Improvement of healthcare quality and provision of patient safety are the primary concerns of healthcare providers. There are some solutions that are applicable to diverse healthcare scenarios. For example, information management solutions can be useful to provide patient care of high quality and increase patient safety thus reducing the incidence of hospital readmissions. One of the solutions for information management is electronic health record (EHR). EHR can be particularly useful in conditions of continuous care to improve care coordination in general and after discharge from hospital in particular. The paper discovers the peculiarities of care for the patient with heart failure and provides the analysis of safety implications significant both for patient outcomes and nursing practice.
Case Summary and Care Implications
The case under analysis presents care for the patient with difficulty in breathing due to heart failure. The care was provided by the multi-disciplinary team with the assistance of the coordination team. Moreover, specialists providing advice on diet and rehabilitation were involved. Both medical and nursing interventions were developed to meet the patient needs and provide care of high quality. These interventions included patient assessment, changes in diet and lifestyle, therapy, and patient and family education.
Due to the complexity of this case, patient and family-centered care implications became important. It was necessary to coordinate care in hospital and after discharge. According to the Agency for Healthcare Research and Quality (as cited in Marshal, 2016, p. 3), patients who understand the instructions for after-hospital care concerning taking medication and follow-up appointments, are “30% less likely to return to the emergency department or be readmitted.”
Thus, self-monitoring was advised as one of the means to control the patient’s condition and report any intense manifestations. Older adults, such as a 65-year-old patient in the case, frequently observe problems with proper self-evaluation. For these patients, family assistance and control are significant. Thus, family members should get necessary information from nursing educators concerning the peculiarities of care for the patient.
Evaluation of Quality and Safety Indicators
The quality and safety indicators are related to the goals and objectives that were conceptualized to enhance patient care delivery. The selected indicators included nursing hours per patient, care coordination, and hospital readmission rates. The indicator concerning nursing hours per patient per day addresses the case scenario in respect that enough of nursing attention and proper care provision, including control of taking the prescribed medications and patient education, mean the high quality of care and positively influence patient outcomes. The responsible attitude of nurses and their readiness to control patient’s condition and address their needs also contribute to the quality of care.
Care coordination as an indicator correlates with the similar goal of patient care delivery. Coordinated work of doctors and other clinical officers is critical for the high-quality care and positive patient outcomes. Good coordination demands effective communication between physicians, nurses, and other specialists involved in the process of care. It is significant for the case under analysis because it united a multi-disciplinary team consisting of a cardiologist, a nurse, and a physical therapist together with the coordination team and other invited specialists to advise on diet or rehabilitation program. In addition, the coordination with a leadership team that consisted of a medical director, nursing director, and nursing administrator, was important.
Finally, hospital readmission rates as an indicator are related to the goal to avoid hospital readmission for the patient within 30 days after the discharge. This indicator is also related to the quality of care because in case patients get appropriate care and are discharged when their condition is stable and treatment can be continued at home, they are not likely to be readmitted to the hospital within a short period of time.
Analysis of Patient Safety Implications
Patient safety implications should be necessarily considered in the planning of patient care. For example, documentation of assessment and care details together with the provision of high-quality care in conditions of joint work of the multi-disciplinary team of professionals demands careful consideration of patient safety. In the case study scenario, the patient safety implication is connected with the availability of patient health record.
The lack of equal access to patient information can result in data misinterpretation and poor coordination of work. Coordination of work can be achieved by making patient information equally accessible for all professionals involved in the process of care. According to Walker et al. (2017), equal access to such information can be provided by the EHR. The availability of recent data on patient condition, results of clinical tests, and notes of the specialists included into the healthcare multi-disciplinary team would contribute to the improvement of the quality of care and increase of patient safety.
Impact of Team Communication and Team Tools
Team communication and the tools applied in the process of care are crucial in case a multi-disciplinary team is involved in the patient care. Healthcare errors are hazardous for patients; thus it is important to stimulate efficient communication between healthcare team members to avoid possible mistakes. The research proves the significance of interpersonal relations within a healthcare team for communication and their influence on patient safety (Lee & Doran, 2017).
In the case study scenario, the team communication and team tools were of primary importance. Due to the fact that the team comprised many specialists, their efficient communication was decisive for the patient outcomes. It allowed optimal delivery of care to the patient and reduced the possibility of early hospital readmission. The coordinated work of the healthcare team allowed to create a favorable care environment and thus contributed to the patient safety.
Analysis of Quality Improvement Interventions
The care for the patient in the case under analysis could be possibly improved. One of the interventions aimed at the improvement of care quality can be the provision of equal access to patient data for all members of healthcare team. It is significant to guarantee their coordinated work that can positively influence patient outcomes. Another intervention that is directly related to the improvement of care quality and its continuity is patient and family education.
It is crucial to continue high-quality care after the discharge of patients with heart failure to provide them with efficient treatment and rehabilitation. It can be achieved through patient and family education specific to every individual case. For example, in the case under analysis, the patient needs to follow a diet, change lifestyles and follow healthier behaviors. Moreover, medication treatment should be continued outside the hospital. Also, the patient should control his condition and report any significant disturbing manifestations.
Both of the mentioned quality improvement interventions can apply health information technology as a solution. For example, equal access to patient information can be provided through the use of electronic health record. This technology helps to reduce the incidence of medical errors and improves coordination of the multi-disciplinary healthcare team thus increasing care quality and safety (Middleton et al., 2013).
Technology can be also applied for the development of interactive patient education plan (Marshal, 2016). It can provide access to diverse tools and automated processes that can educate patients or their families concerning motivation to care, management of chronic conditions, and coordination of behaviors and lifestyles. Interactive patient education plan can assist in treatment compliance, timely medication intake, and regular recalls to a physician or ather healthcare professional in case of necessity.
Still, some safety considerations should be reviewed before the implementation of these interventions. First of all, it is important to provide the security of personal patient data. Thus, the databases of EHR should be properly protected to avoid any external interference. As for the use of technology for patient and family education, it is important to check if people who apply the interactive education plan are able to use the devices necessary for its functioning and have enough knowledge to provide care and evaluation of patient condition. In case people are not able to use the technology appropriately, it can be not safe for the patient, and it is advisable to continue care in the hospital setting or at home under the guidance of a professional nurse.
Patient Values and Perspectives
Patient values and perspectives should be integrated into the delivery of care. As a rule, patient values are influenced by the diversity of social, cultural, and religious factors as well as healthcare environment (Addario et al., 2017). In the delivery of care in this case, the major patient values were family support, high-quality care, and patient involvement in care decisions. Thus, family support is necessary for the continuation of care after discharge. High-quality care is generally accepted as a primary value of care. Finally, patient involvement is realized through patient education and lifestyle and diet changes that depend on the patient and are significant for patient outcomes and success of treatment.
Nursing Documentation
Nursing documentation is a significant component of the care process. The application of EHR for keeping patient records and organization of nursing documentation can be efficient in case a multi-disciplinary team is involved in the process of care. The use of EHR for nursing documentation will provide equal access to relevant patient information for all the involved specialists and guarantee their cooperation and well-coordinated work.
Solution Assessment
To assess the efficiency of the suggested solution after its implementation, it is necessary to evaluate the patient’s condition at different periods of time. Thus, it is important to check the number of patient’s readmissions with the same problem within 30 days, half a year, and one-year period. No readmissions within 30 days after the discharge and a moderate number of readmissions within half a year and one-year period would witness the efficiency of the suggested solution. The data for the assessment can be obtained from the healthcare provider.
Change Implications of the Solution for Nursing
The suggested solution has some implications for change in nursing practice. First of all, nurses should be toughed how to use technology to facilitate healthcare process. It demands change in both nursing education and practice. Thus, the ability of nurses to use such information technology instruments as electronic health record can contribute to the increase in care quality and improvement of patient outcomes.
Moreover, nurses should be able to work in a team. It is significant to provide coordinated care in complicated cases. Finally, another change implication for nursing includes the ability of nurses to provide patient education and control this process giving more freedom to patients. Proper organization of patient or family education leads to the high-quality care and decrease of readmissions.
References
Addario, B., Fadich, A., Fox, J., Krebs, L., Maskens, D., Oliver, K. … Turnham, T. (2017). Patient value: Perspectives from the advocacy community. Health Expectations.
Lee, C., & Doran, D. (2017). The role of interpersonal relations in healthcare team communication and patient safety. Canadian Journal of Nursing Research, 49(2), 75-93.
Marshal, L.C. (2016). Mastering patient and family education: A healthcare handbook for success. Indianapolis, IN: Sigma Theta Tau International.
Middleton, B., Bloomrosen, M., Dente, M., Hashmat, B., Koppel, R., Overhage, J.M. … Zhang, J. (2013). Enhancing patient safety and quality of care by improving the usability of electronic health record systems: Recommendations from AMIA. Journal of The American Medical Informatics Association, 20(e1), e2-e8.
Walker, E., McMahan, R., Barnes, D., Katen, M., Lamas, D., & Sudore, R. (2017). Advance care planning documentation practices and accessibility in the electronic health record: Implications for patient safety. Journal of Pain and Symptom Management.