The History Of Promoting Quality Healthcare

Published Date: 02 Nov 2017

It is unbelievable but still there are a lot of on-going issues which are related to the surgeries are reported. Many of these are coming out as a result of being too pessimistic or being too careless. Once the surgeons are carrying out their practises in a wrong manner it is unlikely that they can bounce back from whatever they committed to themselves. Therefore the health care organisations must make sure that the correct and needful actions are in place prior to the surgery. Also there is another issue that the health care organisations are not maintaining better and quality materials within their premises for the surgeries to be carried out In a proper manner. Therefore as a result many patients are finding hazardous after effects and the legislation is willing to pounce on those acts. Therefore it is highly recommended that the health care organisations must avoid wrong site surgeries being more precise as well as more accurate. The below discussion carries out the understanding deeper.

Patients' safety and its importance

The term patients’ safety has been aroused from the health care movement which is equally considered and briefed in many ways with attached components to the safety procedures. This is defined by the Institute of Medicine (IOM) as a way of prevention of harm to patients (Aspden et al, 2004). As the definition says the consideration is placed care delivery system which prevent errors, and allow the personnel to learn from the errors which occur day to day. On the other hand since this is being built on a culture which was developed by the health care professionals, health care organisations and patients. But the definition of the AHRQ safety network for patient web further explains this safety meaning beyond to what was meant by IOM as the avoidance of harmful or preventable injuries through the health care.

As per Kohn et al (2000), the medical safety practises have been defined by those above authorities as a way of reducing the harmful and disturbances causing the patients as well as the existing medical care practises and conditions. But having looked at the above definition it is clear that there is no stipulated backgrounds for the definitions as the definition says the practises but in reality there are various amounts of practises which are taking place in order to prevent the patients from the rising levels of harm. Some of the medical practice which are to protect the patients from unwanted and harmful diseases are as follows. The correct and useful prophylaxis in order to heal the risky venous thromboembolism affected patients. There must be a better and a more meaningful source of feeding the perioperative beta-Blockers in order overcome the perioperative morbidity and to increase the morality.

Aspden et al (2004) further says that putting the maximum sterile gates and also preventing infections which are causing placing central intravenous specially with placing central intravenous regarding the catheters. The use of the antibiotic should be done accurately otherwise the prophylaxis might be violated leading to postoperative infections. Prior to the examine or noting down the prescription it is vital that the history of the patient is recalled and the necessary important information should be passed on. The repetitive subglottic secretions must be carried out in order to overcome the ventilator-associated pneumonia instances which cause a severe issue for the patients. Using the pressure gauges in order to prevent the wrongful pressure ulcers.

Using the innovative technologies such as ultrasound in order to improve the complications from the existing states. Using the Coumadin to prevent patient related complications especially in order to achieve outpatient anticoagulation. The use of the nutritional advises as the precautions as well as for the surgical patients in order to overcome the states. Using the antibiotics in order to control the catheter related infections as well as issues (Kohn et al, 2000).

Also the use of generic safety practises such as bar codes to define the correct medicine, simulators and computerized patient calling up systems and the crowd handling are also researches has been yielded in these areas but still there is untouched areas which are yet to explore ( Carayon and Schultz, 2004: p. 355). The national quality forums have neutralized the different definitions. Therefore the need of standardizing patient safety taxonomy is a concept given and a vital factor for the health care organisations to adopt. The main idea of the safety taxonomy is that the danger of the health care failure as that might result in short term or long term issues with the patients and there could be negative outcomes with bad practises which will lead to disastrous issues (Cynthia, 2009). Therefore the health care errors must be identified as a way of delivering bad and inappropriate connotations for the humans. Therefore one must not take it as a positive fact as well.

According to Williams and Wilkins (2009), The roots of the patient safety systems are going to the deep throats as types, communication issues. Types are representing the errors which could arise and on the other hand the communication refers to the extensive and vulnerable communication failures which can occur between the patient and the practitioner. In the patient safety management the above discussed areas as well as the areas such as patient management which include the better delegation of the health care work, better tracking of the historical data of the patient, better referral and the better utilization of the resources as well as clinical best performances such as precautions as well as after effects must be passed on to the patient in order to prevent from the causing issues.

The issues arising in the areas of the health can be further discussed as below in the areas if domains or the place or the area which the issue is causing. The harmful causes can be denoted as follows (Denaro et al, 2010). Latent Failure is where the practitioner is not involved but rather the organisational policies and procedures are maintained in order to allocate the resources. The major issue here is that the organisational policies might set up adverse to the patient and which might be an injustice. Also the active failures are also occurring in cases where the proper contacts with the patients are not being able to maintain directly. Organisational systems failure is also another failure which is occurring due to the mismatchment of the organisational culture, management of the organisation as well and the processes are too rigid in terms of transferring the problems to the external factors. There could also be technical failures (Joint Commission Resources, Inc., 2006).

As per Pozgar (2004, this is a common issue arising in the context as the companies are being asked to carry out their tasks in a way that they are being used event after event, disease by disease. Finally the taxonomy is also looking into the areas such as mitigation of harmful activate. These are in most cases the universally adopted stuff as well as the selective. The universally adopted refers to those which are available at the finger tips and which are dedicated to the organisational hierarchy. Selectivity refers to the content of begin chosen those which are risky as well as harmful. There can also be indicative stuff which is specific or clinical processes which are having a probability to fail even though they are in practise.

Wrong Site Surgery

Wrong site surgery is referring to the extent to a thing which is causing hazardous issues to both the surgeon and the medical practitioner as well as to the patient. This is a common result of the poor preplanning, loose controls of the medical institutions, reckless and careless acting or not performing professionally at the surgical act or miscommunications of the patient and surgeon (Iyer, 2001: p. 297). Also it needs to be mindful that this is not an orthopaedic surgery issue still on course as the surgeon operates at the wrong area. This is a common issue which happens to many people as well. There is a concern as the number of orthopaedic surgery issues which are reported are not in equal to the orthopaedic insurance claims as well. An analysis from Biehn (2008), shows that there is a rising issue where there is a 84% possibility that the orthopaedic surgery failures are occurring and those are dragging the payments up to 10 years odd time in comparison to all other orthopaedic claims where these are being claimed in the near times which these occur.

Methods of Eliminating Wrong-Site Surgery

As per Williams and Wilkins (2007: p. 72), This is a case which can be effectively prevented if the following needful activities are in place. Firstly the company must make sure that the correct communication is possible with the patient where the surgeon must note down the necessary actions after hearing and analysing the issues especially with regard to the patient medical history. This must be done at the place where the patient is held in the health care organisation but not on the way to the surgery. The special and common spinal surgeries can be done once the proper X-Rays are being obtained as well as examining the density of the marrow bones. Also the MRI scans reports can also yield in order to make sure that the correct decision is always taken. Once the necessary tests are done then the vertebral level of the surgery should be marked. Once the site of the surgery is designed then the respective nurses, operating room attendants, machinery technicians, room committee members, anaesthesiologists and other respective people should be informed and outlined (Allbee, 2012: p. 303) The correct patient procedure should also need to be exercised and the patient or the guardians must be informed in advance about the procedures which are on the cause.

Once the patient is being taken into the surgical room, the surgeons and the related staff must negotiate the task up head and they should also try to make sure that the correct people are given the correct advises. During this discussion the patient should be authenticated so as the disease which is heading up (Dlugacz, 2009). The double check of the needful equipment is a must as the people are needed to make sure the correct tools and devices are with them and during the course they do not fall short. If there is anything missing, the replacements should not encouraged but rather the originals should be obtained irrespective of the time they consume. Also during the time of the healing stage, the surgeons must make sure that they properly rely on the best practises and the rules and guidelines rather than the beliefs (Pozgar, 2009: p. 121). This is done in order to make sure that the wrong anticipations are not made at the curing surgeries. At this stage the documentation must be carefully initialized in order to make the surgeon be accountable for the act they committed.

Global Steps taken to prevent Wrong Site Surgery

Unlike those explained above, the Universal steps are also taken in order to make the surgical practises to be in line much better. According to the Joint Commission Resources, Inc. (2005), In the US the American Academy of Orthopaedic surgeons (AAOS) and North American Spine Society (NASS) has taken the needful steps to stabilize the ongoing issue with the wrong site surgeries. Having considered the 10 odd years of poor surgical practises, they have found out one main area for the tasks as the concept of ‘Sign your Site’ is imposed. But in reality this is occurring at a slower speed where the health officials are reluctant to say no but try to take up anything comes in their way. This then makes into a warning system where the officials are being to mark NO if they are not at all fit for the task. This is done in order to make the surgical process to be more and more versatile and accurate (Abujudeh, 2012). The NASS has made the signing procedure to be more comprehensive where by adding more and more detailed factors such as X-rays and etc. once the proper signing is done they believe that the surgeon is quite fit to work as well as they are fit to carry out the task.

Practical Incident

Also Abujudeh, (2012) says that a general surgical procedure situation, if it is determined that the surgery is being done at the wrong site, the surgeon should record the facts of the surgery in an appropriate medical record. In the meantime the surgeon should also take further actions in accordance to what the patient asks or wishes to do in order to make sure the patient is safe. In the situation of the surgery is being done under general anaesthesia, the surgeon should then take immediate actions to bring the patient into his earlier conditions (George, 2011). If the surgery is being done at a wrong site the surgeon should immediately advise the patient and his family on the consequences which are likely to happen. The surgeon also can redo the surgery at the correct site, only if there are no medical reasons to omit it, as in a situation of the patient would likely to result in a disability due to the surgery.

As per Tichansky, (2011), when a surgery is being done at a wrong site under a local anaesthetic situation, the patient is capable of understanding the situation. Therefore the surgeon should take actions to bring the patient into his previous conditions as soon as possible, while informing the patient about the situation and explaining the reasons for choosing the final decision regarding the situation. In here the surgeon must make sure that he provides honest and truthful answers to the questions asked by the patient, while agreeing the ideas of the patient. Unlike in the previous situations, but in a situation where it is determined that the surgery is being done at the wrong site, after completing the surgery procedures, the surgeon is responsible for informing about the situation to the patient and to his family as soon as possible (George, 2011). After having discussions with the patient, the surgeon should immediately come up with a plan on how to correct the mistake done unless there is a special medical reason to leave it out as it is.

Recommendations to prevent wrong site surgery in health care

According to the clarification of Sax (2009: p. 1138) wrong site surgeries are very dangerous situation for the patients and it is a great threat which results in the death of the patients in most of the situations. So it is very important to take preventive actions of the occurrence of wrong site surgeries in the hospitals. There are legal requirements to ensure quality service of the health care services and it is essential to concentrate on the available procedures to prevent wrong-site surgery because this belongs to the category of patient safety incidents. These prevention methods for wrong site surgeries support to achieve a good reputation for the health care organisation in the country.

As claimed by Haynes et al. (2009: p. 492) the prevention of such issues supports to ensure better quality health care that is trusted by the general public. Wrong site surgery includes wrong procedures, wrong side or wrong patient and this can be identified as the third most common sentinel event which was reported in the year 2010. It can be introduced a process with six ways that can be used to prevent wrong site surgeries in surgery centres and hospitals.

Khoshbin et al. (2009: p. 309) explains that the first step of the process that prevents wrong site surgery includes leading a campaign around wrong site surgery in the facility. This campaign has to be supported by all the staff in the hospital who represent different levels from top to down. It is very important to make aware the staff about the wrong site surgeries at the staff meetings and take their participation in safety rounds. The progress should be noted in employee newsletters and through the intranet or CEO blogs. Also the health care facilities have the ability to take the support for the prevention of wrong- site surgery from the rest of health care facilities , this supports to achieve the contribution from health care experts.

As described in American College of Surgeons (2002: p. 21) there are different health care facilities in the world who have lower record of the occurrence of wrong site surgeries. These facilities are using better strategies to prevent wrong site surgeries, so the health care facilities where the occurrence is high can take the advices and instructions from the facilities which are reporting less incidents. The second step of the wrong site surgery prevention process in the implementation of check list. This check list supports to identify the all related information which requires to do for the patient pre- operatively. This includes the marking for the site and side of the surgery which supports to reduce the possibility of wrong site surgery occurrences.

According to the explanation of Kwaan and Studdert (2006: p. 369) the operating room circulating nurse should become the in charge of the checklist, but it is important to take the responsibility of the surgeon for marking the side and site of surgery. Operating rooms are places that involve with busy environment, so it is necessary to enlarge the checklist and print it on a poster to attach to the wall of the operating room. Then there is a possibility to see it by every provider and the circulating nurse will check off the necessary steps of the process. The checklist can be used in two versions, one is a PDF and the other is a customizable word document. Then the providers have the ability to use it according to the type of case. For instance, a cardiac case may consist of different steps than a cataract surgery which takes seven minutes.

According to the explanation of the American College of Surgeons (2002: p. 22) the third way is watching miscommunication during hand-offs and the provider has the opportunity with the use of a checklist in communicating during patient hand –offs. The checklist supports the next provider to understand the processes of the previous provider. This supports to avoid any mistakes when involving a new provider because there is more than one provider in most of the surgery cases in the hospitals. The fourth way of wrong site surgery prevention is taking the involvement of the patient in marking the side and site of the surgery.

In the view of Haynes et al. (2009: p. 492) It is important to talk with the patient before marking the side and site of the surgery. For example, the provider can ask from the patient" Mr. Peter, we will operate on your right knee today and now it is marking, is this correct?". Also the provider can ask" Which knee that will be operated today?". These two questions can be asked by the provider with the understanding about the educational level and cognition of the patients. But this cannot be done in the situations where the patient is not in a clear mind because most of the patients may nervous before doing a surgery. The fifth step of the process of preventing wrong site surgery is thinking outside the operating room.

As described in Kwaan and Studdert (2006: p. 366) some facilities do not concentrate on the areas of the hospital other than the operating room, they only take the efforts for prevention of wrong site surgery in the operating room. But this is not acceptable, because surgical procedures and chest tubes are done in the intensive care unit of the hospital or in the emergency room. So it is important to practice the prevention procedure for wrong site surgeries in all departments of the hospital without thinking it is only a responsibility of the staff in the operating room. The enough time should be taken by all the departments of the facility to ensure it does not contain any possibilities to occur a wrong site surgery. The sixth step of the process of preventing the wrong site surgery is taking the involvement of every team member.

As claimed by Sax et al. (2009: p. 135) team work is very important for the health care organisations, the team should have a common goal and maximum contribution of all the team members is essential to achieve the expected results. Sometimes it may be difficult to take the involvement of some providers to implement a checklist or such an effort that is practiced in order to prevent wrong site surgeries. For example, some physicians may say that he has done surgeries for 20 years and he does not need to use a checklist. It is very important to work with these people and this is a common situation that shows resistance to change.

Conclusion

Having looked at the above discussion it is certain that the organisations who are in the maintenance of the surgeries needs to pay a deeper attention to their existing practises. They should adopt the rules and better practises irrespective of the country of the rules. Also since the possibility is high with regard to the wrong site surgeries to be on the higher side, always the signing should be done in order to be more and more accountable for the work they carry out. Furthermore the health care organisations must make sure that they don’t over rely on the beliefs that they have but rather they must stick to the proper and authorized guidelines as well. Once the above outlooks are done, the health care organisations can carry out their plans to a better extent.