in the previous year to 1.9. The number of ventilator associated pneumonia also increased from 2.2 to 3.0 per 1000 ventilator days. This is an indication of declining level of staff effectiveness.
Trends that Limit Nightingale Compliance
Several trends limit Nightingale Community Hospital compliance with the Joint Commission Standards for patient care. One of these trends concerns the hospital nursing effectiveness. The survey reveals that the overall nursing effectiveness is on the decline within the hospital. Declining nursing effectiveness has been marked by several indicators. One of these indicators is the rising cases of patient falls. The survey confirmed an increase in the number of patient falls in the 4E and the ICU departments. The survey also recorded an overall rise in the number of patient falls despite the decline in the numbers of falls within the 3 East departments. The primary goal of the Joint Commission Standards is to promote the safety of patient. The increase in the number of patient falls undermines the realization of this goal. Patients falls is a significant threat to the safety of patients.
Declining nursing effectiveness is also marked by increased cases of pressure ulcers. The survey revealed an increase in the number of patient suffering from pressure ulcers within the 4 E department. Pressure ulcers are an indication of falling standard of care and, therefore, undermine the organization compliance with the Joint Commission Standards (Buttery, 2009). Declining nursing effectiveness is also marked with the increase in the cases of ventilation pneumonia with the ICU. Ventilation pneumonia is a healthcare associated infection (WHO, 2010). Prevalence of healthcare associated infection undermines the safety of patients and thus, undermines the realization of the goals of Joint Commission Standards.
Staffing Patterns of Patient Care Unit
The staffing effectiveness report evaluates staffing patterns using the nursing care hours per patient day metric. This a metric that defines the total numbers of hours that the hospital providers direct nursing services to an inpatient. This metric discloses the relationship between the staffing level of the organization and the number of patients that the organization serves. Nursing care hours is calculated the number of productive hours that the organization nurses spend with the patient. These hours are dividend by the average number of days spent by patients within the hospital.
According to Liang and Chen (2012), low staffing levels within hospitals is among the leading cause of preventable death within hospital. Low staffing levels means that the available staff dedicated limited amount of time to the services of the patient. This undermines the quality of care that the hospital delivers to the patient. The study by Liang and Chen (2012) indicates that hospitals with low staff levels have poor patient outcomes. The survey indicates that nursing care hours per patient for Nightingale hospital fluctuate from one month to the other. These may be due to a fluctuation in the number of patients that the hospital receives in different months of the year. However, various indicators reveal that the hospital nursing care hours per patient is not sufficient.
One of the indicators that are revealing insufficiency in Nightingale’s nursing care hours per patient is increasing numbers of patient falls. Low number of staff compromises patients’ safety (Liang and Chen, 2012). According to Liang and Chen (2012), hospitals that have low staffing levels exhibit longer patient stay, increased adverse events such as pneumonia infection, medical errors and high patient mortality. According to Kane and Mueller (2009), every additional number of patients per nurse increases the risk of pneumonia infection by 7%. Some of these characteristics are visible in Nightingale Community Hospital.
Staffing Plan
The problem in Nightingale Community Hospital originates from the low number of nurses per patient. This has increased the workload for existing staff. The natural solution would be to increase the number of nurses. Reducing workload by to two patients per a registered nurse will save 25 lives in every 1000 inpatients (Kane and Mueller, 2009). A further reduction to 1.5 patients per a registered nurse will save addition 4 lives for every 1000 inpatients. However, it is not realistic for Nightingale Community Hospital to implement staffing rate of this magnitude. This is because staffing of nurses is a significant problem among American healthcare establishment. The aging nature of the country population means that nurses are leaving the field at a rate that is faster than the rates at which new nurses are entering the field (Liang & Chen, 2012). The shortage of nurses is also propagated by the reduction in the number of citizens willing to join the nursing profession. The staffing problem is bound to get worse due an increase in the number of people in need of healthcare services. An aging population is one of the factors that are leading to increased demand for healthcare services (Liang & Chen, 2009). Prevalence of life style diseases such as diabetes is also a factor that is contributing the rising demand for healthcare services.
Fluctuations in the number of patients that the hospital receives have also compounded the task of establishing the right level of staffing. In order to overcome these challenges, Nightingale needs a flexible staffing plan. The flexible staffing plan will enable the hospital to hire part time employee during months where the number of patients is high (Kane and Mueller, 2009). The plan also seeks to maintain a reasonable ratio of nurse to patients. The ratio of nurse to patients will vary in different units, based on the level of care needed. Different patients needed different level of care and; thus, the plan will give priority to the level of care that different patient requires. Apart from increasing the number of staff, this plan also seeks to increase benefits for employee (Kane and Mueller, 2009). The nurse will receive payment for extra hours served during the peak months. Motivation can leads to improved performance. Thus, providing better pay will keep the nurses motivated and, thus, increase the quality of services.
Reference
Alberta College of Pharmacists (2007). Ensuring Safe & Efficient Communication of Medication Prescriptions. December 8, 2012. http://www.cpsa.Efficiet_Communication_of_Medication_Prescriptions.pdf
Buttery P. (2009). Exploring Pressure Ulcer Prevalence and Preventative Care. Nursing Times. 105: 16
Hitcho E. (2004). Characteristics and Circumstances of Falls in a Hospital Setting. Journal of General Internal Medicine. 19 (7): 732- 739
Kane R and Mueller C. (2009). Nurse Staffing and Quality of Patient Care. AHRQ Publication
Khorasani R. (2009). Optimizing Communication of Critical Test Results. December 8, 2012. http://www.brighamandwomens.org/Research/labs/cebi/CCTR/files/OptimizingCommunicationCcriticalTestResults.pdf
Liang Y. and Chen W. (2012) Nurse Staffing, Direct Nursing Care Hours and Patient Mortality. BMC Health Services Research. 12 (44):
Pearson K. (2011). Evidence Based Falls Prevention in Critical Access Hospital. December 8, 2012. http://flexmonitoring.org/documents/PolicyBrief24_Falls-Prevention.pdf
WHO (2010). Health Care Associated Infections. December 8, 2012. http://www.who.int/mediacentre/news/notes/2010/infections_20101210/en/index.html
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