Question

FUNDAMENTAL QUESTIONS. Case Study, Chapter 1, Health Care Delivery and Evidence-Based Nursing Practice 1. Suzanne Jones, 76-year-old patient with COPD is admitted to the ICU. Mrs. Jones is placed on mechanical ventilation to assist with her breathing. After 2 days on the ventilator, Mrs. Jones is extubated and then transferred to a medical-surgical unit. The medication regimen is adjusted during the hospitalization. Mrs. Jones is discharged home after 6 days. She and her family are pleased with the care she receive in the hospital. (Learning Objectives 3 and 6) a. Describe the quality performance tools that may be used to demonstrate that the care and treatment rendered are both cost-efficient and of high quality. b. Describe the quality performance tools that may be used to demonstrate that the nursing care utilized is evidence-based care and high quality, resulting in patient satisfaction and good patient outcomes.

Answer 1

The mission and vision of every healthcare institution is to provide a quality care so as to achieve total patient satisfaction. In order to evaluate the quality of care, there are various indicators which are used bt the healthcare settings. These are the quality performance tools for the hospital also known as PATH. This tool supports the hospital to assess their performance, question their results and evaluate if there is need for improvement. The various performance indicators are:

• Clinical effectiveness evaluated through the mortality rates, rate of readmission, return to ICU, appropriate use of antibiotics, timely administering the medications, doctors responsiveness to nurses call.
• Safety evaluated through incidences of patient harm due to fall, ensure right patient and right procedure, safe use of high alert medications, preventing harm due to equipment malfunctioning, maintaining privacy and confidentiality.
• Efficiency evaluated through adequate staffing, competency of the staff, short length of stay.
• Patient centeredness evaluated through score on patient perception and patient satisfaction survey, opportunity to patient to participate in decision making for his treatment, and use of informed consents.
• Responsive goverance evaluated through care rounds,care calls, follow up visits and rehabilitative services.
• Staff orientation evaluated through adequate inservice education,budget for staff health improvement, healthy and safe working environment, staff incentives, staff excessive weekly working hours.

The role of nursing care in gaining patient satisfaction is crucial. The patient gives a positive feedback when they receive high quality nursing care. For achieving this target of patient satisfaction and good patient outcome,nursing faculty uses evidenced based care practices which is to be delivered by highly skilled and competent staffs. In case of COPD patient, the evidenced based practices followed are:

• An adeqaute staffing pattern to avoid workload on staff is the initial requirement. For nurses to work effectively a safe working environment and autonomy to make decisions for patient's care is important. It has been proven with evidence that a positive working environment of the staff effects the patient outcome positively.
• Use of skilled and competent staff: This is important because patients with COPD may appear to be stable at times, but may become critical to handle in no time. Therefore those staff who have adequate knowledge about the disease condition and is capable to manage emergency situation should be assigned to the patient.
• Oxygenation is the crucial step for COPD patient. This is to prevent hypoxia and organ damage.The use of oxygen is the correct treatment for COPD which is proven with evidence and it improves the quality of life of these patients.
• Appropriate use of antibiotics to treat the underlying infections and use of steroids to reduce the inflammation of airways is applied that will improve the patients health condition.
• Health education to identify various allergans which may trigger an episode of COPD.Education on certain lifestyle modifications and activity planning is also important.
• Informed consents for the procedures and adequate explaination of the treatment regimen to make patient participate in their treatment and decision making will foster positive outcome.
• Patients feedback is the tool to evaluate any quality performance.This will also help to understand the drawback of the interventions applied and pave a way for making improvements.