Health Care Safety and Quality

The wide use of health care services, the abuse of some services, as well as overuse and underuse of other ones reveals a broad scope of quality problems that exist in a modern healthcare system. The Department of Health and Human Services in conjunction with other specialized agencies and non-governmental organizations recognize the improvement of the quality of healthcare and reduction in the number of medical errors and malpractices to be one of their top priorities (Committee on Quality of Health Care in America [CQHCA], 2001). Billows of American citizens are able to avail themselves of the high quality healthcare on a daily basis, which is conducive to the restoration and maintenance of a good physical and mental condition. On the other hand, plethora lot of people cannot take an advantage of the same benefits. This is because they cannot gain an entry into hospitals or due to any other reason. Still, it is the misuse of services both on the part of patients and doctors. That accounts for the lion’s share of all quality problems (CQHCA, 2001). For instance, a staggeringly high level of medical errors is responsible for the premature death of many people. In this respect, the abovementioned governmental organs embark on the policy of improving healthcare system quality with a view of sustaining what is good about the current system and focusing doubled attention on the domains that leave a lot to be desired. To this end, they work hard to come up with decent measures and standards of quality, as well as to find out the most suitable ways to garner, juxtapose and dissect the information on the quality of the existing healthcare system. The surveys have snowballed from there. They have since resulted in the divulgence of the data about the most efficient measures of improving healthcare quality.

Despite the fact that quality problems have some deleterious effects on all swathes of the society, a certain strata of population like racial and ethnic minorities are among the most susceptible. For example, a painstaking research conducted by the scholars from the University of Alabama has found a series of pronounced disparities in the use of clot busters among different patients (Pelliciotti & Kimura, 2001). Although they concluded that this auspicious therapy was underused for all races and ethnicities, physicians were found to have swayed the balance in favour of autochthonous and white-skinned Medicare beneficiaries (Pelliciotti & Kimura, 2010). Fortunately, as the 21st century unfolds, this tendency unravels. It is important in this respect to establish the role that nursing errors have played, as well as to pinpoint their impact on the mortality rate among patients. Considering that these interconnections have been niggardly doled in a couple of full-bore scientific studies so far, the need is indubitable. Consequently, this paper makes an arduous attempt to seal an existing gap as well as traverses some possible solutions and recent improvements concerning the given problem. One of the most heatedly debated ways out of this nettlesome problem is persuading patients to report nursing errors. The bottom line is that despite the fact that a perfunctory discharge of duties on the part of nurses is not a rare phenomenon; the healthcare authorities have made the remarkable strides to eradicate it. This academic paper illuminates the recent developments in the sphere.

A peer-reviewed research conducted by the most prominent scholars in the realm has spread a tenable deal of light upon several types of quality problems that eat away in the system of healthcare. First of all, some medical facilities still retain an old-fashioned pattern of treating patients. This means that health care practice is different throughout the country. This is an evident sign of medical facilities not keeping abreast with the evolving achievements in the area of healthcare (CQHCA, 2001). As horrendous as it may sound, healthcare practice is not always based on the ironclad evidence in some American cities. The unequal access to services is yet another issue. Far too many people are unable to have their health maintained or improved and, thus, suffer some supererogatory complications, which can both set them back significantly and reduce the likelihood of a positive outcome. According to the most conservative estimates, as many as 18,000 people perish every year due to effective intervention not being provided to them (CQHCA, 2001). For instance, many Medicare patients who have suffered apoplexy could not receive beta-blockers even though they had been eligible for this life-saving implement (CQHCA, 2001). In order to realize the gruesomeness of this situation it would be wise to mention that a mortality rate among non-recipients is almost two times higher than that among those patients who have received beta-blockers (CQHCA, 2001). Another fruitful research has found that the use of blockers prior to the heart bypass surgery results in the lower rate of lethal ends as well as almost rules out the possibility of complications after surgery compared to those patients who have not undergone this therapy.

In a stark contrast to the abovementioned tier of population, myriad citizens receive superfluous or even unnecessary healthcare services, which increase costs and even jeopardize their health. Numerous studies have proved that this phenomenon is prevalent in many states (Clifton-Koeppel, 2008). It would be fair to start with drawing an example. Thus, a thorough analysis of surgical operations performed to remove all or a part of the women’s womb evinced that roughly three out of 20 operative interventions were not necessary (CQHCA, 2001). Another opprobrious finding was made during the study investigating the use of preparations in the process of treating ear infections. To wit, it was established that expensive drugs had been prescribed far more often than indicated (Pelliciotti & Kimura, 2010). Summing up their research, if the prescriptions written each year were for less expensive but equally efficient antibiotics, this could save an exorbitant sum of money for both federal and state authorities. Therefore, a little more prudent management could forestall the unwarranted evisceration of budget earmarked for healthcare.

Misuse of services is also a very daunting challenge to the specialised governmental bodies. Often, a wrongful course of treatment results in the health of millions of Americans being impaired. Lethal outcomes are not few and far between as well. For example, nearly 4% of patients treated in the New York State clinics experienced adverse implications in the aftermath of injuries (Helmchen, Richards, & McDonald, 2010). What is more important, these implications were provoked by the reasons not related to the very injuries themselves. Approximately 12% of the above-mentioned patients succumbed to the implications, while other 3% were crippled for good (Helmchen et al., 2010). Curiously enough, negligence and nonchalance were the main raisons hidden behind one-fourth of these adverse occasions. According to the findings of a national study, a medical malpractice is responsible for roughly 5,000 deaths annually (O’Connor, Coates, Yardley, & Wu, 2010).

Some keynote researchers have found that the nurse-related factors are the most inimical ones to the propitious statistics on medication errors occurrence (Karga, Kiekkas, Aretha, & Lemonidou, 2011). In other words, their contribution to the occurrence of medication errors is much more significant as compared to that of some managerial and environment-related factors. The examinations of parallels between the frequency of medication mistakes occurrence and the condition of nursing human resources demonstrate that an organizational structure and context play a paramount role in controlling nursing malpractices. However, there is no ironclad evidence to vindicate the plausibility of this interrelationship; and a further research is required. A questionnaire survey conducted in 2010 revealed that nurses themselves indicated a wide range of factors under duress of which they had committed errors (Santos, Silva, Munari, & Miasso, 2010). Thus, these factors run the gamut of importance from patient-related to the management-related ones (Santos et al., 2010).

In this paper, the author riveted the attention on the slipshod performance of nurses as a top-contributing factor. This emphasis is buttressed by the fact that the overwhelming majority of researchers regard negligence on the part of nurses as one of the most substantial too (Karga et al., 2010). From the perspective of nurses who took part in the research of Mark & Belyea (2009), the combination of languor, ennui and enervation is the second most prevalent factor responsible for the medication errors. General ignorance, in the whole, and the lack of a profound knowledge in the sphere of pharmacology (drug incongruities, inability to forestall side-effects, incompetence in dealing with administration routes and dosage calculations), in particular, constitute another vitally important factor that leads to the appearance of nursing errors. A bevy of other studies reckon the inadequate pharmacological knowledge as one of the key factors in terms of contribution to the medical errors occurrence (Syrriyeh, Lawton, Gardner, & Armitage, 2010). In spite of the fact that all nursing students sedulously learn pharmacology at university; they have to undergo some further educational programs in order to cement tentative expertise and prowess. Bearing in mind that the new drugs are being incessantly purveyed to the market and the necessity to overhaul new applications of old drugs exists; nurses have no choice but to muddle away the bulk of their time over studying.

Hamrick (2012) argues that nursing errors also ensue from scarce work experience. Several studies have established a linear correlation between an educational level and professional skills of nurses, on the one hand, and medication errors, on the other one (O’Connor et al., 2010). Nursing is deemed by many scholars to be a kind of job fraught with numerous stresses and anxieties, which are spawned and further intensified by an erratic sleeping schedule and a heavy workload. Furthermore, the unregulated workday usually has detrimental effects on the mental and emotional state of nurses, which results in the deterioration of their professional performance (Kyung & Barbara, 2011). As a rationale to explain this state of affairs it would be wise to mention that nurses have to grapple with many chores and assignments, which are very often irrelevant to their own terms of reference, in the overcrowded paediatric wards. Thus, the necessity to cope with an extra workload and increased responsibilities is duly considered to have a crucial impact on the ballooning rate of medication errors (Harding & Petrick, 2008). On the other hand, a broad engagement of earnest and callow nurses in such a strenuous career could endow them with malleability that renders doctors unbreakable. Among other aspects, some scholars point out the nurses conspicuous lack of interest and dire financial straits as secondary factors, which nevertheless have a tangible bearing on the occurrence of medication nurses. Still, the vast majority of researchers tend to disregard financial aspects as such that are of a little importance (Kyung & Barbara, 2011).

Practicing nurses themselves believe that such factors as an improper transfer of medication orders from the so-called kardex into the patients medical record and, vice versa. as Also, notorious illegibility of doctors notes in the patients files are among the most infamous management-related factors that contribute to the nursing errors occurrence (Syrriyeh et al., 2010). Harding & Petrick (2008) identify indecipherable handwriting of nurses as one of the dominant factors responsible for the occurrence of nursing malpractices. Millions of unintelligible prescriptions have to be double-checked annually (Santos et al., 2010). Illegibility of nurses orders accompanied by the recurrent changes in these orders, as well as the use of rare abbreviations in health records and making verbal orders in lieu of the written ones are a recipe for the development of medication mistakes. A close interaction and interoperability between healthcare team members have been heralded by a phalanx of researchers as an essential instrument of preventing nursing errors (Helmchen et al., 2010). This means that the most accurate medication orders may be ineffective and inexpressive without a coherent cooperation on the part of practicing nurses. Apparently, the advent of the state-of-the-art information technologies that allow physicians to computerize medical orders has beneficial effects on the patients health because this obviates the recourse to illegible handwriting.

Inability of hospitals to man different work shifts properly is yet another essential reason that explains why nurses discharge their responsibilities in a perfunctory manner sometimes. A lot of nurses, who have taken part in the survey of Mark & Belyea (2009), maintain that working a night shift can have negative implications up to the medication errors. A gruelling schedule of nurses is exacerbated by the fact that they often have to fulfil several tasks in a hurry and at the same time. That is why they are prone to committing egregious errors.

It would make sense to reiterate that a high workload is one of the most significant ward environment-related factors, which cause medication errors. An extensive study of Helmchen et al. (2010) reveals that the insufficient number of nurses in the labour market and, therefore, a heavy workload and overtime hours are instrumental in the perpetration of errors by a fatigued nursing team. As busy schedule is one of the major culprits for the nursing malpractices, the organs in charge of this area of healthcare bestirred themselves to hire the additional personnel and moderate the existing work hours. By means of expunging the irrelevant assignments and activities from the nurses terms of reference they could reach much success too. Another very perplexing factor is the similarity of certain drug labels and packing, especially in regard to the unsophisticated practicing nurses. A proper arrangement of drugs on the shelves can solve the problem. However, the admonitions that nurses should do this often encounter a solid wall of ignorance and reluctance.

A lot also hinges on the type of ward where the events take place. Generally, the degree of suspense is equally high in paediatric, emergency and intensive care wards. Nevertheless, it is a matter of conventional wisdom that stresses reach a fever pitch in the emergency wards and intensive care units because of the hectic and frenetic pace of activities, in which nurses get enmeshed (Syrriyeh et al., 2010). In the result of a painstakingly meticulous research into the nursing errors in few hospitals in the Northwest region of the US it was ascertained that factors inseparably linked with the serviceability of hospitals have a substantial impact on the occurrence of medication errors (Mahmood, Chaudhury, & Valente, 2011). For example, an unreasonably long distance from a nurse station to the wards were patients are kept, the inadequate possibility of monitoring patients, an obstreperous environment of the nursing team, a misplaced arrangement of medical devices, sparse lightning, insufficient proportions of the treatment room, a little degree of privacy in the nurse station and a multitude of other small-bore factors influence the performance of practicing nurses badly.

It is widely accepted that nurse-related factors are the main culprit for the occurrence of nursing errors. It would be an inconceivable folly to dismiss this phenomenon as a uni-faceted one though. To the contrary, it is important to evaluate it from both managerial and organizational sides. Scientific interests concur that the bulk of attention must be paid to human resources (Kyung & Barbara, 2011). Karga et al. (2011) opine that it is next to impossible to eliminate human errors utterly and irrevocably. Simultaneously, it is quite obvious that the quality of healthcare system can be ameliorated by the means of ensuring de rigueur organizational and managerial conditions. In order to remedy this state of affairs the government has settled the policy of moderating working hours, giving motivational fillips to nurses, ensuring a thorough enlightenment of nursing teams on the pharmaceutical lore, getting rid of tasks not related to a nursing career, and promoting working space environments, in general.

Still, another watershed development took place in May 2013. It ushered in a new period in the realm of healthcare. For the sake of brevity, patients were granted an opportunity to assist professionals in pharmacies, hospitals, nursing homes and other settings to improve the quality of care. The Agency for Healthcare Research and Quality, hereinafter referred to as AHRQ, received dispensation from the Washington government for a proposed system, which allows patients to tattle on medical malpractices, nursing errors and other unsafe practices. The overriding objective of this initiative is to glean important trouvailles from the reports of patients and perceive their interpretation of medication mistakes in order to help healthcare workers to provide a safe care. The maiden patient reporting system complements the existing reports and, therefore, makes a significant contribution to a comprehensive and precise understanding (Phan et al., 2011). Having a more accurate comprehension of the situation, healthcare professionals, in general, and nurses, in particular, can take some appropriate measures to eradicate medical errors.

Intent on hedging the patients against heinous nursing errors, the federal government has established some measures enabling them to report the relevant information both through the Internet and telephone questionnaires (Phan et al., 2011). The questionnaire requests the information about the details of a medication error, the type of harm inflicted, the date and locale of the incident, etc. The afflicted persons are also asked about the reasons of why the malpractice has occurred and can choose from the proposed variants. Similarly, they are asked whether nurses were too busy, as well as whether they dedicated the sufficient time to a patient and worked in cahoots with other members of the nursing team. Furthermore, the authors of the questionnaire inquire what has been the level of interpersonal communication between the patient and their health provider.

References

  1. Clifton-Koeppel, R. (2008). What nurses can do right now to reduce medication errors in the neonatal intensive care unit. Newborn and Infant Nursing Reviews, 8, 72-82.
  2. Committee on Quality of Healthcare in America. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academic Press.
  3. Hamrick, A. B. (2012). Empirical research on moral distress: Issues, challenges, and opportunities. HEC Forum, 24, 39-49.
  4. Harding, L., & Petrick, T. (2008). Nursing student medication errors: A retrospective review.Journal of Nursing Education, 47, 43-47.
  5. Helmchen, L. A., Richards, M., & McDonald, T. (2010). How does routine disclosure of medical error affect patient propensity to sue and their assessment of provider quality? Evidence from survey data. Med Care, 48(11), 955-961.
  6. Karga, M., Kiekkas, P., Aretha, D., & Lemonidou, C. (2011). Changes in nursing practice: Associations with responses to and coping with errors. Journal of Clinical Nursing, 20(21), 3246-3255.
  7. Kyung, C. Y., & Barbara, M. (2011). Moderating effects of learning climate on the impact of RN staffing on medication errors. Nursing Research and Practice, 60, 32-39.
  8. Mahmood, A., Chaudhury, H., & Valente, M. (2011). Nurses perception of how physical >environment affects medication errors in acute care settings. Applied Nursing Research, 24, 229-237.
  9. Mark, B. A., & Belyea, M. (2009). Nurse staffing and medication errors: Cross-sectional or longitudinal relationships? Research in Nursing & Health, 32, 18-30.
  10. O’Connor, E., Coates, H. M., Yardley, I. E., & Wu, A. W. (2010). Disclosure of patient safety incidents: A comprehensive review. International Journal of Healthcare Quality Assurance, 22(5), 371-379.
  11. Pelliciotti, J. S., & Kimura, M. (2010). Medications errors and health-related quality of life of nursing professionals in intensive care units. Rev Lat Am Enfermagem, 18, 1062-1069.
  12. Pham, J. C., Story, J. L., Hicks, R. W., Shore, A. D., Morlock, L. L., & Cheung, D. S. (2011). National study on the frequencies, types, causes, and consequences of voluntarily reported emergency department medication errors. The Journal of Emergency Medicine, 40, 485-492.
  13. Santos, J. O., Silva, A. C., Munari, D. B., & Miasso, A. I. (2010). Conducts adopted by nursing technicians after the occurrence of medical errors. Acta Paul Enferm, 23(3), 328-333.
  14. Syrriyeh, R., Lawton, R., Gardner, P., & Armitage, G. (2010). Coping with medical error: A systematic review of papers to assess the involvement in medical errors on healthcare professionals psychological well-being. Quality & Safety in Heath Care, 19(6), 1-8.