Introduction
Patient safety is often a top priority to nurses. Patient safety is a top priority for nurses. There are leadership, teamwork, evidence-based, communication, learning, just, and patient-centered components of patient safety culture (Sammer, 2010). The need for quality healthcare globally is not questionable. Patient safety forms part of quality healthcare provision. Most health facility spends a lot of money in enhancing patient safety. For instance, Medical Park hospital in the United States spent a total of $2 million on improving organizational culture of patients safety (Schelbred & Nord, 2007). However, patient safety is threatened by internal factors within the hospital. Such factors include hospital overcrowding and medication errors among others. The purpose of this paper is to examine threats to patient safety cultures at hospitals. It is important to note that medication errors remain the main threats to patient safety and well-being at hospitals. This has seen increased deal of attention being focused on it. For instance, it is estimated that in 2006, 98,000 patients in America died as a result of errors in medications prescribed within hospitals. This later saw the launch of federal initiative aimed at medical error reduction and patient safety improvement.
Literature Review
Many researchers have focused on exploration of various factors that threaten patient safety in hospitals. Most acknowledged that medical errors/misdiagnosis remained the leading threat to patient safety within the hospitals. However, they cite other reasons that potentially pose threat to patient safety in hospitals including hospital overcrowding and verbal orders to some extent.
Diagnostic/Medical Errors
In many cases when an individual gets sick or experience an injury, the most appropriate thing to do is visit a hospital and see a doctor. In return, the individual gets treatment trusting that whatever the doctor prescribes is the right treatment for his/her ailment. Many people believe that when they visit a health facility, they put their health in the hands of right persons capable of diagnosing the right disease/ailment. Even though the diagnosis is uncertain, the patient is often given treatment assuming the diagnosis to be working. When the patient gets well, it is assumed that the diagnosis was right and hence yielded positive results. A diagnosis is considered wrong when the expected results fail to come to fruition. The period taken until the doctors reach the right diagnosis may impact deeply on the patients health as an error can be made during the trial diagnosis and hence seriously harm or even lead to death of a patient. Considerations given to how doctors handle the working diagnosis and treatment plan of the patient is very little hence enough time should be given to clinical officers to carefully diagnose and treat the patient.
Schelbred & Nord mentions that medical diagnostic/medical errors are the main threats to patient safety globally (2010). Management and control of the same is considered the best way of avoiding critical negative impacts to patients undergoing treatment within hospitals. It is essential therefore that, doctors have adequate time to come with the right diagnosis and hence avoid wrong medicine prescription. Additionally, they emphasizes the importance of allowing doctors adequate time to come up with right diagnosis (Schelbred & Nord, 2010). This is taking into consideration the fact that such diagnosis could either save or destroy a patient’s life.
Clinical officers need to be allocated more time to make better diagnosis which leads to sufficient treatment planning and patient review.
In United States medical errors is one of the top causes of death, killing more patients than incurable diseases like HIV/Aids and even fatal accidents like plane crash. Furthermore, the costs of correcting a medical error can add up to billions and billions of dollars. However, no matter the cases of misdiagnosis, wrong prescriptions and incorrect surgeries at the end of it all the patient bears the suffering (Chang & Mark, 2009). Mistakes are often made when medical professionals are forced to come up with prescriptions during emergencies where the situation requires quick and accurate decision.
Errors can also occur in situations where there is lack of experience, language barrier or different cultures between the clinician and the patient. Incorrect medication can also occur due to situations where some medicines have similar or complex names and in most cases doctors rely fully on the information given by the patient so that they can come up with the correct diagnosis of the situation (Chang & Mark, 2009). It is very important for patients to have good knowledge on whatever is happening to them and they should also be open enough to whatever worries they face. When a person is ailed, it is important to see a doctor and talk it out and if necessary seek a second opinion.
Hospital overcrowding
In United States, lack of enough space in a hospital is regarded as an unsafe hospital hence a major hindrance to the provision of good health care (Ramanujam, Abrahamson, & Anderson, 2008). The elderly, the sick, and disabled patients are often subjected to long wait periods in insecure emergency trolleys and accorded little or no privacy.. Studies show that overcrowding hospitals are inefficient due easy transmission of diseases and inadequate facilities.
It is important to put more pressure on efforts to fight against overcrowding in hospitals. By using different methods and different populations, studies show that there is a strong alliance between mortality rates and access block where access block is a safety issue in that it gives the community and healthcare workers a responsibility. It is mandatory on leaders to prevent overcrowding in hospitals by providing necessary resources to improve health care system (Ramanujam, Abrahamson, & Anderson, 2008). The studies earlier mentioned, have certain policy concerns that require observation. Firstly, both studies used governmental catalogs which are appropriate and allow high populations to be studied.
Regrettably, in governmental records, many data elements are not available. Additionally, data relating physiological variable to patient history are lacking resulting into difficulty in adjustment. Despite this, the union between increased mortality and overcrowding is very strong in that in both studies, there is a room for adjustments for confounders such as type of illness, age, seasonal effect, mention but a few (Ramanujam, Abrahamson, & Anderson, 2008). While some studies have indicated a correlation between mortality rates and hospital overcrowding, others show that overcrowding does not result into mortality.
Many attempts have been put through to improve the problem of access block across the world. Changes of working hours, aged care, hospital beds and work force have contributed a lot in access block (Ramanujam, Abrahamson, & Anderson, 2008). Governments are responding positively to these changes by improving efficiency in hospitals as well as controlling the number of patients within a given hospital.
What should be done?
Reduce hospital demand
Governments have diverted some patients to community services where by they encourage hospitals in the homes and after-work general practices (Ramanujam, Abrahamson, & Anderson, 2008). The government controls the range of services that are offered in hospitals, in that the community is trained to differentiate between the essential services and desirable services depending on how much the community is willing to pay.
Optimize bed capacity
Government offer adequate funds to purchase enough beds to provide the community with better health care. It also discharges patients quickly immediately the recovery to create more space for new patients. An overcrowded hospital can easily jeopardize patients safety, health professionals should avoid providing health services in such hospitals hence an overcrowded hospital is regarded as unsafe (Ramanujam, Abrahamson, & Anderson, 2008). Government and community at large should ensure better health facility for better health care.
Nursing intervention to patient misdiagnosis/wrong medicine prescription
Evidence based practice is emerging as the choice alternative to solving most of problems originally affecting nursing practice. In essence, evidence based practice lowers the chances of misdiagnosis by a considerably large percentage.
Evidence base practice
Evidence based clinical practice is a derivation of evidence based medicine. It involves conscious and judicious judgment based on existing evidence to come up with rational decisions regarding a particular case (Duffy, Fisher & Munroe, 2008).This approach involves collection, interpretation and gathering of information which are relevant, valid and applicable to patient case scenario. The resulting report is based on clinician observed, tested and research driven information as evidence to the selected line of treatment. This method emphasizes on incorporation of particularized clinical expertise and external clinical evidence into interpretation and analysis of collected data in order to come up with relevant diagnosis (Buysse & Wesley, 2006). In general, this practice is based on evidence and independent analysis of each patient case. It explicitly acknowledges the role of evidence in assisting decision making with regard to patient case treatment (Buysse & Wesley, 2006). Clinical decisions are to a large extent based on the level of collected evidence. However, it is important to note that such evidence is evaluated against available research evidence (Duffy, Fisher & Munroe, 2008). The clinical cases study presented in this paper takes a step by step approach towards evidence based clinical practice.
Recommendations for future research
Based on the findings from literature sources used in this report, it is important that future researches adopt a more focus oriented approach. It is on this basis therefore that the following recommendations are highlighted for consideration in future researches:
- Future research should incorporate statistical evidence of the actual effect that misdiagnosis/wrong prescription cases affect health safety of patients. This would create the actual picture of the level of effect that medication errors have on patient safety.
- Future research should also focus on identification the most common drugs /diseases that and subject to medical errors and the conditions that lead to such.
Conclusion
In general, it may be concluded that evidence based nursing practice is time intensive and requires a lot of dedication. However, its success has seen a number of organizations adopting it and incorporating it into its medical practice. It popularity continues to grow by the day. Patients are treated based on a number of factors that may contribute to the ailments they suffer there by making it a wholesome treatment approach as compared to the other techniques available in nursing practice.
References
Buysse, V., & Wesley, P.W. (2006). Evidence-based practice: How did it emerge and what does it really mean for the early childhood field? Zero to Three, 27(2), 50-55.
Chang, Y., & Mark, B. (2009). Antecedents of severe and nonsevere medication errors. Journal of Nursing Scholarship, 41(1), 70-78.
Crigger, N., & Meek, V. (2007). Toward a Theory of Self-Reconciliation Following Mistakes in Nursing Practice. Journal of Nursing Scholarship, 39(2), 177-183.
Duffy P, Fisher C, Munroe D (2008). “Nursing knowledge, skill, and attitudes related to evidenced based practice: Before or After Organizational Supports”. MEDSURG Nursing 17 (1): 55–60.
Ramanujam, R., Abrahamson, K., & Anderson, J. (2008). Influence of workplace demands on nurses’ perception of patient safety. Nursing & Health Sciences, 10(2), 144-150.
Sammer, C. et al. (2010). What is Patient Safety Culture? A Review of the Literature. Journal of Nursing Scholarship, 42(2), 156-165.
Schelbred, A., & Nord, R. (2007). Nurses’ experiences of drug administration errors. Journal of Advanced Nursing, 60(3), 317-324.