When indulging in tracer methodology systems, the key word is flexibility. The surveyors involve staff members through many processes of service provision. The processes include how the staff makes decisions towards the patient's safety, provision of care to patients, communication to other staff and also patients, and many other aspects. In other cases, the surveyors indulge in patients and other care recipients so as to acquire extra insights on the feedback. When the discussions with both patients and the staff are recorded, together with patient records and other observations that may have been made by the surveyors, builds a strong survey process, which provides a clear indication of the general operations of the organization. The surveyors use different tracers; these could either be individuals, system tracers, environment of care tracers or even program specific tracers (Joint Commission Resources, 2008).
In the selection of patients to conduct the survey and trace, the surveyors usually consider CGS's and other priority focus areas (PFA's) for all organizations. Mostly the PFA's are gathered through the use of PFP. The units visited depend on CSGs, which are identified in the PFP. This way the tracer is gotten, but there is also the option of using on-site surveys to get a tracer. The review happens so that those surveying get to know how care is provided, understand the process of ordering and receipt of medication and many other care-oriented procedures. The surveyor is obligated to conduct a few things in order to be successful in conducting a vigorous tracer. These include; interviewing the staff for delivery of care, treatment procedures and any other services rendered to the individual, evaluation of the PFA's, evaluation of the environment where applicable, reviewing how information is clarified and confirmed and interviewing the patient's family where applicable and appropriate, though the last conduct is not mandatory (Joint Commission Resources, 2008).
Nightingale Community Hospital
Observations on the patient tracer worksheet
The tracer worksheet records the actions that need to be considered by the staff of the hospital, all the notes made by the staff where all the deficiencies are identified, and there is also a column for tracer tips. From the results of the worksheet, the admission assessment was hardly done within the expected time of 24 hours. Actually, it was done 72 hours after admission. For the medication reconciliation, the nurse went ahead and verbalized the medication reconciliation process. The functional assessment was not documented at all. The nutritional assessment was, however, documented and hence proper recording. The nurse indicated the necessity for a social work referral, but there was no documentation as the referral was verbal. Though the patient had advance directives, the patient had not brought it with her, and despite her family being requested for it, they hardly brought it so no documentation was made. The patient was not found to be allergic and also had no issues with religious and cultural needs.
In addition, because of the patient's infection and poor nutrition, there is a possibility of skin breakdown problems. The assessment of the risk is done on admission, and the patient is put on a specialty bed. The nurse appreciates the fact that the patient is at risk of falling over, and the information is included in the handoff form. Precautions are taken as the patient is provided with slip off socks and night-lights are provided. The patient has a nursing plan, which is documented, but the records are hardly updated. The patient has undergone education, and no barriers to education have been identified so far. The patient's husband has assisted to help the patient demonstrate a central line dressing code. The discharge plan for the patient was that the patient could go home with home health being provided. Communication among different disciplines was done through interdisciplinary progress notes and 1:1. Pain assessment was at an interval of four hours. For the case of environment care, the oxygen tanks were not secured, and were found on the floor meaning no care was actually given to the equipments. The air vents were also dusty in both the patient's rooms and clean utility room. The staff hardly used "read back" procedures when describing any receipts of critical values. The identifiers, which were used before medication and blood administration, were verbalization of the patient's name and medical record.
The nurse was unable to explain and elaborate on the range order policy. The standard communication was the SBAR, especially when communicating to the MD. Before the operation/surgery, the nurse was to name the anesthesiologist, but did not. The nurses indicated that the assessment of pain during the post operation was done by analyzing the facial expressions of the patient when leaving the anesthesia. Reassessments were also conducted. The PFA's addressed included communication, assessment and care services, infection control, medication management, quality improvement, rights and ethics and finally patient safety. Recommendations for these aspects are provided in the proceeding paragraphs.
Action Plan (Inclusive of Recommendations)
The action plan addresses the common factors considered in the PFA's. These aspects have already been mentioned earlier.
Assessment and Services
The patient has to get the best care as expected, and a procedure has to be followed in a serial form. There has to be screening within the right time, followed by assessment and planning care and treatment. The provision for care, reassessment and discharge planning has to be convenient for the patient, together with the discontinuation of services and continuity of care. Most of this care has to be backed up by the right leadership of the organization, which in this case, is the Nightingale Community Hospital (Joint Commission Resources, 2007).
During communication, there has to be transfer of information between different individuals and service providers. For effectiveness, the communication strategy ahs to indulge all aspects in the healthcare organization, ranging from care provisions, patient treatment, and methods for performance improvement to quality of the services provided. It also involves the patient education, staff coordination, dissemination of information and enhancing of teamwork. The credentialed practitioners are also responsible for the implementation of the relevant communication systems and processes (Joint Communication on Accreditation Health, 2011).
For infection control, there has to be identification of the patient, and practitioners have to ensure that patients receive preventive actions, and there has to be control of the infections among all patients. The process of infection control is an integrated one, with procedures like identification, prevention and control, reporting and measurements happening to be the mandatory ones.
In case an organization provides medication to specific individuals then the organization has the obligation to ensure that the administration of medicine to clients is prompt. The managing of medication is usually multi-disciplinary, where the staff of the organization has to implement, evaluate and ensure improvement in the administration and monitoring of medication effects for the purpose of patient safety and care. The management will involve the training and educating of families and patients on the use of different medications, together with their side effects (Joint Commission Resources, 2007).
Rights and ethics of patients
The rights and ethics will always include the rights of clients and the working ethics of the healthcare organization. Both the rights and the ethics have to be narrowed down to client care. The rights include the client's right to privacy, confidentiality of information and protection of the health situation. Other rights include consent to certain procedures and various restrains. Organization ethics revolve around organization responsibilities and client care towards the patient (Joint Commission Resources, 2007).
Quality improvement and activity
This aspect identified both the interdisciplinary and collaborative approach to the recurring study and growth towards the provision of better health care. The aim of service quality is that…