The Problem of Lack of Respect for Time-out Procedures and Protocols at St. Joseph Pain and Rehabilitation Center: Presenting the Existing Evidence for the Presence of the Problem and Making a Choice of Quality Improvement Model
Quality healthcare is a major necessity in today’s healthcare landscape. The success of any healthcare setting depends on its ability to provide quality healthcare. That is care given to patients that is timely, safe, effective, efficient, equitable, patient-centered (Tzelepis et al., 2015). It is for this reason that quality improvement or QI has become an important pillar of the strategic objectives of many healthcare organizations. Many quality indicators exist and are used by organizations to monitor and improve the quality of care they offer. Regulatory bodies such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) also monitor these quality benchmarks for quality assurance and certification purposes.Analysis of the Existing Evidence for the Problem and Choice of Quality Improvement in the Operation Room. It is a common feature to find several quality indicators being monitored on the dashboards of electronic health record (EHR) systems of many healthcare organizations. At the St. Joseph Pain and Rehabilitation Center, it has been found that surgical care given to patients is not safe, effective, efficient, and patient-centered. This is with regard to observing of the time-out protocols as required for safe surgical procedures. This is a quality improvement issue and practice problem that must be corrected immediately as it has led to an increase in the rate of wrong-site surgeries. Wrong-site surgeries are described as sentinel events by the JCAHO (The Joint Commission, 2021). The purpose of this paper is to restate the clinical problem, analyze and synthesize available scholarly evidence for the existence of the problem, and choose a quality improvement model to be used to address the clinical problem. Analysis of the Existing Evidence for the Problem and Choice of Quality Improvement in the Operation Room.
Quality Improvement Project
The quality improvement project aimed at addressing the time-out problem is about diagnosing the root cause of the non-adherence, retraining all the surgical staff using resource persons from JCAHO, and restructuring the supervisory management of the operating theaters and the surgical unit. After retraining and reskilling, nurse managers overseeing operations in the theaters and the surgical unit will need to properly perform their managerial duties of planning, organizing, directing, and controlling. In this case, supervision and monitoring as components of the function of ‘controlling’ must be done properly.Analysis of the Existing Evidence for the Problem and Choice of Quality Improvement in the Operation Room. This will deter staff from taking costly shortcuts that negatively impact patient safety. The nurse managers will have both authority and responsibility to carry out this function and will be held responsible in case of non-compliance to time-out procedures. The key stakeholders at the facility to collaborate with on this are the nurses, the surgeons, and the management. Their buy-in has already been sought and they are ready to co-operate.Analysis of the Existing Evidence for the Problem and Choice of Quality Improvement in the Operation Room.
Measurable Indicators
The Quality Improvement Committee at St. Joseph Pain and Rehabilitation Center has, through the tracking of quality metrics on the institution’s electronic health record (EHR) system dashboard, found a safety issue requiring addressing. The data they have shows that there has been a 20% increase in sentinel events in the surgical unit with regard to wrong-site operations in the last financial year. This resulted in several medical malpractice lawsuits for the Tort of Negligence. Three of these already resulted in settlements of remedies amounting to $1.8 million dollars in compensation. According to The Joint Commission, a sentinel event is a preventable patient safety incident that causes permanent disability, severe bodily harm, or death to a patient. According to Chung (2015), a total of 8,275 sentinel events were recorded by the JCAHO between 2003 and 2014. A whole 67% of these were however self-reported, meaning that the real magnitude of the problem could be astonishingly higher.Analysis of the Existing Evidence for the Problem and Choice of Quality Improvement in the Operation Room.
Rationales and Patient Outcomes
The reason why this specific clinical problem was chosen is that the rates of wrong-site surgeries (WSS) as a quality indicator are not as regul
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