Task 1 C489 - Grade: B PDF

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C489 – Organizational Systems and Quality Leadership SAT Task 1 Michelle Simpson, RN Western Governors University

September 26, 2020

C489 – Organizational Systems and Quality Leadership In the scenario presented, Mr. J is a 72 y/o retired rabbi with a diagnosis of mild dementia. He is in the hospital for treatment of a right hip fracture that he sustained from a fall. Due to the prescribed pain medication in conjunction with his dementia, the patient is drowsy and can only answer simple questions. While he is in the hospital, it is determined that he needs restraints to keep him from harming himself. When his daughter visits, he asks her to remove the restraints so that he may ambulate to the restroom. She gets assistance with this and notices that he has a red, depressed area on his lower spine. The CNA that is helping him to the restroom stated that it would go away when he was up out of the bed. After using the restroom, the patient was returned to his bed and placed in the same position he was in prior to getting out of the bed. Another issue that occurred while the patient was in the hospital was that he was not given the kosher meal that was requested for him. He was provided the chopped meat as requested but it was pork which the patient is not allowed to eat due to his religious beliefs. While him eating pork did not seem to be a concern for the workers in the hospital, it was a big issue for the patient who was not able to make his needs known due to his disease process. In the instance of the pressure ulcers related to the use of restraints, the use of nursing quality indicators would have helped to identify issues in the nursing care that would have prevented the adverse outcomes in this scenario. “The National Database of Nursing Quality Indicators better known as the NDNQI is the only national nursing database that provides quarterly and annual reporting of structure, process, and outcome indicators to evaluate nursing care at the unit level.” (Montalvo, 2007) Nursing indicators are different from medical indicators of quality care in that they are specific to the nursing aspect of care only. Nursing Quality Indicators have been a part of nursing since Florence Nightingale used statistical methods to

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C489 – Organizational Systems and Quality Leadership identify the nurses’ role in health care quality by measuring outcomes of their actions. (Montalvo, 2007) Several of the NDNQI Indicators should be evaluated to help prevent the development of pressure ulcers in this situation are the following: Nursing Hours per Patient Day; Pressure Ulcer Prevalence; Restraint Prevalence; and Skill Mix. In the acute care setting, many patients that are recovering from surgery as well as the elderly, may require more assistance with their activities of daily living. These requirements put additional stress on the staff that is evident when the nursing hours per patient day is evaluated. This may lead to pressure ulcers in cases like Mr. J where he is in restraints and is unable to change positions for himself. Restraints are often used when the staffing is not such that the difficult patient is able to receive the one on one attention that they require from the floor staff. Skill mix is also evaluated to determine the mix of acuity of the patients and the time that each acuity level requires from the nursing staff. Pressure ulcer prevalence as well as restraint prevalence should be evaluated by the nursing staff to determine if there is a correlation between the two circumstances and the patient outcome of hospital acquired pressure ulcers. Nursing hours per day should be evaluated to determine if staff shortages led to not only the use of restrains and the development of the pressure ulcer but also the incorrect food order for the patient. While the incorrect food order may not seem as important as the pressure ulcer, to the rabbi, it is very important. The incorrect food delivery should be as important to the nurses as it is to the patient, as we as nurses are supposed to be patient advocates. (Montalvo, 2007) Was the nurse unable to double check the nutritional order that was placed due to staff shortages? Was the nurse unable to verify that the patient received the correct plate due to the

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C489 – Organizational Systems and Quality Leadership skill mix on the floor? Did the nurse have too many higher acuity patients to take care of? Did the nurse have time to perform a restraint check on the patient every 2 hours? Was the patient assisted in changing positions every 2 hours to prevent pressure ulcers? These are just a few questions that should be evaluated to determine the reason that the error occurred and what processes should be put in place to keep this error from occurring again. The data that was gathered from the nursing quality indicators on the floor that Mr. J. received his care, can then be used to put processes in place for the whole hospital through pilot testing and ongoing monitoring of the process for effectiveness. To resolve the ethical issue in this scenario of the patient receiving a meal that it was against religious beliefs, as the shift nursing supervisor, I would consult with the appropriate staff at the neighboring Jewish hospital to see what processes that they have in place to prevent the error from occurring in their facility. The hospital may need to contract with the Jewish hospital to provide the meals for their Jewish patients due to the strict requirements that the Jewish religion has related to how their food is prepared as well as what they can and cannot eat. The hospital should be able to meet all the nutritional needs of its patients no matter what they are. The Jewish physician would also be a good source of information for the committee to use when determining how to best serve the Jewish population that seeks medical services in their facility. In conclusion, the use of nursing quality indicators can be used and applied to many different situations to increase the positive patient outcomes in the hospital setting.

References

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C489 – Organizational Systems and Quality Leadership Montalvo, I., (September 30, 2007) "The National Database of Nursing Quality IndicatorsTM (NDNQI®)" OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 3, Manuscript 2.

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