Telemetry: Patient Safety Analysis
Clinical Application Assignment
Telemetry is not considered a complex specialty as compared to some fields of nursing. Floor nursing as it’s commonly referred to deals with managing the care of several patients anywhere from 3-7 patients but most commonly 4-6. Patients on telemetry units vary is age greatly from 21 to 101. However is most often accustomed to an aging population approximately 60 and older. When the elderly come into the hospital there are several things that take a number one priority, safety. Hospitals nationally report fall rates among the elderly continue to remain steady or see an increase in numbers but rarely do fall rates decline in the ageing population. With most things in life when people are placed in new environments …show more content…
we acquire an increased sense of awareness due partly in fact that it is not a familiar environment. In the elderly population we don’t see those changes occurring. Instead the sense of awareness turns into confusion and an altered mental status only exacerbating what may be a mild disease process resulting in mental changes such as dementia or Alzheimer’s. In some cases we see this population more prone to UTI’s which result in confusion as one of the first signs in this group. In cases of confusion patients don’t comprehend the concept of their safety. These scenarios result in falls and injury’s unrelated to falls.
Hospitals nation-wide are giving awareness to elderly fall rates that happen yearly due to the rising in the population of the elderly. Across the nation evidence based practice and research has surfaced on new techniques, protocols, and safety features to help reduce fall rates. One of the most tried and true ways to maintain safety of patients is implementing patient sitters for safety. Recent changes in protocols for a local hospital facility have instituted the removal of patient sitters for safety. I would like to see the reinstatement of patient sitters. Not only did the facility decrease their fall rate throughout the entire hospital but also increase patient satisfaction without that being a direct goal of the outcome. I am going to discuss several areas of research related to the topic and review upcoming new technology to reduce fall rates of all ages.
The Problem
As nearly all healthcare facilities do, there are several protocols that keep nurses and physicians directed toward safe patient care. I am focusing on would be Patient Sitters for Safety. This recent change in protocol removing it from hospital policy has negatively affected staff members and patients as a whole. Outlined in this protocol were guidelines and scenarios in which patient sitters are warranted or strongly advised. By following the algorithm set in place nurses and physicians could effectively make provisions for their patients placing their safety at a number one priority. I believe this protocol should re-implemented into patient care to provide a more safe and effective healing environment for our patients and providers alike. In January of 2016 the National Patient Safety Goals were released and for another straight year fall rate reduction again made the list. If fall rates are such a concern for the hospitals across the nation then why did this facility do away with them, even with positive outcomes?
Background & Literature Review
Within the past 15 years patient safety and fall rates have been given top priority and have become recognized nationally.
As operationally sound as the idea may be patient safety analyst Susan C. Wallace from the Pennsylvania Patient Safety Authority writes that using patient sitters to directly observe patients at a high risk for falls is a practice suggested as part of several evidence-based fall prevention guidelines. However, the clinical and cost-effectiveness of sitters have been questioned. Unfortunately, this is one of the exact reasons this program was cut from this local facility. It all comes back around to cost-effectiveness in relation to goals or outcomes achieved. The battle between costs and rewards is a delicate balance. Michelle Feil, a senior patient safety analyst weighs in on the subject reporting, sitters can be effective in reducing falls, and the savings can exceed the costs of the sitters themselves. The cost savings achieved in decreasing rates of falls with harm, both in terms of money saved and decreased severity of injury, might justify the costs associated with implementing and maintaining a sitter program. Feil’s analysis resulted in the cost savings achieved in decreasing rates of falls with harm, both in terms of money saved and decreased severity of injury, might justify the costs associated with implementing and maintaining a sitter program. Although the results can be spotty related to countless research on the topic of safety sitters. …show more content…
Facilities have to look at the entire picture weighing the pros and cons and ask themselves do sitters truly assist in preventing falls? According to CE Lang, a published author with the US National Library of Medicine and National Institute of Health, the cost savings achieved in decreasing rates of falls with harm, both in terms of money saved and decreased severity of injury, might justify the costs associated with implementing and maintaining a sitter program. Regardless of the costs of sitter programs the data consistently points toward showing an increase in fall rates when sitters are not present. In recent studies modeled after the Pennsylvania Patient Safety Authority a tool was developed to aid facilities in justifying the costs of a patient sitter program. The tool is known as a Falls-With-Harm Savings Calculator. The equation begins with hospitals entering in their current fall rate with harm and the calculator provides the estimated average additional costs and length of stay associated with the current rate, along with estimates of costs savings that can be achieved with the desired percentage (whichever is the hospitals goal percentage) 10%-100% reduction in the fall rates with harm. I do believe when it comes to safety of patients re-instituting the patient sitter for safety protocol would be most beneficial to the facility with the benefits outweighing the costs. The removal of this protocol has affected the telemetry floor the greatest due in part because of the population we take on has the highest fall rate in all of the hospital. Every nurse that is currently employed on the telemetry unit has seen and been effected directly by these changes, patients safety being the ones that suffer the most.
Project Plan
First implementation of the plan of re-instate to patient sitter safety program was contact the unit coordinator who helped set up a scheduled meeting with the telemetry unit director. In the meeting I would present the data gather from various trusted sources and personal accounts of both myself and fellow colleagues whose patients were affected by this change. With all the information gathered from evidence based practice, interviews with fellow nurses on my unit and other units across the facility, interviewed physicians testing both their comprehension and any deficits that remain in their knowledge related to patient safety. Several other facilities in the area were also observed and nurses interviewed on their perspective of the effectiveness of their patient sitter programs that remain in place. After meeting with my director she was pleased with the information that was presented, she very willingly agreed that this was a program the hospital as a whole needed to renew in hopes of advocating for future patients. The process of re-approval is a long and involves the crossing of the infamous ‘red tape’. The remainder of the plan would begin with the setting up a meeting with the CNO, or Chief Nursing Officer. Given the idea and information is received well it would go on be communicated/passed before the Board of Directors. Only if deemed appropriate and addendums made to the budget in hopes of re-approval of the program. This concern was brought to my own attention by a fellow colleague who also happened to be our Unit Resource after both a patient and myself were affected by the termination of the patient sitter program. I chose Lippit’s phases of change created in 1958 as my basis for development of my change theory. Communication is essential is nursing and in all of the phases of change theory. The steps are listed here: (1) diagnosing the problem, (2) assessing the motivation and capacity for change, (3) assess the change agents motivation and capacity for change, (4) selecting progressive change objectives, (5) choosing and appropriate role for the change agent, (6) maintaining the change after it has been started, and (7) terminating the helping relationship (Kelly, 299-300). This change theory in particular fit the scenario best to re-implement the needed change. The phases in this theory brought you through all the necessary steps to help you achieve the change in which you seek. Do to the affect the discontinuation this program has had on the nurses getting all the employees on board would be an easy task. Things constantly change in nursing but, patient safety continues to top the lists of concerns and in search of ways to reduce fall rates. Lippit’s phases of change do focus heavily on participation of personnel that would be needed to implement change. The purpose of this theory is to make a change in a protocol or policy that is already established or in this case one that needs to be re-established.
Method of Evaluation This is a change that could be shown and proven with evidence based practice (EBP) and could be implemented in other facilities that have not already changed this in their protocol.
The objective data would prove this change as successful would be to re-instate the patient sitter program. From this they could compare the current data acquired from the point in which the program was terminated to data gathered in the following months to year when sitters are implemented again. This would be positive change to the facility and would also correlate to higher patient satisfaction scores hospital
wide.
Conclusion
In conclusion, I do believe it would be in the interest of the hospital for them to place patient sitters back at the bedside for safety. Through personal nursing experience and the countless years of experience held by my colleagues, collectively we do believe in will be a positive transition back. I have heard many positive feedbacks from fellow nurses, physicians, and nursing administrators alike in support of bringing this program back all in agreement that this is needed and have high hopes that it will be brought back into practice.
Telemetry is not considered a complex specialty as compared to some fields of nursing. Floor nursing as it’s commonly referred to deals with managing the care of several patients anywhere from 3-7 patients but most commonly 4-6. Patients on telemetry units vary is age greatly from 21 to 101. However is most often accustomed to an aging population approximately 60 and older. When the elderly come into the hospital there are several things that take a number one priority, safety. Hospitals nationally report fall rates among the elderly continue to remain steady or see an increase in numbers but rarely do fall rates decline in the ageing population. With most things in life when people are placed in new environments …show more content…
we acquire an increased sense of awareness due partly in fact that it is not a familiar environment. In the elderly population we don’t see those changes occurring. Instead the sense of awareness turns into confusion and an altered mental status only exacerbating what may be a mild disease process resulting in mental changes such as dementia or Alzheimer’s. In some cases we see this population more prone to UTI’s which result in confusion as one of the first signs in this group. In cases of confusion patients don’t comprehend the concept of their safety. These scenarios result in falls and injury’s unrelated to falls.
Hospitals nation-wide are giving awareness to elderly fall rates that happen yearly due to the rising in the population of the elderly. Across the nation evidence based practice and research has surfaced on new techniques, protocols, and safety features to help reduce fall rates. One of the most tried and true ways to maintain safety of patients is implementing patient sitters for safety. Recent changes in protocols for a local hospital facility have instituted the removal of patient sitters for safety. I would like to see the reinstatement of patient sitters. Not only did the facility decrease their fall rate throughout the entire hospital but also increase patient satisfaction without that being a direct goal of the outcome. I am going to discuss several areas of research related to the topic and review upcoming new technology to reduce fall rates of all ages.
The Problem
As nearly all healthcare facilities do, there are several protocols that keep nurses and physicians directed toward safe patient care. I am focusing on would be Patient Sitters for Safety. This recent change in protocol removing it from hospital policy has negatively affected staff members and patients as a whole. Outlined in this protocol were guidelines and scenarios in which patient sitters are warranted or strongly advised. By following the algorithm set in place nurses and physicians could effectively make provisions for their patients placing their safety at a number one priority. I believe this protocol should re-implemented into patient care to provide a more safe and effective healing environment for our patients and providers alike. In January of 2016 the National Patient Safety Goals were released and for another straight year fall rate reduction again made the list. If fall rates are such a concern for the hospitals across the nation then why did this facility do away with them, even with positive outcomes?
Background & Literature Review
Within the past 15 years patient safety and fall rates have been given top priority and have become recognized nationally.
As operationally sound as the idea may be patient safety analyst Susan C. Wallace from the Pennsylvania Patient Safety Authority writes that using patient sitters to directly observe patients at a high risk for falls is a practice suggested as part of several evidence-based fall prevention guidelines. However, the clinical and cost-effectiveness of sitters have been questioned. Unfortunately, this is one of the exact reasons this program was cut from this local facility. It all comes back around to cost-effectiveness in relation to goals or outcomes achieved. The battle between costs and rewards is a delicate balance. Michelle Feil, a senior patient safety analyst weighs in on the subject reporting, sitters can be effective in reducing falls, and the savings can exceed the costs of the sitters themselves. The cost savings achieved in decreasing rates of falls with harm, both in terms of money saved and decreased severity of injury, might justify the costs associated with implementing and maintaining a sitter program. Feil’s analysis resulted in the cost savings achieved in decreasing rates of falls with harm, both in terms of money saved and decreased severity of injury, might justify the costs associated with implementing and maintaining a sitter program. Although the results can be spotty related to countless research on the topic of safety sitters. …show more content…
Facilities have to look at the entire picture weighing the pros and cons and ask themselves do sitters truly assist in preventing falls? According to CE Lang, a published author with the US National Library of Medicine and National Institute of Health, the cost savings achieved in decreasing rates of falls with harm, both in terms of money saved and decreased severity of injury, might justify the costs associated with implementing and maintaining a sitter program. Regardless of the costs of sitter programs the data consistently points toward showing an increase in fall rates when sitters are not present. In recent studies modeled after the Pennsylvania Patient Safety Authority a tool was developed to aid facilities in justifying the costs of a patient sitter program. The tool is known as a Falls-With-Harm Savings Calculator. The equation begins with hospitals entering in their current fall rate with harm and the calculator provides the estimated average additional costs and length of stay associated with the current rate, along with estimates of costs savings that can be achieved with the desired percentage (whichever is the hospitals goal percentage) 10%-100% reduction in the fall rates with harm. I do believe when it comes to safety of patients re-instituting the patient sitter for safety protocol would be most beneficial to the facility with the benefits outweighing the costs. The removal of this protocol has affected the telemetry floor the greatest due in part because of the population we take on has the highest fall rate in all of the hospital. Every nurse that is currently employed on the telemetry unit has seen and been effected directly by these changes, patients safety being the ones that suffer the most.
Project Plan
First implementation of the plan of re-instate to patient sitter safety program was contact the unit coordinator who helped set up a scheduled meeting with the telemetry unit director. In the meeting I would present the data gather from various trusted sources and personal accounts of both myself and fellow colleagues whose patients were affected by this change. With all the information gathered from evidence based practice, interviews with fellow nurses on my unit and other units across the facility, interviewed physicians testing both their comprehension and any deficits that remain in their knowledge related to patient safety. Several other facilities in the area were also observed and nurses interviewed on their perspective of the effectiveness of their patient sitter programs that remain in place. After meeting with my director she was pleased with the information that was presented, she very willingly agreed that this was a program the hospital as a whole needed to renew in hopes of advocating for future patients. The process of re-approval is a long and involves the crossing of the infamous ‘red tape’. The remainder of the plan would begin with the setting up a meeting with the CNO, or Chief Nursing Officer. Given the idea and information is received well it would go on be communicated/passed before the Board of Directors. Only if deemed appropriate and addendums made to the budget in hopes of re-approval of the program. This concern was brought to my own attention by a fellow colleague who also happened to be our Unit Resource after both a patient and myself were affected by the termination of the patient sitter program. I chose Lippit’s phases of change created in 1958 as my basis for development of my change theory. Communication is essential is nursing and in all of the phases of change theory. The steps are listed here: (1) diagnosing the problem, (2) assessing the motivation and capacity for change, (3) assess the change agents motivation and capacity for change, (4) selecting progressive change objectives, (5) choosing and appropriate role for the change agent, (6) maintaining the change after it has been started, and (7) terminating the helping relationship (Kelly, 299-300). This change theory in particular fit the scenario best to re-implement the needed change. The phases in this theory brought you through all the necessary steps to help you achieve the change in which you seek. Do to the affect the discontinuation this program has had on the nurses getting all the employees on board would be an easy task. Things constantly change in nursing but, patient safety continues to top the lists of concerns and in search of ways to reduce fall rates. Lippit’s phases of change do focus heavily on participation of personnel that would be needed to implement change. The purpose of this theory is to make a change in a protocol or policy that is already established or in this case one that needs to be re-established.
Method of Evaluation This is a change that could be shown and proven with evidence based practice (EBP) and could be implemented in other facilities that have not already changed this in their protocol.
The objective data would prove this change as successful would be to re-instate the patient sitter program. From this they could compare the current data acquired from the point in which the program was terminated to data gathered in the following months to year when sitters are implemented again. This would be positive change to the facility and would also correlate to higher patient satisfaction scores hospital
wide.
Conclusion
In conclusion, I do believe it would be in the interest of the hospital for them to place patient sitters back at the bedside for safety. Through personal nursing experience and the countless years of experience held by my colleagues, collectively we do believe in will be a positive transition back. I have heard many positive feedbacks from fellow nurses, physicians, and nursing administrators alike in support of bringing this program back all in agreement that this is needed and have high hopes that it will be brought back into practice.