Patient Safety High Priority Health Care System

Within the health care system patient safety remains a high priority to assist in preventing morbidity and mortality amongst consumers of health care, 4 -16.6% of adverse events occurring and up to 50% of these events could have been prevented (Johnstone & Kanitsaki 2006).

Below are four themes that can enhance patient safety.

Incident reporting – Adverse events in hospitals are commonly associated with surgery, drug errors and wound infections (Armstrong 2004). Incident reporting allows staff and management to ascertain information about errors without assigning individual blame and typically adverse events are not caused by a single event or action (Armstrong 2004). Using incident reporting management can establish what, why and how adverse events occur and then through quality activities implementation of interventions to prevent or minimise the risk to the consumer can take place.

Patient involvement – when the patient can be involved in their own care harm to the patient can be minimised, this is can be achieved by empowerment, with the appropriate information and can alert health professionals to situations of possible harm (Armstrong 2004).

Improving records - patient safety can be improved if all information could be centralised to a patient’s medical record, medical history/treatment minimises the risk of harm by allowing the vast range of health professionals from all fields to have access to the same information about the patient which also improves communication among the health care team enabling health professionals to provide the best patient care (Johnstone & Kanitsaki 2006).

Research – research is needed to understand the root cause of errors and how we as humans manage the errors that occur (Johnstone & Kanitsaki 2006). To provide safe care we need to find out what went wrong to cause the error/s, although sometimes understanding how to provide safe care we also need to know what went right, as research into the foundation for success can be a means of understanding failure (Johnstone & Kanitski 2006).

Activity 1.2

Name of Inquiry: Health Care Complaints Commission, 2003, The investigation report of the Campbelltown and Camden Hospitals, Macarthur healthService, New South Wales. Part 1,2,3,5,6.

Governance principles applied and explained

Example of inquiry,page number found.

1.Effective governance

2.Capable management

3.Diligent monitoring

4.Responsible risk management

5.Clear accountability and responsibility

Activity 1.3

SECTION 2.

Activity 2.1

Natural justice - natural justice consists of two main priniciples.

That no one maybe deprived of their autonomy or livelihood or belongings without being given timely notice or without reasons to do so and not without being given the opportunity to be heard in their own defence (McIlwraith&Madden 2010).

That no one who may have interest in the outcome of the verdict to sit in judgement of another who is being judged (McIlwraith&Madden 2010).

Rule of Law – The principles of rule of law institutes two things

A person can only be found guilty of a criminal offence at the time the offence and cannot be charged after the criminal offence has occurred (McIlwraith&Madden 2010).

The executive branch of the government is subject to law just the same as a citizen is, so that the citizen is protected from the random action by public officials and members of parliament (McIlwraith&Madden 2010).

Presumption of innocence – implies that a person charged with an offence is to be treated innocent until the facts have proven otherwise (McIlwraith&Madden 2010).

Activity 2.2

Differentiate sources of civil and criminal law

Criminal law and civil law – is based on the common law system (Staunton & Chiarella 2008). Criminal law is sourced from laws made by a recognised authority also known as Legislative law essentially based on rules of behaviour backed by the sanction of punishment (Staunton &Chiarella 2008). Civil law enables us to resolve disputes and differences of a personal property nature (Staunton&Chiarella 2008).

Criminal Law – is where alleged criminal behaviour has occurred, the person alleged to have committed this behaviour is then arrested by the police who are also responsible for the burden of proof,to provide evidence that this behaviour has taken place (McIlwraith&Madden 2010).

Civil Law – is where harm occurs to a person aka plaintiff or their property. The plaintiff is then responsible for contacting the other party stating the plaintiff’s demands, if no negotiation is achieved it is then up to the plaintiff to provide burden of proof to be able to take the matter to the court systems (McIlwraith&Madden 2010).

Activity 2.3

Principle 1: The defendant owed the plaintiff a duty of care

Case and legal reasoning as to how the case developed legal determination.

Source from McIlwraith and Madden

Case: Goode vs Nash

The plaintiff suffered a serious and permanent injury from treatment the doctor provided, however the doctors activities were potentially dangerous and negligent and the doctor should have taken precautions to prevent those injuries from occurring.

Page 182.

Principle 2: The defendant’s conduct on the occasion in question fell below the standard expected.

Case and legal reasoning as to how the case developed legal determination.

Source from McIlwraith and Madden

Case: Sherry vs Australiasian Conference Association (trading as Sydney Adventist Hospital).

The patient suffered an intrathoracic haemorrhage as a complication postoperatively of coronary surgery. The hospital was found to have inadequate nursing staff for the ICU that was at a safe standard along with not having dedicated medical coverage at the time of the incident according to the minimum standards and guidelines

Page 215.

Principle 3: that as a consequence of the defendant’s breach of their duty of care to the plaintiff, the plaintiff suffered damage.

Case and legal reasoning as to how the case developed legal determination.

Source from McIlwraith and Madden

Case: Rufo vs Hosking

Patient was treated for SLE (lupus) with corticosteroids, over a period of time the patient developed vertebral microfractures that was a result of osteoporosis that developed because of the steroids, it was held that because the steroid sparer imuran was not introduced soon enough, the doctor had breached duty of care

Page 239

Principle 4: The damage the plaintiff is complaining about is a reasonably foreseeable consequence of the defendant’s negligent act.

Case and legal reasoning as to how the case developed legal determination.

Source from McIlwraith and Madden

Case: Millicent and district hospital inc vs Kelly

The defendant was held liable for breaching the duty of care it owed the plaintiff by not removing the container that held her unborn foetus that the patient miscarried and had received a curette for and subsequently developed post traumatic stress disorder. The court held that there was forseeability of harm that the defendant should have seen that the sight of the container would cause undue stress to the plaintiff

Page 235

Activity 2.4

SECTION 3.

Activity 3.1

From reading the article “Role stress in Nurses: Review of related factors and strategies for moving forward" Chang,Hancock,Johnson,Daly and Jackson, 2005.

I have identified the following 4 themes:

Increased patient workloads

As nurses we are becoming more aware of increased stress from increased workloads and decreased time frames, this usually comes about from skill mix on the ward and the availability of experienced staff. This usually causes the nurses to be stressed with not being able to provide longer adequate direct patient care.

Nurses have been given more administrative work to do along with their already heavy nursing workload, this decreases the amount of direct nursing care given as the standard of documentation writing and record keeping has increased to ensure that the requirements placed on them are completed.

Newly graduated Registered Nurses have added stressors such as lack of confidence, unrealistic expectations by medical staff, role conflict and role ambiguity and also at times lack of support (Kelly cited in Chang et al 2005). In my current workplace there is a clinical educator in the role two days per week for orientation of graduate nurses or new midwives commencing employment. As an experienced Registered nurse completing my midwifery, the Registered Nurse Graduates look to me to support them in the diverse role in the maternity unit as they are not employed as a midwife and as such are usually paired with a midwife, however their scope of practice does not allow them to practice midwifery care.

In nursing it is noted that most nurses are women of childbearing age, so the family role and demands on family so flexible rostering and hours is imperative (Chang et al 2005). Nursing staff are constantly trying to balance family life with the nonflexible hours we as nurses have, this results in the nurses suffering not only extra stress but acute or chronic fatigue. The unit currently allows requests however they must be only what is definite and cant be changed. There is a book where nursing staff can places regular requests, but at times due to skill mix these can’t be guaranteed.

Activity 3.2

When a maternity unit accepts medical or surgical outlies, these patients are required to be at times cared for by a registered nurse/midwife, however

Activity 3.3

Activity 4.1

Elements of consent contain 3 parts for consent to be effective. Firstly, consent must be given freely and voluntarily without persuasion from any source, for example by either threat or duress, consent may be withdrawn at any time and the patient should be made aware of this. Secondly, the intervention or procedure consented to must be for thus specific act and nothing more. Finally, consent is valid only if the patient is capable of understanding the intervention or procedure being consented to and can weigh up the benefits and risks involved (McIlwraith& Madden 2010).

A risk is material if the health professional knows or should know that a person or in the patient’s situation or the patient themselves would be likely to attach importance too (McIlwraith &Madden 2010).

If a patient is asking questions about the intervention/procedure this is a good indication that the patient concerns and is unable to give consent as the patient is not fully informed and will require assistance by a health professional to provide appropriate information (McIlwraith &Madden 2010).

An adult who is competent and requires a blood transfusion may refuse the blood transfusion regardless of their health status, although if a child’s life is in danger and requires a blood transfusion to save the child’s life, the doctor may with a second doctor’s opinion give the blood transfusion without the parent’s permission to do so (McIlwraith &Madden 2010).

In the situation of a pregnant woman and consent there is much controversy over the mother’s rights to the foetus’ rights. The common law has established that until the foetus has been physically born it shall have no legal rights and the woman retains her right to autonomy (McIlwraith &Madden 2010).

When research is undertaken the patient/s should be aware that undergoing research does not provide any therapeutic benefit to the patient (McIlwraith &Madden 2010). Some research may depend on the patient being misinformed or uninformed, and in these cases the research proposal has to undergo careful consideration by ethical committees to ascertain the necessity and the risks involved (McIlwraith & Madden 2010).

Activity 5.1

Nurses have a responsibility to provide a responsibility to provide adequate care and comfort to a terminally ill patient. A nurse may administer drugs for the therapeutic effect of pain relief to a terminally ill patient even though aware that the administration of the drug may shorten their life expectancy, which is classed as double effect, according to section 17 of the consent to medical treatment and palliative care act 1995 (SA), as long as the patient has no prospect of recovery and is in severe pain (McIlwraith & Madden 2010). A nurse or general practitioner who administers drugs without the intent to solely relieve pain can be found guilty of euthanasia which is the deliberate act or action that brings what is considered to be an intolerable existence to end (McIlwraith & Madden 2010).