Introduction
In planning for Nightingale Community Hospital’s (NHC) upcoming Joint Commission (JC) audit, a mock tracer survey was conducted to evaluate Nightingale Community Hospital’s level of consistency in providing safe, high-quality care and services to its patients. The reason for the tracer methodology is to guarantee that consistent and uniform care is provided all through the continuum of care from admission to release.
Tracer Patient Summary
The case examination was conducted as a feature of a procedure change to evaluate compliance with The Joint Commission norms. In this procedure, a random patient chart was selected and the process was traced from admission to discharge including any straightforwardly related development or readmission.
The outline chosen for this tracer was a 67-year-old patient who underwent an open hysterectomy five weeks before hospitalization. The patient was admitted for a postoperative infection, abscess formation and drainage at the surgical site and fever seven days back.
She presented with fever and postoperative wound drainage. During her readmission, she underwent a subsequent surgical procedure for the treatment of the wound drainage, including the insertion of a central venous catheter for the administration of antibiotics. The patient’s discharge planning included home health care to continue anti-infection treatment.
The main course of treatment for this patient was to reduce her fever and control her infection. While meeting the nurse regarding the range-order approach for the administration of the antitoxins, the attendant was not ready to verbalize what the means would be if a request were made for the antimicrobial administration to be inside a range in milligrams. For instance; the request endorsed was for administering antibiotics within a range of 0.25-100 mg. At the point when the nurse was asked what dose ought to have been given, the response was 100 mg. Legitimate and precise administration of antimicrobials is basic in the treatment of diseases. On the off chance that the measurement of the anti-infection is not satisfactory, it won’t be powerful for the treatment of the disease and can prompt bacteria to develop resistance. Range orders should be clarified, and the dose or dosing interval will differ depending on the patient’s condition. Per the Joint Commission, “Medication blunders may happen when staff is communicating or translating medication.”
With a review by the Joint Commission sooner rather than later, the Nightingale Community Hospital created a role-play tracer-patient exercise to quantify our consistency and distinguish issues that need remediation. Furthermore, the approach of this kind of study tracks the quality of care for the patient throughout the admission process until discharge. This framework enables us to evaluate our strengths and weaknesses concerning strategy, methods, and frameworks set up to give quality care in combination with the models put forward by the Joint Commission.
Furthermore, the patient’s history and physical condition are critical for the utilization of the care group. It is utilized to give an up-to-date picture of the patient’s general condition and any historical risk factors or conditions that may influence treatment. The H& P additionally informs all other care colleagues of the planned course of action for the patient with the goal that they and the patient might be appropriately prepared for any upcoming treatment. That this patient’s history and physical were not updated according to protocol and that the patient was taken to surgery without it being refreshed demonstrates that corrective action is required promptly to ensure safe and efficient patient care. It is important that the H& P is completed according to the hospital policy within 24 hours of admission to maintain compliance with TJC norms.
The quality group will be entrusted with completing 20 extra tracers in the next 30 days to evaluate the degree of this issue and determine whether it happens haphazardly or as often as possible. The consequences of these extra reviews will be given to the Chief Nursing Officer, who will oversee any additional strategy initiated.
The hand-off process will be refreshed to incorporate a check of H& P completion preceding the end of the shift on the day of admission and any move made by the nurse to get the H& P from the admitting or attending provider.
Analysis
The entire approach of using a tracer patient as a test case could have resulted in an adverse outcome concerning the quality of care and condition of the patient. On the off chance that a history and physical examination has been done in the required timeframe, the plan of care could have been fittingly altered in an opportune way, and patient-education issues addressed well before the release time drew closer. When all is said and done, this one disappointment in the process seriously affected the quality of care the tracer patient received, as treatment was conducted before a comprehensive profile of the patient’s condition could be determined. Therefore, it must be understood that the complete profile could have uncovered the actual issues of the patient that would have changed the approach and selection of the treatment plan for the patient. Therefore, a corrective action has been developed to determine this issue that ought to be implemented immediately.
The history and physical are imperative instruments for utilization by the care group. It is utilized to provide an up-to-date picture of the patient’s general condition and any recorded hazard factors or conditions that may influence treatment. The H& P likewise educates all other care colleagues of the planned strategy for the patient with the goal that they and the patient might be appropriately prepared for any upcoming treatment. That this patient’s history and physical were not updated according to protocol and that the patient was taken to surgery without it being refreshed demonstrates that corrective action is required immediately to guarantee protected and proficient patient care. It is basic for the H& P to be completed according to hospital arrangements within 24 hours of admission to maintain compliance with TJC standards.
Moreover, the case of the tracer patient has demonstrated that there are areas of patient care that we need to improve, to comply with the standards developed by the Joint Commission.
As per the Joint Commission standards, compliance with Joint Commission Standard PC.01.02.03 requires that a history and physical examination must be done within 24 hours of admission of the patient and before the surgery is conducted because this tracer patient, the history, and physical examination were actually done on the 3rd day of the admission of the patient. Furthermore, this patient underwent the surgery two days after she was admitted, much before the history and physical examination were conducted (The Joint Commission, n.d.).
The overall examination of the patient is an essential device in a patient’s care. Moreover, it gives data regarding the patient’s general condition and also potential hazard factors that may influence the planned course of treatment. Moreover, the history and physical permit the treatment group to decide whether any additional interventions are required to lessen the hazard to the patient. The fact that this essential aspect was deficient in this present patient’s care is unsuitable, and a corrective action plan is required.
Corrective Action Plan
Correcting the inadequacies in the tracer patient review will require a review-and-retrain approach. This will require the contribution from staff roles that added to the current issues and additionally, the initiative group to implement these new ideas. The initial segment of the plan will include changing the arrangement. This has the following parts which consist of:
- Conduct group meetings to seek input on conceivable changes that would try to correct the expressed issue
- Using the employee input gathered make and revise procedures as it was expected to require that a complete history and physical be performed within 24 hours of admission as per Joint Commission.
- The quality group will be entrusted with completing 20 extra tracers in the next 30 days to survey the degree of this issue and find out whether it happens arbitrarily or often. The consequences of these extra reviews will be given to the Chief Nursing Officer, who will manage any extra game plan that has been started.
- The hand-off process will be refreshed to incorporate a check of H& P completion preceding the move’s finish upon admission’s arrival and any action taken by the nurse to get the H& P from the admitting or going to the supplier.
References
The Joint Commission. (n.d.). Standards information. https://www.jointcommission.org/standards_information/edition.aspx
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