BSN-FP4008 Safety Score Improvement Plan – Sample Essay

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BSN-FP4008 Safety Score Improvement Plan – Sample Essay

BSN-FP4008 Safety Score Improvement Plan – Sample Essay

Safety Score Improvement Plan

                “Leapfrog Hospital Safety Grades (formerly known as Hospital Safety Scores) are assigned to more than 2,600 general acute-care hospitals across the nation twice annually. The Safety Grade is becoming the gold standard measure of patient safety. This grade represents a hospital’s overall performance in keeping patient’s safe from preventable harm and medical errors” (About the Grade, n.d.) In the Spring 2017, when the scores were released, the staff at Danbury Hospital’s orthopedic unit were made aware of an alarming increase in patients who developed a venous thromboembolism (VTE) in the last 6 months. Since these scores are available to the public it can affect the hospital’s public relations but more importantly it can affect the hospitals finances as well. VTEs are preventable and can be costly to treat because Medicare and Medicaid no longer cover the costs associated with hospital acquired conditions such as VTEs. The management team at the hospital, along with staff, will need to develop an improvement plan to decrease the number of deep vein thrombosis (DVT) and pulmonary embolisms (PE) acquired in the post-op period.

Study of Factors

                Venous Thromboembolism (VTE) is a serious health problem that affects 900,000 patients in the U.S. every year and one third of these cases end up in death (Tocco, Martin & Stacy, 2016). Two main forms of VTE are deep vein thrombosis (DVT) and pulmonary embolism (PE). DVT is a blood clot that occurs in a deep vein, usually in the leg or thigh and PE is when a clot breaks free and travels to the lungs. Nursing leadership, along with a multidisciplinary team, are using systems theory, “the ability to recognize, understand, and synthesize the interactions and interdependencies in a set of components designed for a specific purpose” (Dolansky, 2013) to assist in creating their plan. This approach will better than what has been used in the past because it allows for a conversation about what works and how well it works, in each situation. For there to be a significant decrease in the number of hospital acquired DVT’s or PE’s, this cannot be a one man show. It must be a multidisciplinary approach that is tailored to each situation, and at times, to each individual. It is critical that nursing be part of this team because nurses are at the forefront to prevention and treatment of VTEs since they are the one to assess the patient and most often identify risks factors.

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Recommendations

                To improve surgical results and decrease the incidence of DVT and PE in the orthopedic surgery patient it is recommended that perioperative prophylaxis be implemented for all patients. When the patient is admitted and the initial assessment is done, the nurse will determine risk factor and establish prophylactic DVT protocol according to the risks for that patient. If needed the nurse will also contact the physician for orders accordingly. Assessment will continue throughout surgery and in the post-op period, with adjustments to the plan being made as necessary.

                To determine the source of the and they why of the problem the team will need to gather data. Some of the information needed will be Admission assessments, Post-op assessments and reports, imaging reports and assessment of risk factors upon admission and during hospital stay. Examples of high risk factors are:

• patients older than 40 years of age
• pregnant or post-partum
• immobility
• surgery lasting longer than 30 minutes
• cardiac disease
• presence or central venous access. (McNamara, 2014)

            Commonly it is the nurse who assesses the patient, finds and categorizes the risks and will begin prevention protocol, including contacting physicians for prophylaxis orders. By looking at previous patient records, billing, interviewing staff and random patient rounding, the administration will be able to determine the source of the problem and will then be able to find a solution.

             There is evidence based practices to prevent VTE’s that should be started as soon as a risk is identified. According to McNamara (2014) the AORN Journal’s “Recommended practice for prevention of deep vein thrombosis” offers protocol that can apply to all surgical patients but can also be individualized to each patient once a nurse assesses DVT risk during admission and throughout the patients stay in the hospital.

There are nine (9) Recommend Practices included in the RP Summary:

1) Development and implementation of an organization-wide protocol to include care of perioperative patient;

2) Nurses should complete a pre-op assessment for DVT risk factors;

3) Implement specific interventions to decrease potential for complications when patient is receiving mechanical prophylaxis.

4) Understand and be familiar with standards of nursing practice, policies and procedures for administering pharmacologic DVT prophylaxis. Be conscious of complications and contraindications.

5) Provide patient and caregiver with instructions regarding prevention of DVT and the prescribed prophylaxis

6) Personnel should receive initial and ongoing education and competency validation, as applicable to their role.

7) Documentation should include patient assessment, plan of care, nursing diagnosis, desired outcome and interventions, and evaluation of response to care.

8) Policies and Procedures should be developed, reviewed periodically, revised as needed, and readily available.

9) Regular quality improvement projects to improve/ensure safe quality care.

Recommended Practices 6 through 9 are integral to implementation. (RP Summary: Recommended Practices for Prevention of Deep Vein Thrombosis) & (Van Wicklin, 2011)

In the implementation phase, it is important that all staff be trained and evaluated as is pertinent to their position. In addition to training staff, the administration will also need to track compliance with the new policies and procedures established and develop a plan of action for noncompliance. Feedback of effectiveness and level of compliance is also important for all participants.

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BSN-FP4008 Safety Score Improvement Plan – Sample Essay