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USW1.9U.202030 - NURS-4005-4/NURS-4006-4-TOPICS IN
CLIN NURSING2019 WINTER QTR 11/25-02/16-PT3
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Submission ID: 926525de-5295-4e41-a352-d27d4f59298c
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Running head: 1 DASHBOARD ANALYSIS AND NURSING
PLAN 2
DASHBOARD ANALYSIS AND NURSING PLAN 2
WEEK 5 ASSIGNMENT: DASHBOARD ANALYSIS AND
NURSING
PLAN
Walden University
Word Count: 1,372
Attachment ID: 2466101114
DashboardAnalysisandNursin…
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1 Another student's paper
2 Another student's paper
3 Another student's paper
4 Another student's paper
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1 NURS 4005/NURS 4006: TOPICS IN CLINICAL NURSING
2 DASHBOARD ANALYSIS AND NURSING PLAN THE
DATA
COLLECTED FROM WITHIN A HEALTHCARE FACILITY
AND
SURVEYS SENT OUT TO PATIENTS ENABLES A
HEALTHCARE
FACILITY TO IMPROVE ITS CARE DELIVERY TO
PATIENTS. 1 THE
INFORMATION COLLECTED IS FORMATTED INTO A
QUARTERLY
DASHBOARD WHERE GOALS ARE SET FOR EACH
QUALITY
INDICATOR AND THEN INTERPRETED IF THE FACILITY
MET
THOSE GOALS. THROUGH THE USE OF DASHBOARDS
AND
QUALITY INDICATORS, PROACTIVE DECISIONS CAN BE
MADE
BASED ON ACTUAL EVENTS OCCURRING, RATHER THAN
CHANGING THE PLAN OF CARE BASED ON
ASSUMPTIONS. THE
DASHBOARD IS EFFECTIVE IN DETERMINING
PARTICULAR AREAS
IN WHICH IMPROVEMENTS WOULD BE BENEFICIAL TO
NOT ONLY
THE CARE OF THE PATIENT, BUT THE OVERALL
MORALE OF THE
HEALTH CARE FACILITY. THE DASHBOARD IS ALSO
HELPFUL IN
STRATEGIC PLANNING, WHERE THE ASSESSMENT OF
PERFORMANCE CAN BE UNDERTAKEN (TOMLINSON.,
2013). THE
PAPER ANALYZES AREAS WHERE THE FACILITY EXCELS
AND
DETERMINING STRATEGY TO IMPROVE NEGATIVE
PERFORMANCE BY UTILIZING EVIDENCED-BASED
PRACTICE.
AFTER CAREFULLY ANALYZING THE DATA PRESENTED
IN THIS
WEEK’S DASHBOARD, COMMUNICATION BETWEEN THE
NURSES
AND THE PATIENTS EXCELS. NURSES DEVELOP A GOOD
RAPPORT
WITH THE MAJORITY OF THEIR PATIENTS AND GIVE
THOROUGH
EXPLANATIONS OF THE CARE PROVIDED. HOWEVER,
NURSES’
PROMPTNESS AND ATTENTION TO DETAIL A NEED TO
BE AN AREA
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ADDRESSED TO IMPROVE PATIENT OUTCOMES. THUS, IT
COULD
ALSO BE THE RESULT OF NEGATIVE DATA REFLECTED
ON THE
DASHBOARD THAT REPRESENTS PATIENT SAFETY
MEASURES
SUCH AS FALLS, PRESSURE ULCERS, MISLABELED
SPECIMENS,
AND UNCONTROLLED PAIN. PATIENT SAFETY IS
CRUCIAL IN THE
PLAN OF CARE AND, IF NOT CAREFULLY ADDRESSED,
COULD
LEAD TO ADVERSE EVENTS AND OUTCOMES.
Nurses need to focus on details to minimize the chances of
errors, ensure
efficiency, preventing injuries, provide a good impression, and
analyze
information. Emphasizing on the improvement of details
enhances tasks’
performance accuracy. It is essential to avoid errors during
treatment to ensure
quality services to all patients. 1 CAREFUL MANAGEMENT
OF DETAILS
INFLUENCES GENERAL EFFICIENCY AND SUCCESS IN
THE
HEALTHCARE FACILITY. Error minimization also leads to
the satisfaction of
the patient. 1 BY DEVELOPING A NURSE-PATIENT
RELATIONSHIP,
YOU CAN ADDRESS NEEDS AND CONCERNS OF THE
PATIENT, AS
WELL AS PICK UP ON DETAIL-ORIENTED CUES THAT
WILL NEED
IMPLEMENTATION FOR EVERY PATIENT TO MAINTAIN A
BALANCE OF TRUST AND COMMUNICATION DURING
THE
PATIENTS STAY.
THE ATTENTION OF DETAIL LEADS TO PATIENT
SAFETY. THE
LEADERSHIP SHOULD DEVELOP PATIENT SAFETY
THROUGHOUT
THE HOSPITAL. Leadership plays a crucial role in building
and developing a
culture. This created safety culture reduces hazards since the
main emphasis is on
processes of care (IHI, 2017). The organization’s managers
should take the
responsibility of creating a conducive working environment by
being role models.
For instance, they should;
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· Ensure patient safety as health care facility priority · Offer
education to the
hospital staff concerning the dedication to reduce errors
witnessed in medication
processes · Strengthen proactive methods for reducing care
errors · Incorporate
patient safety priorities into the new treatment models of all
relevant organization
processes and functions Many quality indicators fall into the
category of patient
safety, such as medication errors or adverse events, pressure
ulcers, falls, restraint
use, nosocomial infections, VTE, etc. 1 VARIOUS TOOLS
CAN BE SET IN
PLACE TO ENSURE ADEQUATE MONITORING OF THESE
AREAS TO
PROTECT THE PATIENTS AND THE FACILITY.
CONDUCTING A
THOROUGH HEAD-TO-TOE PHYSICAL EXAMINATION ON
ADMISSION IS A HIGH PRIORITY. PATIENTS COME INTO
THE
HOSPITAL, AND WE TREAT THEIR SYMPTOMS,
HOWEVER, MANY
TIMES THERE MAY BE AN UNDERLINING PROBLEM
THAT NEEDS
TO BE ADDRESSED TO ENSURE AN OPTIMAL OUTCOME
AND
PATIENT EXPERIENCE. A FULL PHYSICAL ASSESSMENT
GIVES
YOU A THOROUGH PICTURE OF THE PATIENT’S
CONDITION.
THE BEST PRACTICE WOULD BE CONDUCTING A FALL
RISK
ASSESSMENT AND A SKIN RISK ASSESSMENT ON EACH
PATIENT
EVERY SHIFT OR AS NEEDED IF THERE HAS BEEN A
CHANGE IN
THE PATIENT’S CONDITION. WITH A FALL RISK
ASSESSMENT, IT
CAN DETERMINE WHAT INTERVENTIONS NEED PUT IN
PLACE TO
ENSURE PATIENTS ARE FREE FROM PHYSICAL INJURY
WHILE IN
OUR CARE. THE FALL RISK ASSESSMENT WE USE AT
OUR
FACILITY IS SIMILAR TO THE ONE PRESENTED BY JOHN
HOPKINS, CALLED THE JHFRAT (HOPKINS MEDICINE,
2017). THE
FALL RISK ASSESSMENT APPROACH ADDRESSES
VARIOUS
VICTIM SAFETY INDICATORS SUCH AS;
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· AGE AND HISTORY OF FALLS WITHIN SIX MONTHS ·
ELIMINATION OF BLADDER AND BOWEL (URGENCY,
INCONTINENCE, AND FREQUENCY) · MEDICATIONS
(ANTICONVULSANTS, ANTIHYPERTENSIVE, HYPNOTICS,
LAXATIVES, SEDATIVES, PSYCHOTROPIC, AND
DIURETICS,) · USE
OF PATIENT CARE EQUIPMENT (A IV INFUSION, A CHEST
TUBE,
INDWELLING CATHETER, AND IV INFUSION) · MOBILITY
(UNSTEADY GAIT OR NEEDS ASSISTANCE) ·
SENSATIONS (A
DECREASE IN HEARING, AND VISION) · COGNITION
(IMPULSIVE
BEHAVIOR, SEDATION, OR ALTERED MENTAL STATUS)
IF THE
PATIENT SCORES GREATER THAN SIX, THEN THEY ARE
REQUIRED TO WEAR FALL RISK SOCKS, FALL RISK
BRACELETS,
AND BED/CHAIR ALARMS ARE PUT IN PLACE. THIS FALL
RISK
ASSESSMENT IS A GREAT TOOL AS WE CAN REASSESS
IT
MULTIPLE TIMES THROUGHOUT THE DAY TO ENSURE
THE
SAFETY OF THE PATIENT AND DECREASE THE RATE OF
FALLS ON
OUR DASHBOARD TO IMPROVE QUALITY INDICATORS.
IT ALSO
SHOWS THE PATIENTS THAT WE ARE CONCERNED FOR
THEIR
SAFETY AND ARE PUTTING ALL MEASURES OF SAFETY
IN PLACE
TO ENSURE A POSITIVE OUTCOME.
ANOTHER BEST PRACTICE TOOL WE CAN UTILIZE
WOULD BE THE
SKIN RISK ASSESSMENT FOR COMBATING AND
MANAGING
PRESSURE ULCERS. 3 A CLINICALLY VALIDATED TOOL
IS THE
BRADEN SCALE THAT PREDICTS PRESSURE SORE RISK.
The tool also
permits health practitioners to confidently score the level of
risk of a client for
pressure ulcer development. 1 THE TOOL MEASURES A
PATIENT’S
FUNCTIONAL CAPABILITIES THAT LEAD TO EITHER
HIGH
INTENSITY OR REDUCED TISSUE TOLERANCE FOR
PRESSURE.
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HIGH LEVELS OF RISK FOR ULCER PROBLEM IS
ASSOCIATED
WITH LOWER LEVELS OF FUNCTIONING (NLM, 2013). The
Braden
scale employs different categories to establish skin risk of a
patient, such as
exposure to moisture, physical activity, meaningful response to
pressure-based
discomfort, nutrition, and friction and shear risk, regulation,
and control of body
positions. 1 A SCORE OF 18 OR BELOW ALERTS THE
NURSE THAT
THE PATIENT MAY BE AT RISK FOR PRESSURE AREAS, A
SCORE OF
9, AND BELOW INDICATES THAT A PATIENT
VULNERABLE TO
AREAS WITH HIGH PRESSURE. INTERVENTIONS FOR
TREATMENT
SHOULD AVAILED TO PREVENT PRESSURE ULCERS FOR
AT-RISK
PATIENTS. The nurses should;
1 · INSPECT THE PATIENTS’ SKIN ON EACH SHIFT ·
MANAGE
MOISTURE ON THE SKIN SURFACE · CONDUCT A SKIN
RISK
ASSESSMENT OR AS NEEDED IN CASE OF A CHANGE IN
A CLIENT’S
CONDITION · MINIMIZE PRESSURE TO BONY
PROMINENCE BY
REPOSITION PATIENT EVERY 1-2 HOURS · INCREASE
NUTRITION
INTAKE AND HYDRATION (IF THE PATIENT IS UNABLE
TO
CONSUME THESE ORALLY THEN INTRAVENOUS
METHODS NEED
TO BE IMPLEMENTED). BY COMPLETING EACH OF
THESE STEPS
FOR ALL PATIENTS, IT WILL PREVENT SECONDARY
DIAGNOSIS
AND PROLONGING OF PATIENT STAY.
4 · MAINTAIN SKIN INTEGRITY TO INCREASE THE
PATIENT’S
OUTCOME AND SATISFACTION THROUGH THE USE OF
QUALITY
INDICATORS AND DATA COLLECTION, WE CAN
IMPROVE OUR
PATIENT SATISFACTION AND THE CARE WE DELIVER
DAILY. 1 BY
UTILIZING THE BEST PRACTICES TO MAINTAIN PATIENT
SAFETY
AND RECOGNIZING THE NEEDS AND CONCERNS OF OUR
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PATIENTS, WE CAN ACHIEVE HIGH STANDARDS. WE
MUST
REALIZE THAT PERFECT SCORES ACROSS THE
DASHBOARD IS
UNREALISTIC. 4 HEALTH CARE AND EVIDENCED-
BASED
PRACTICES ARE ALWAYS CHANGING, AND THE CARE
WE ARE
PROVIDING IS BECOMING MORE ACUTE. 1 BY
CONTINUING OUR
EDUCATION AND HAVING OUR PATIENT’S SAFETY AS
OUR
NUMBER ONE PRIORITY, WE WILL CONTINUE TO EXCEL
IN THE
HEALTH CARE CONTINUUM.
Reference
Hopkins Medicine. (2017). 1 FALL RISK ASSESSMENT:
JHFRAT. 1 THE
JOHNS HOPKINS UNIVERSITY, THE JOHNS HOPKINS
HOSPITAL,
AND JOHNS HOPKINS HEALTH SYSTEM. Retrieved from: 3
HTTP://WWW.HOPKINSMEDICINE.ORG/INSTITUTE_NURSI
NG
/MODELS_TOOLS/FALL_RISK.HTML
INSTITUTE FOR HEALTHCARE IMPROVEMENT. (2017). 1
PATIENT
SAFETY PLAN. St. 1 FRANCIS HEALTH SYSTEM: St. 1
JOSEPH
MEDICAL CENTER. Bloomington, Illinois. Retrieved from: 3
HTTP://WWW.IHI.ORG/RESOURCES/PAGES/TOOLS
/PATIENTSAFETYPLAN.ASPX
NATIONAL LIBRARY OF MEDICATION. (2013). Braden
Scale. 1
NATIONAL INSTITUTES OF HEALTH, HEALTH & HUMAN
SERVICES. Retrieved from: 1 HTTPS://WWW.NLM.NIH.GOV
/RESEARCH/UMLS/SOURCERELEASEDOCS/CURRENT
/LNC_BRADEN/ TOMLINSON, P., HEWITT, S., &
BLACKSHAW, N.
(2013). 1 JOINING UP HEALTH AND PLANNING: HOW
JOINT
STRATEGIC NEEDS ASSESSMENT (JSNA) CAN INFORM
HEALTH
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AND WELLBEING STRATEGIES AND SPATIAL PLANNING.
PERSPECTIVES IN PUBLIC HEALTH, 133(5), 254-262.
Retrieved from:
4 HTTP://DX.DOI.ORG/10.1177/1757913913488331
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Week 5 Assignment: Dashboard Analysis and Nursing Plan
Alexis Nicole Runge
Walden University
NURS 4005/NURS 4006: Topics in Clinical Nursing
May 12, 2017
Dashboard Analysis and Nursing Plan
In order for health care facilities to enhance and improve the
care they deliver to their patients, they rely on data collected
within their facility and from surveys sent out to patients. The
information collected is formatted into a quarterly dashboard
where goals are set for each quality indicator and then
interpreted if the facility met those goals. Through the use of
dashboards and quality indicators proactive decisions can be
made based on actual events occurring, rather than changing the
plan of care based on assumptions. The dashboard is effective in
determining particular areas in which improvements would be
beneficial to not only the care of the patient but the overall
morale of the health care facility. The dashboard is also helpful
in strategic planning, where the assessment of performance can
be undertaken (Tomlinson, Hewitt, & Blackshaw, 2013). The
overall objective of this paper is to analyze areas where the
facility excels, and determining a plan of action to improve
negative performance by utilizing evidenced based practice.
After carefully analyzing the data presented in this week’s
dashboard, communication between the nurses and the patients
excels. Nurses develop a good rapport with the majority of their
patients and give thorough explanations of the care provided.
However, their promptness and attention to detail needs to be an
area addressed to improve patient outcomes. Thus, could also be
the result of negative data reflected on the dashboard that
represents patient safety measures such as falls, pressure ulcers,
mislabeled specimens and uncontrolled pain. Patient safety is
crucial in the plan of care and if not carefully addressed could
lead to adverse events and outcomes.
Paying attention to details is important for avoiding errors,
maintaining efficiency, preventing injuries, making a good
impression and analyzing information. Attention to detail
improves accuracy in performing tasks. Preventing errors is
valuable when providing care to all patients. Careful
management of details contributes to overall efficiency and
success in the healthcare facility. Reducing errors also
contributes to patient satisfaction. By developing a nurse-
patient relationship you are able to address needs and concerns
of the patient, as well as pick up on detail-oriented cues that
will need implemented for each individual patient in order to
maintain a balance of trust and communication during the
patients stay.
Attention of detail leads to patient safety. Patient safety
throughout the hospital should be developed by the leadership.
Leadership assumes a role in establishing a culture of safety
that minimizes hazards and patient harm by focusing on
processes of care. The leaders of the organization are
responsible for fostering an environment through their personal
example; emphasizing patient safety as an organizational
priority; providing education to medical and hospital staff
regarding the commitment to reduction of medical errors;
supporting proactive reduction in medical/health care errors;
and integrating patient safety priorities into the new design and
redesign of all relevant organization processes, functions and
services (IHI, 2017).
There are many quality indicators that fall into the
category of patient safety such as: medication errors or adverse
events, pressure ulcers, falls, restraint use, nosocomial
infections, VTE, etc. Various tools can be set in place to ensure
adequate monitoring of these areas to protect the patients and
the facility. Conducting a thorough head-to-toe physical
examination on admission is a high priority. Patients come into
the hospital and we treat their presenting symptoms, however
many times there may be an underlining problem that needs
addressed to ensure an optimal outcome and patient experience.
A full physical assessment gives you a thorough picture of the
patient’s condition.
Best practice would be to conduct a fall risk assessment
and a skin risk assessment on each patient every shift or as
needed if there has been a change in the patient’s condition.
With a fall risk assessment, it can determine what interventions
need put in place to ensure patients are free from physical
injury while in our care. The fall risk assessment we use at our
facility is similar to the one presented by John Hopkins, called
the JHFRAT (Hopkins Medicine, 2017). The fall risk
assessment tool addresses various patient safety indicators such
as: age, history of falls within 6 months, elimination of bowel
and bladder (incontinence, urgency or frequency), medications
(PCA/opiates, anticonvulsants, antihypertensive, diuretics,
hypnotics, laxatives, sedatives, psychotropic, etc.), use of
patient care equipment (IV infusion, chest tube, indwelling
catheter, SCDs, etc.), mobility (unsteady gait or needs
assistance), sensations (decrease in hearing, vision, etc.), and
cognition (impulsive behavior, sedation, or altered mental
status). If the patient scores greater than 6 then they are
required to wear fall risk socks, fall risk bracelet, and bed/chair
alarms are put in place. This is a great tool as we can reassess it
multiple times throughout the day to ensure the safety of the
patient and decrease the rate of falls on our dashboard to
improve quality indicators. It also shows the patients that we
are concerned for their safety and are putting all measures of
safety in place to ensure a positive outcome.
Another best practice tool we can utilize would be the skin
risk assessment to prevent and manage pressure ulcers. The
Braden Scale for predicting pressure sore risk is a clinically
validated tool that allows nurses and other health care providers
to reliably score a patient/client's level of risk for developing
pressure ulcers. It measures functional capabilities of the
patient that contribute to either higher intensity and duration of
pressure or lower tissue tolerance for pressure. Lower levels of
functioning indicate higher levels of risk for pressure ulcer
development (NLM, 2013). The Braden Scale uses various
categories to determine the patient’s skin risk such as: sensory
perception (ability to respond meaningfully to pressure-related
discomfort), moisture (degree to which skin is exposed to
moisture), physical activity (degree of physical activity),
mobility (ability to change and control body positions),
nutrition (usual food intake pattern), and friction and shear risk.
A score of 18 or below alerts the nurse that the patient may be
at risk for pressure areas, a score 9 or less determines that the
patient is high risk. Interventions should be put in place to
prevent pressure ulcers for at risk patients. The nurses should
be required to inspect patients skin each shift, manage moisture
on the skin, conduct a skin risk assessment each shift or as
needed if there is a change in the patient’s condition, minimize
pressure to bony prominence by reposition patient every 1-2
hours, increasing nutrition intake and hydration (if the patient is
unable to consume these orally then intravenous methods need
to be implemented). By completing each of these steps for all
patients it will prevent secondary diagnosis and prolonging of
patient stay. Maintaining skin integrity will increase the
patient’s outcome and satisfaction.
Through the use of quality indicators and data collection
we have the ability to improve our patient satisfaction and the
care we deliver on a daily basis. By utilizing best practices to
maintain patient safety and recognizing the needs and concerns
of our patients we can achieve high standards. We must realize
though that perfect scores across the dashboard is unrealistic.
Health care and evidenced-based practices are always changes
and the care we are providing is becoming more acute. By
continuing our education and having our patient’s safety as our
number one priority we will continue to excel in the health care
continuum.
Reference
Tomlinson, P., Hewitt, S., & Blackshaw, N. (2013). Joining up
health and planning: How Joint Strategic Needs Assessment
(JSNA) can inform health and wellbeing strategies and spatial
planning. Perspectives In Public Health, 133(5), 254-262.
Retrieved from: http://dx.doi.org/10.1177/1757913913488331
Institute for Healthcare Improvement. (2017). Patient Safety
Plan. St. Francis Health System: St. Joseph Medical Center.
Bloomington, Illinois. Retrieved from:
http://www.ihi.org/resources/Pages/Tools/PatientSafetyPlan.asp
x
Hopkins Medicine. (2017). Fall Risk Assessment: JHFRAT. The
Johns Hopkins University, The Johns Hopkins Hospital, and
Johns Hopkins Health System. Retrieved from:
http://www.hopkinsmedicine.org/institute_nursing/models_tools
/fall_risk.html
National Library of Medication. (2013). Braden Scale. National
Institutes of Health, Health & Human Services. Retrieved from:
https://www.nlm.nih.gov/research/umls/sourcereleasedocs/curre
nt/LNC_BRADEN/
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  • 2. 2 Another student's paper 3 Another student's paper 4 Another student's paper SafeAssign Originality Report https://class.waldenu.edu/webapps/mdb-sa- BBLEARN/original... 1 of 8 12/24/19, 12:05 AM 1 NURS 4005/NURS 4006: TOPICS IN CLINICAL NURSING 2 DASHBOARD ANALYSIS AND NURSING PLAN THE DATA COLLECTED FROM WITHIN A HEALTHCARE FACILITY AND SURVEYS SENT OUT TO PATIENTS ENABLES A HEALTHCARE FACILITY TO IMPROVE ITS CARE DELIVERY TO PATIENTS. 1 THE INFORMATION COLLECTED IS FORMATTED INTO A QUARTERLY DASHBOARD WHERE GOALS ARE SET FOR EACH QUALITY INDICATOR AND THEN INTERPRETED IF THE FACILITY MET THOSE GOALS. THROUGH THE USE OF DASHBOARDS AND QUALITY INDICATORS, PROACTIVE DECISIONS CAN BE MADE BASED ON ACTUAL EVENTS OCCURRING, RATHER THAN CHANGING THE PLAN OF CARE BASED ON
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  • 4. ADDRESSED TO IMPROVE PATIENT OUTCOMES. THUS, IT COULD ALSO BE THE RESULT OF NEGATIVE DATA REFLECTED ON THE DASHBOARD THAT REPRESENTS PATIENT SAFETY MEASURES SUCH AS FALLS, PRESSURE ULCERS, MISLABELED SPECIMENS, AND UNCONTROLLED PAIN. PATIENT SAFETY IS CRUCIAL IN THE PLAN OF CARE AND, IF NOT CAREFULLY ADDRESSED, COULD LEAD TO ADVERSE EVENTS AND OUTCOMES. Nurses need to focus on details to minimize the chances of errors, ensure efficiency, preventing injuries, provide a good impression, and analyze information. Emphasizing on the improvement of details enhances tasks’ performance accuracy. It is essential to avoid errors during treatment to ensure quality services to all patients. 1 CAREFUL MANAGEMENT OF DETAILS INFLUENCES GENERAL EFFICIENCY AND SUCCESS IN THE HEALTHCARE FACILITY. Error minimization also leads to the satisfaction of the patient. 1 BY DEVELOPING A NURSE-PATIENT RELATIONSHIP, YOU CAN ADDRESS NEEDS AND CONCERNS OF THE PATIENT, AS WELL AS PICK UP ON DETAIL-ORIENTED CUES THAT
  • 5. WILL NEED IMPLEMENTATION FOR EVERY PATIENT TO MAINTAIN A BALANCE OF TRUST AND COMMUNICATION DURING THE PATIENTS STAY. THE ATTENTION OF DETAIL LEADS TO PATIENT SAFETY. THE LEADERSHIP SHOULD DEVELOP PATIENT SAFETY THROUGHOUT THE HOSPITAL. Leadership plays a crucial role in building and developing a culture. This created safety culture reduces hazards since the main emphasis is on processes of care (IHI, 2017). The organization’s managers should take the responsibility of creating a conducive working environment by being role models. For instance, they should; SafeAssign Originality Report https://class.waldenu.edu/webapps/mdb-sa- BBLEARN/original... 3 of 8 12/24/19, 12:05 AM · Ensure patient safety as health care facility priority · Offer education to the hospital staff concerning the dedication to reduce errors witnessed in medication processes · Strengthen proactive methods for reducing care errors · Incorporate patient safety priorities into the new treatment models of all relevant organization
  • 6. processes and functions Many quality indicators fall into the category of patient safety, such as medication errors or adverse events, pressure ulcers, falls, restraint use, nosocomial infections, VTE, etc. 1 VARIOUS TOOLS CAN BE SET IN PLACE TO ENSURE ADEQUATE MONITORING OF THESE AREAS TO PROTECT THE PATIENTS AND THE FACILITY. CONDUCTING A THOROUGH HEAD-TO-TOE PHYSICAL EXAMINATION ON ADMISSION IS A HIGH PRIORITY. PATIENTS COME INTO THE HOSPITAL, AND WE TREAT THEIR SYMPTOMS, HOWEVER, MANY TIMES THERE MAY BE AN UNDERLINING PROBLEM THAT NEEDS TO BE ADDRESSED TO ENSURE AN OPTIMAL OUTCOME AND PATIENT EXPERIENCE. A FULL PHYSICAL ASSESSMENT GIVES YOU A THOROUGH PICTURE OF THE PATIENT’S CONDITION. THE BEST PRACTICE WOULD BE CONDUCTING A FALL RISK ASSESSMENT AND A SKIN RISK ASSESSMENT ON EACH PATIENT EVERY SHIFT OR AS NEEDED IF THERE HAS BEEN A CHANGE IN THE PATIENT’S CONDITION. WITH A FALL RISK ASSESSMENT, IT CAN DETERMINE WHAT INTERVENTIONS NEED PUT IN PLACE TO ENSURE PATIENTS ARE FREE FROM PHYSICAL INJURY WHILE IN
  • 7. OUR CARE. THE FALL RISK ASSESSMENT WE USE AT OUR FACILITY IS SIMILAR TO THE ONE PRESENTED BY JOHN HOPKINS, CALLED THE JHFRAT (HOPKINS MEDICINE, 2017). THE FALL RISK ASSESSMENT APPROACH ADDRESSES VARIOUS VICTIM SAFETY INDICATORS SUCH AS; SafeAssign Originality Report https://class.waldenu.edu/webapps/mdb-sa- BBLEARN/original... 4 of 8 12/24/19, 12:05 AM · AGE AND HISTORY OF FALLS WITHIN SIX MONTHS · ELIMINATION OF BLADDER AND BOWEL (URGENCY, INCONTINENCE, AND FREQUENCY) · MEDICATIONS (ANTICONVULSANTS, ANTIHYPERTENSIVE, HYPNOTICS, LAXATIVES, SEDATIVES, PSYCHOTROPIC, AND DIURETICS,) · USE OF PATIENT CARE EQUIPMENT (A IV INFUSION, A CHEST TUBE, INDWELLING CATHETER, AND IV INFUSION) · MOBILITY (UNSTEADY GAIT OR NEEDS ASSISTANCE) · SENSATIONS (A DECREASE IN HEARING, AND VISION) · COGNITION (IMPULSIVE BEHAVIOR, SEDATION, OR ALTERED MENTAL STATUS) IF THE PATIENT SCORES GREATER THAN SIX, THEN THEY ARE REQUIRED TO WEAR FALL RISK SOCKS, FALL RISK BRACELETS, AND BED/CHAIR ALARMS ARE PUT IN PLACE. THIS FALL
  • 8. RISK ASSESSMENT IS A GREAT TOOL AS WE CAN REASSESS IT MULTIPLE TIMES THROUGHOUT THE DAY TO ENSURE THE SAFETY OF THE PATIENT AND DECREASE THE RATE OF FALLS ON OUR DASHBOARD TO IMPROVE QUALITY INDICATORS. IT ALSO SHOWS THE PATIENTS THAT WE ARE CONCERNED FOR THEIR SAFETY AND ARE PUTTING ALL MEASURES OF SAFETY IN PLACE TO ENSURE A POSITIVE OUTCOME. ANOTHER BEST PRACTICE TOOL WE CAN UTILIZE WOULD BE THE SKIN RISK ASSESSMENT FOR COMBATING AND MANAGING PRESSURE ULCERS. 3 A CLINICALLY VALIDATED TOOL IS THE BRADEN SCALE THAT PREDICTS PRESSURE SORE RISK. The tool also permits health practitioners to confidently score the level of risk of a client for pressure ulcer development. 1 THE TOOL MEASURES A PATIENT’S FUNCTIONAL CAPABILITIES THAT LEAD TO EITHER HIGH INTENSITY OR REDUCED TISSUE TOLERANCE FOR PRESSURE. SafeAssign Originality Report https://class.waldenu.edu/webapps/mdb-sa- BBLEARN/original...
  • 9. 5 of 8 12/24/19, 12:05 AM HIGH LEVELS OF RISK FOR ULCER PROBLEM IS ASSOCIATED WITH LOWER LEVELS OF FUNCTIONING (NLM, 2013). The Braden scale employs different categories to establish skin risk of a patient, such as exposure to moisture, physical activity, meaningful response to pressure-based discomfort, nutrition, and friction and shear risk, regulation, and control of body positions. 1 A SCORE OF 18 OR BELOW ALERTS THE NURSE THAT THE PATIENT MAY BE AT RISK FOR PRESSURE AREAS, A SCORE OF 9, AND BELOW INDICATES THAT A PATIENT VULNERABLE TO AREAS WITH HIGH PRESSURE. INTERVENTIONS FOR TREATMENT SHOULD AVAILED TO PREVENT PRESSURE ULCERS FOR AT-RISK PATIENTS. The nurses should; 1 · INSPECT THE PATIENTS’ SKIN ON EACH SHIFT · MANAGE MOISTURE ON THE SKIN SURFACE · CONDUCT A SKIN RISK ASSESSMENT OR AS NEEDED IN CASE OF A CHANGE IN A CLIENT’S CONDITION · MINIMIZE PRESSURE TO BONY PROMINENCE BY REPOSITION PATIENT EVERY 1-2 HOURS · INCREASE NUTRITION
  • 10. INTAKE AND HYDRATION (IF THE PATIENT IS UNABLE TO CONSUME THESE ORALLY THEN INTRAVENOUS METHODS NEED TO BE IMPLEMENTED). BY COMPLETING EACH OF THESE STEPS FOR ALL PATIENTS, IT WILL PREVENT SECONDARY DIAGNOSIS AND PROLONGING OF PATIENT STAY. 4 · MAINTAIN SKIN INTEGRITY TO INCREASE THE PATIENT’S OUTCOME AND SATISFACTION THROUGH THE USE OF QUALITY INDICATORS AND DATA COLLECTION, WE CAN IMPROVE OUR PATIENT SATISFACTION AND THE CARE WE DELIVER DAILY. 1 BY UTILIZING THE BEST PRACTICES TO MAINTAIN PATIENT SAFETY AND RECOGNIZING THE NEEDS AND CONCERNS OF OUR SafeAssign Originality Report https://class.waldenu.edu/webapps/mdb-sa- BBLEARN/original... 6 of 8 12/24/19, 12:05 AM PATIENTS, WE CAN ACHIEVE HIGH STANDARDS. WE MUST REALIZE THAT PERFECT SCORES ACROSS THE DASHBOARD IS UNREALISTIC. 4 HEALTH CARE AND EVIDENCED- BASED
  • 11. PRACTICES ARE ALWAYS CHANGING, AND THE CARE WE ARE PROVIDING IS BECOMING MORE ACUTE. 1 BY CONTINUING OUR EDUCATION AND HAVING OUR PATIENT’S SAFETY AS OUR NUMBER ONE PRIORITY, WE WILL CONTINUE TO EXCEL IN THE HEALTH CARE CONTINUUM. Reference Hopkins Medicine. (2017). 1 FALL RISK ASSESSMENT: JHFRAT. 1 THE JOHNS HOPKINS UNIVERSITY, THE JOHNS HOPKINS HOSPITAL, AND JOHNS HOPKINS HEALTH SYSTEM. Retrieved from: 3 HTTP://WWW.HOPKINSMEDICINE.ORG/INSTITUTE_NURSI NG /MODELS_TOOLS/FALL_RISK.HTML INSTITUTE FOR HEALTHCARE IMPROVEMENT. (2017). 1 PATIENT SAFETY PLAN. St. 1 FRANCIS HEALTH SYSTEM: St. 1 JOSEPH MEDICAL CENTER. Bloomington, Illinois. Retrieved from: 3 HTTP://WWW.IHI.ORG/RESOURCES/PAGES/TOOLS /PATIENTSAFETYPLAN.ASPX NATIONAL LIBRARY OF MEDICATION. (2013). Braden Scale. 1 NATIONAL INSTITUTES OF HEALTH, HEALTH & HUMAN SERVICES. Retrieved from: 1 HTTPS://WWW.NLM.NIH.GOV /RESEARCH/UMLS/SOURCERELEASEDOCS/CURRENT /LNC_BRADEN/ TOMLINSON, P., HEWITT, S., & BLACKSHAW, N.
  • 12. (2013). 1 JOINING UP HEALTH AND PLANNING: HOW JOINT STRATEGIC NEEDS ASSESSMENT (JSNA) CAN INFORM HEALTH SafeAssign Originality Report https://class.waldenu.edu/webapps/mdb-sa- BBLEARN/original... 7 of 8 12/24/19, 12:05 AM AND WELLBEING STRATEGIES AND SPATIAL PLANNING. PERSPECTIVES IN PUBLIC HEALTH, 133(5), 254-262. Retrieved from: 4 HTTP://DX.DOI.ORG/10.1177/1757913913488331 SafeAssign Originality Report https://class.waldenu.edu/webapps/mdb-sa- BBLEARN/original... 8 of 8 12/24/19, 12:05 AM Week 5 Assignment: Dashboard Analysis and Nursing Plan Alexis Nicole Runge
  • 13. Walden University NURS 4005/NURS 4006: Topics in Clinical Nursing May 12, 2017 Dashboard Analysis and Nursing Plan In order for health care facilities to enhance and improve the care they deliver to their patients, they rely on data collected within their facility and from surveys sent out to patients. The information collected is formatted into a quarterly dashboard where goals are set for each quality indicator and then interpreted if the facility met those goals. Through the use of dashboards and quality indicators proactive decisions can be made based on actual events occurring, rather than changing the plan of care based on assumptions. The dashboard is effective in determining particular areas in which improvements would be beneficial to not only the care of the patient but the overall morale of the health care facility. The dashboard is also helpful in strategic planning, where the assessment of performance can be undertaken (Tomlinson, Hewitt, & Blackshaw, 2013). The overall objective of this paper is to analyze areas where the facility excels, and determining a plan of action to improve negative performance by utilizing evidenced based practice. After carefully analyzing the data presented in this week’s
  • 14. dashboard, communication between the nurses and the patients excels. Nurses develop a good rapport with the majority of their patients and give thorough explanations of the care provided. However, their promptness and attention to detail needs to be an area addressed to improve patient outcomes. Thus, could also be the result of negative data reflected on the dashboard that represents patient safety measures such as falls, pressure ulcers, mislabeled specimens and uncontrolled pain. Patient safety is crucial in the plan of care and if not carefully addressed could lead to adverse events and outcomes. Paying attention to details is important for avoiding errors, maintaining efficiency, preventing injuries, making a good impression and analyzing information. Attention to detail improves accuracy in performing tasks. Preventing errors is valuable when providing care to all patients. Careful management of details contributes to overall efficiency and success in the healthcare facility. Reducing errors also contributes to patient satisfaction. By developing a nurse- patient relationship you are able to address needs and concerns of the patient, as well as pick up on detail-oriented cues that will need implemented for each individual patient in order to maintain a balance of trust and communication during the patients stay. Attention of detail leads to patient safety. Patient safety throughout the hospital should be developed by the leadership. Leadership assumes a role in establishing a culture of safety that minimizes hazards and patient harm by focusing on processes of care. The leaders of the organization are responsible for fostering an environment through their personal example; emphasizing patient safety as an organizational priority; providing education to medical and hospital staff regarding the commitment to reduction of medical errors; supporting proactive reduction in medical/health care errors; and integrating patient safety priorities into the new design and redesign of all relevant organization processes, functions and services (IHI, 2017).
  • 15. There are many quality indicators that fall into the category of patient safety such as: medication errors or adverse events, pressure ulcers, falls, restraint use, nosocomial infections, VTE, etc. Various tools can be set in place to ensure adequate monitoring of these areas to protect the patients and the facility. Conducting a thorough head-to-toe physical examination on admission is a high priority. Patients come into the hospital and we treat their presenting symptoms, however many times there may be an underlining problem that needs addressed to ensure an optimal outcome and patient experience. A full physical assessment gives you a thorough picture of the patient’s condition. Best practice would be to conduct a fall risk assessment and a skin risk assessment on each patient every shift or as needed if there has been a change in the patient’s condition. With a fall risk assessment, it can determine what interventions need put in place to ensure patients are free from physical injury while in our care. The fall risk assessment we use at our facility is similar to the one presented by John Hopkins, called the JHFRAT (Hopkins Medicine, 2017). The fall risk assessment tool addresses various patient safety indicators such as: age, history of falls within 6 months, elimination of bowel and bladder (incontinence, urgency or frequency), medications (PCA/opiates, anticonvulsants, antihypertensive, diuretics, hypnotics, laxatives, sedatives, psychotropic, etc.), use of patient care equipment (IV infusion, chest tube, indwelling catheter, SCDs, etc.), mobility (unsteady gait or needs assistance), sensations (decrease in hearing, vision, etc.), and cognition (impulsive behavior, sedation, or altered mental status). If the patient scores greater than 6 then they are required to wear fall risk socks, fall risk bracelet, and bed/chair alarms are put in place. This is a great tool as we can reassess it multiple times throughout the day to ensure the safety of the patient and decrease the rate of falls on our dashboard to improve quality indicators. It also shows the patients that we are concerned for their safety and are putting all measures of
  • 16. safety in place to ensure a positive outcome. Another best practice tool we can utilize would be the skin risk assessment to prevent and manage pressure ulcers. The Braden Scale for predicting pressure sore risk is a clinically validated tool that allows nurses and other health care providers to reliably score a patient/client's level of risk for developing pressure ulcers. It measures functional capabilities of the patient that contribute to either higher intensity and duration of pressure or lower tissue tolerance for pressure. Lower levels of functioning indicate higher levels of risk for pressure ulcer development (NLM, 2013). The Braden Scale uses various categories to determine the patient’s skin risk such as: sensory perception (ability to respond meaningfully to pressure-related discomfort), moisture (degree to which skin is exposed to moisture), physical activity (degree of physical activity), mobility (ability to change and control body positions), nutrition (usual food intake pattern), and friction and shear risk. A score of 18 or below alerts the nurse that the patient may be at risk for pressure areas, a score 9 or less determines that the patient is high risk. Interventions should be put in place to prevent pressure ulcers for at risk patients. The nurses should be required to inspect patients skin each shift, manage moisture on the skin, conduct a skin risk assessment each shift or as needed if there is a change in the patient’s condition, minimize pressure to bony prominence by reposition patient every 1-2 hours, increasing nutrition intake and hydration (if the patient is unable to consume these orally then intravenous methods need to be implemented). By completing each of these steps for all patients it will prevent secondary diagnosis and prolonging of patient stay. Maintaining skin integrity will increase the patient’s outcome and satisfaction. Through the use of quality indicators and data collection we have the ability to improve our patient satisfaction and the care we deliver on a daily basis. By utilizing best practices to maintain patient safety and recognizing the needs and concerns of our patients we can achieve high standards. We must realize
  • 17. though that perfect scores across the dashboard is unrealistic. Health care and evidenced-based practices are always changes and the care we are providing is becoming more acute. By continuing our education and having our patient’s safety as our number one priority we will continue to excel in the health care continuum. Reference Tomlinson, P., Hewitt, S., & Blackshaw, N. (2013). Joining up health and planning: How Joint Strategic Needs Assessment (JSNA) can inform health and wellbeing strategies and spatial planning. Perspectives In Public Health, 133(5), 254-262. Retrieved from: http://dx.doi.org/10.1177/1757913913488331 Institute for Healthcare Improvement. (2017). Patient Safety Plan. St. Francis Health System: St. Joseph Medical Center. Bloomington, Illinois. Retrieved from: http://www.ihi.org/resources/Pages/Tools/PatientSafetyPlan.asp x Hopkins Medicine. (2017). Fall Risk Assessment: JHFRAT. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. Retrieved from: http://www.hopkinsmedicine.org/institute_nursing/models_tools /fall_risk.html National Library of Medication. (2013). Braden Scale. National Institutes of Health, Health & Human Services. Retrieved from: https://www.nlm.nih.gov/research/umls/sourcereleasedocs/curre nt/LNC_BRADEN/