Question

CASE STUDY

You have just completed your first week employed as assistant executive manager in a 180-bed skilled nursing facility, named Sanctuary Nursing Home. On your first day, the facility CEO gave you a tour of the facility, introducing you to staff and residents. Throughout the week, you have been observing and getting to know your staff and residents. Now, as your first full week on the job winds to a close, you are dismayed to notice a pattern of care indicative of some organizational deficiencies. Some of these problems are so serious that, were an inspection to happen today, Sanctuary would likely receive a number of citations. Most of these issues have the potential to cause at least minimal harm. The list of problems you have noticed includes: There is urine and/or feces on the bathroom floors of several incontinent patients. Less than 40% of staff and 70% of residents received an influenza vaccine this year. Medication patches ordered “discontinued” for a resident were found on the resident’s shoulder one day after the discontinuation order was placed in chart. Four activities scheduled on the Recreation Calendar were cancelled within your first week without notice, leaving residents sitting in front of the television in the activity room. As a new manager, you recognize a need to: 1) engage in an in-depth assessment of quality of care being provided at Sanctuary, and 2) develop a plan to proactively improve care quality and prevent citations or sanctions from external oversight entities. Question Do you think that the situation as described here at Sanctuary is typical of skilled nursing facilities, or do you think that nursing homes suffer from poor, inaccurate press based on a few isolated situations?

Answer 1

Being an assistant executive manager one must have to acknowledge the problems in the Sanctuary and solve them with ideas. The manager was worked for a week and acknowledge the deficiencies in the nursing home. There were a lot of issues thus the manager wasn't happy about it. It was really required to implement a few things. The nurses must take proper training before joining. Full care of incontinent patients must be done. The training must be of at least a year so that they have all the knowledge regarding medication, nursing, catering, etc.

There is urine and/or feces on the bathroom floors of several incontinent patients. Less than 40% of staff and 70% of residents received an influenza vaccine this year. Thus these problems must be considered a proper meeting must be conducted by the manager he should motivate people to do the things accordingly as planned.

What is there in a recreation calendar must be given emphasis and should be executed in a sanctuary Proper engagement of employees must be there.

Nurses should be recruited who have done proper training. If there are less skilled workers a proper training must be provided to the unskilled ones. For this, properly trained nurses could teach & train the untrained ones.

Recent attention in health care has been on the actual architectural design of a hospital facility, including its technology and equipment, and its effect on patient safety. To address the problems of errors in health care and serious safety issues, fundamental changes in health care processes, culture, and the physical environment are necessary and need to be aligned, so that the caregivers and the resources that support them are set up for enabling safe care. The facility design of the hospital, with its equipment and technology, has not historically considered the impact on the quality and safety of patients, yet billions of dollars are and will be invested annually in health care facilities. This provides a unique opportunity to use current and emerging evidence to improve the physical environment in which nurses and other caregivers work, and thus improve both nurse and patient outcomes.

Nurse staffing levels

Preventable adverse events such as falls and complications have been found to be related to both the design of health care facilities and nurse staffing levels. Patient falls in acute care settings can result from slippery floors, poor placement of handrails, inappropriate door openings, furniture heights, and inadequate nurse staffing. Infection rates have been found to be lower in patients, particularly critically ill patients when there are higher staffing levels. High rates of postoperative infections, especially related to wounds among patients ages 65 to 70, have been found to be associated with facilities that were overcrowded, had few private rooms, lacked individual bathrooms and toilets, had no isolation facilities, and had deficient ventilation systems.

Debate continues as to whether hospitals should have single-bed rooms or semiprivate rooms for patients. Research over the past 10 years has compared single to semiprivate rooms and, in so doing, has provided greater insight into cost implications, patient satisfaction, and impact on patient care and outcomes. Several reviews of the literature found that single-bed rooms were more conducive for infection control and patient care, were associated with reduced stress and improved outcomes for patients, and increased privacy and accessibility for patients and families.

The condition is so bad in the hospitals, very bad maintenance when it comes to cleaning. The reality is that if everyone has ample of money everyone would like to be in private rooms since there is very less care of hygiene when there are joined rooms.