This case study about patient safety presents clinical indicators, team interactions, and safety concepts for a heart failure patient.
A Background for a Clinical Care Scenario
A 65-year-old man presents to the emergency department with difficulty in breathing due to heart failure. During the assessment phase, the nurse gathered both objective and subjective data about the real and possible clinical issues for the patient. Diagnoses were then developed from the information and interventions and indicators for the patient care included. The involved healthcare team developed their intervention goals, care objectives, interventions for the goals and objectives, and the expected outcomes. The goals and objectives were conceptualized to enhance patient care delivery through a multidisciplinary team to improve care coordination, eliminate the need for hospital readmission within 30 days after the discharge, and to improve the patient’s quality of life (McAlister, Youngson, & Kaul, 2017).
The Care Environment
The multi-disciplinary team for the patient in the cardiac unit consisted of the core team made up of a cardiologist, a nurse in charge and assistants, and a physical therapist. There was also the coordination team that consisted of the unit and the cardiac rehabilitation manager. Additionally, the patient also received care from a dietician, social services team, housekeeping, and rehabilitation therapy assistants, as well as an emergency response team. Leadership team was made up the medical director, nursing director, and nursing administrator.
From the above team, care coordination and effective communication were extremely important for optimal delivery of care to the patient for improved intervention outcomes, quality of care, and to ensure that no hospital readmission was recorded within 30 days after the discharge (Riley & Masters, 2016).
Medical and Nursing Components
For the patient, both nursing and medical interventions were designed to meet certain issues as noted during nursing diagnosis. Once these interventions were implemented, the outcomes were evaluated to determine if the desired outcomes were attained. Thus, interventions were focused on assessing vital signs, changes in the patient’s life style, changes in diet, medication administration, and oxygen therapy. Care coordination and patient and family health education were also used.
Heart failure adversely impairs patients’ vital signs. Nurses monitored vital signs, observed abnormal variations, noted, and changed the nursing care plan. The report was submitted to physicians. These vital signs included pulse patterns, blood pressure, respiration, saturation, and body temperature.
Another aspect of the patient care plan involved lifestyle modification. Nurses involved the patient and his family in this intervention. Patient education was focused on behaviors, activities, and emotions to reduce heavy workload on the heart. The nurse worked with the family members and the patient to during nursing interventions for change in the patient’s lifestyle to improve the quality of life. The patient and family members learned about the importance of rest and avoidance of excess activities to restrict strains on the heart. The patient was advised to avoid noise and to manage his emotions, as well as polluted air environments to limit chances of hypoxia. Further, the patient was advised to avoid smoking (active or passive) and alcohol consumption.
Dieticians were also involved in the diet modification for the patient. Diet was critical in improving patient quality of life and intervention outcomes. Diets low in salt and fat were recommended for the patient. Diets low in salt were necessary to reduce fluid retention while fat free diets were provided to reduce the risk of ischemic heart conditions. Foods were also prepared soft to limit mechanical digestion processes and to enhance metabolic activities. The patient was advised to consume meals in small quantities and to ensure a semi-Fowler position to reduce pressure exerted on the heart. Diets rich in energy and vitamins were recommended.
Physicians prescribed medication and other therapies for the patient, and nurses were responsible for the administration of the prescribed drugs and therapies. The prescription included the exact quantity of oxygen the patient required based on his blood test. Nurses worked with pharmacists who dispensed drugs and advised on their uses and side effects to ensure improved outcomes and to avoid complications associated with drug setbacks. Heart failure drugs are known to cause adverse effects and discretion was therefore necessary. Nurses were responsible for monitoring all outcomes related to drug usages. Some of the drugs prescribed for the patient included digitalis, diuretics, ACE inhibitors, digoxine, and furosemide (Amakali, 2015).
The case of this patient was complex and, therefore, required effective care coordination. Physicians were responsible for the prescriptions of all the diagnostic tests the patient received, and nurses were primarily responsible for implementing all the necessary care. Additionally, they also provided results to physicians for interpretation to improve to treatment. The patient underwent chest X-rays, laboratory blood tests, and Electro-Cardio Graph tests.
As previously stated, nurses were generally responsible for patient education and counseling to improve the quality of life through self-care after discharge. The patient was guided to accept and adapt to his condition and to focus on positive living. Additionally, the patient received education on self-care for better outcomes after discharge. Patient education highlighted self-monitoring, changes in lifestyle, moderate physical activities, self-administration of medications, diet modifications, and adherence to follow-up treatments. These interventions were guided by clinical care during interventions at the hospital.
The patient was informed about reduced circulation, systemic output, and hypoxia for self-monitoring. Thus, he was most likely to experience dizziness, palpitation, weakness, shortness of breath, and other related symptoms. The patient, therefore, had to observe possible difficulties in breathing and oedema. Any intense cases had to be reported to the nurse immediately. Additionally, patient education also included changes in risky behaviors and lifestyle, diets, engaging in physical activities, and emotional stability.
These modifications required the involvement of family members or care providers outside the hospital setting. Diet restrictions had to be strictly observed, and any changes had to be communicated immediately to avoid errors. Further, the patient had to adhere to medication and treatment regimen without fail during self-care (White, Kirschner, & Hamilton, 2014). These processes required support of family members. They are instrumental in supporting the patient after the discharge. All results of the intervention were to be recorded and shared with the multi-disciplinary team.
Conclusion
In this patient safety case involving a heart failure patient, it was noted that offering clinical nursing care needed the intervention of a multidisciplinary team. Care coordination was extremely important for improved quality of care and patient outcome. Therefore, team structure, nurse leadership, mutual support, effective communication, and constant monitoring of the patient situation were required to achieve high quality of care and avoidance of readmission within 30 days following the discharge.
References
Amakali, K. (2015). Clinical care for the patient with heart failure: A nursing care perspective. Cardiovascular Pharmacology, 4(2), 142. Web.
McAlister, F. A., Youngson, E., & Kaul, P. (2017). Patients with heart failure readmitted to the original hospital have better outcomes than those readmitted elsewhere. Journal of the American Heart Association, 6(5), e004892. Web.
Riley, J. P., & Masters, J. (2016). Practical multidisciplinary approaches to heart failure management for improved patient outcome. European Heart Journal Supplements, 18(Suppl. G), G43–G52. Web.
White, M. F., Kirschner, J., & Hamilton, M. A. (2014). Self-care guide for the heart failure patient. Circulation, 129(3), e293-e294. Web.