SNPG927 Promoting Clinical Excellence

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Question:

Think about your experiences as a healthcare professional.

Compare and contrast your experiences at a current (or past) workplace with current literature about health service design.

It is important to focus your reflections on the following:

How the principles and practices of clinical governance can be used to improve the health care systems

Your role as an individual member of staff in ensuring quality and safety of healthcare

How can you empower consumers to play a greater role in their healthcare experience

Answer:

To ensure that healthcare recipients receive the best possible service, it is important to adhere to certain guidelines and protocols.

To ensure the patient’s wellbeing and speedy recovery, it is important to maintain safety and quality in healthcare.

To provide more information about quality and safety in healthcare, you may cite a case study that was published in relevant literature.

Gluyas & Morrison (2014) presented the case that describes the death in a nursing facility resident, and the medication error that occurred before it.

The article offered a peek at cognitive functioning which is related to the processing of information and thoughts of the person concerned.

The resident died from the disease’s underlying causes, not the actions of anyone.

Surprisingly, the resident died because 25mg of morphine was administered subcutaneously by the attending nurse, instead of 2.5mg.

In the clinical sector, it is crucial to have a framework that allows for an analysis of patient safety care and context factors.

The London Protocol was created to facilitate root cause analysis in order to recognize patient safety issues in a more efficient manner (Ahmed, et al.

According to the London Protocol, any clinical practice that may lead to an incident could be affected by other contributing factors.

Some of the contributing factors include individual, task, technology, and team factors.

In this particular case, the individual, team and workplace environmental factors are particularly relevant.

While the incorrect dose of subcutaneous injection of morphine administered by a nurse could be considered the primary factor in the accident, it is possible that the patient’s critical illness was also a factor.

The nurse, a newly graduated nurse, was performing her duties as a registered nursing assistant for the second shift.

Even though the nurses were constantly reminded by the nursing assistants about the importance of administering the prescribed morphine medication, they felt it was too late. When the nurse asked the nurse who was on duty to confirm the dosage of the medication, she did not feel that the nurses had seen.

Nursing burnout can cause a decrease in quality of work (Van Bogaertet and al.

This incident was directly caused by the team factor.

In addition to the overwhelming workload caused by the high number of patients, confusion about morphine administration, and the inability to attend the orientation course for nursing home staff, chaos and work pressure resulted for the nurse professional.

The incident was caused by the change in work environment due to the increased workload of the newly-appointed registered nurse.

The patient’s experience with incorrect medication dosage, as found on the second location while administering the medication, may be due to interaction of multiple factors.

Modern healthcare is focused on clinical governance, which is a highly valued concept.

The primary goal of clinical governance is to improve the efficiency and effectiveness of services by eliminating or restricting harmful practices and those that offer little benefit.

Participation by consumers has been recognized as an important factor in this process.

It is considered a progressive measure that allows resource allocation to be maintained and properly done by taking into account consumer preferences.

Relevant literature has demonstrated that public funding of health services is increasing the importance of consumer participation. It has been documented in policies and standards.

The process of resource allocation was designed to facilitate communication, consultation, participation and improvement in the provision of healthcare services for recipients.

The importance of consumer perspectives and values is increasing in the clinical governance sector. This allows for vital decision-making capability (Harris, et al.

Patients are the potential service users.

The patient’s understanding and support might help to improve the quality and safety the service being provided to them.

In order to provide the best possible healthcare service for patients, the issue has been addressed and integrated into public health policy.

So that the healthcare experience can be improved, the data collected from the patients takes into account their preferences and values (Hripcsak and colleagues).

The principle of consumer involvement is invalid in the present context. It is unclear whether patients’ opinions and preferences were considered when formulating the care program.

Medication error was another factor that could have contributed to the resident’s death in the nursing home.

In the case study, it was not stated that nurses failed to conform to patient preferences. We can infer that the consumer participated in negligence of duty.

Clinicians must also be able to demonstrate clinical effectiveness in order to deliver the best possible care.

It is essential that healthcare professionals and other professionals make every effort to increase the effectiveness of clinical care.

Clinical governance, which is indicative of a continuous learning environment, focuses primarily on the creation of safe and responsive services.

Commissioning quality healthcare services is still the core of the healthcare delivery system. Evidence-based practice has been stressed to inform healthcare staff about the best methods to increase service efficacy. (Hamer, Collinson 2014).

Another relevant research has also highlighted the importance of providing high quality and safe healthcare services by using ongoing research evidences.

A coordinated, integrated, continuous healthcare delivery system is essential in this respect (Jones 2017).

If a simulation-based strategy was available for clinical and educational implementation, the clinical effectiveness of the above scenario could have been significantly improved.

It is possible to eliminate both rule-based and knowledge-based errors by investing in such procedures. This tool has been considered a critical tool for reducing error-prone situations, such as medication administration (Keerse et al.

An improved workforce might be a key factor in ensuring that patients receive quality healthcare.

For optimal outcomes, clinical settings should emphasize modern interdisciplinary methods.

The adoption of a multi-professional healthcare system is a way to manage clinical standards more effectively and foster collaboration with healthcare workers (Kennedy et. al.

Learning evidence-based practice principles can be made easier by involving the relevant workforce in the clinical setting. This has been well established.

McKeever et. al. suggested that nurses, clinicians, and students from other disciplines play an important role in maintaining a skilled workforce to improve clinical outcomes.

In this case, the nursing staff did not provide the necessary support on-site to prevent medication errors.

In the given context, orientation of new staff members wasn’t done. This contributed to the emergence of medication errors.

It is possible that the situation could have been avoided if there had been some cooperation, unity, and proper professional knowledge and instruction among the attending nurses and registered nurses.

Another aspect of clinical Governance is risk management. This involves ensuring that all safety principles are adhered to in order to ensure patients receive the highest quality care without posing any dangers or harms to their bodies.

In order to ensure that the risk assessment and subsequent tasks can be done properly, governance roles must include both management and practice roles (Brennan und Flynn 2014.

The training of healthcare staff that are directly involved in providing care to patients based on their circumstances and needs can be a way to advocate for patient safety (Sendlhofer, et al.

This scenario suggests that the absence of an orientation course and training for new registered nurses for increasing familiarity in the local environment could have helped to reduce the risk associated medication administration.

Promoting clinical excellence involves the interaction of a multitude of factors like the principles of consumer participation, clinical efficacy, workforce effectiveness and risk management. These are all key components of the clinical governance aspect.

To provide safe and high-quality healthcare to patients, emphasis must be placed on each component.

Refer to

Ahmed, M.

Lessons Learnt patient safety training program: Building a safer foundation

BMJ Qual Saf. 23(1). pp.78-86.

Brennan, N.M. & Flynn M.A.

Differentiating clinical governance from clinical management.

Clinical Governance: An International Journal. 18(2), pages 114-131.

Gluyas H. and Morrison P., 2014.

A case study of human factors and medication mistakes.

Nursing Standard, 29, 15 pp. 37-42.

Hamer, S. and Collinson G. (2014).

E-book: A Handbook for Practitioners on Creating Evidence-Based Practice.

Harris, C. Harris. Ko, H. Waller. C. Sloss. P. and Williams. P.

Sustainability in Healthcare by Allocating Resource Effectively (SHARE4) 4 – Exploring potential and methods of consumer engagement in resource allocation in a local healthcare environment.

BMC health services research 17(1), p.329.

Keenan G.M.

A report from AMIA’s 2012 Health Policy Meeting.

Journal of the American Medical Informatics Association. 21(2): pp.204-211.

Jones, A. and Killion S. 2017, title Clinical governance of Primary Health Networks.

Keers R.N. Williams S.D. Cooke J. Ashcroft D.M.

The prevalence and nature medication administration errors in healthcare settings: A systematic review based on direct observational evidence.

Annals of Pharmacotherapy. 47(2). pp. 237-256.

Kennedy, M. Elcock M. Ellis D. Tall, G. 2017.

Pre-hospital and retrieval Medicine: Clinical Governance and Workforce Models.

McKeever S., Twomey B. Hawley M., Lima S. Kinney S. and Newall F. 2016.

Engagement of a Nursing Workforce in Evidence-Based Nursing Practice: Establishment of a Nursing Clinical Efficiency Committee.

Worldviews on Evidence Based Nursing, 13(1) pp. 85-88

Sendlhofer G. Brunner G. Tax C. Falzberger G. Gmolle J. Leitgeb K. Kober B. Kamolz L.P. 2015

A large university hospital’s systematic implementation of clinical management: The impact of risk mangers.

Unit-level nursing unit teams are important: Effect of nurse practice environment, nurse characteristics, and burnout upon nurse reported job outcomes, quality and patient adverse events. This was a cross-sectional study.

International journal for nursing studies 51(8), pp. 1123-1134.

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