Evidence Centered Patient Safety Initiative

Evidence- Based Patient Safety Initiative
Introduced in the year 2003, Transforming Care at A Bedside (TCAB) represents a national- level initiative originally formulated and headed by the IHI (Institute for Healthcare Improvement) and RWJF (Robert Wood Johnson Foundation). TCAB ensures leadership involvement at every healthcare institutional level and authorizes front- line nursing staff and other healthcare workers to contribute towards improving healthcare safety and quality on surgical- medical units, increasing nursing personnel retention and vitality, improving overall patient care team efficacy, and engaging patients and their family members to improve their care experience. The following design themes or goals – dependable, safe patient care; value added healthcare processes; vitality and collaboration; and client- focused care – form the elementary framework when it comes to formulation of changes for accomplishing TCAB objectives (Rutherford, Moen & Taylor, 2009).
A number of elements set TCAB apart from other programs targeted at improving quality. Firstly, TCAB attempts at engaging frontline healthcare employees’ and unit heads’ minds and hearts when it comes to care process improvement. With TCAB, novel ideas to transform how care is provided do not merely arise from hospital managers or members of quality improvement units; rather, frontline nursing staff and other healthcare workers who spend maximum time with the patients and family members also provide input. Furthermore, TCAB promotes transformative change. Frontline employees and organizational leaders challenge and prove theories, engage in critical reflection upon personal experiences, and come up with novel models and views. Lastly, TCAB stresses on ongoing discovery and learning. Units test novel theories and constantly attempt to bring about improvements to care processes, learning the method to achieve desired outcomes (Rutherford et al, 2009).
Aged individuals typically display multifaceted clinical and psychiatric requirements, necessitating input from multiple medical disciplines and specialties. Interdisciplinary experts’ participation ensures patients have access to more expertise as compared to that offered by a single clinician. But it has been linked to major challenges in the areas of healthcare integration and coordination. Though the principle of delivering effectively- coordinated interdisciplinary care to aged patients suffering from medical and psychiatric conditions is approved of and supported, it has also been acknowledged that realizing it is difficult and usually inadequate (American Psychiatric Association, 2009).
Though major service provision- related problems and challenges prevail, several noteworthy programs and efforts have been initiated for dealing with them. These include attempts at promoting collaboration in supportive and mental health service delivery; consumer advocacy group organization; supporting studies focusing on aged individuals suffering from mental health conditions; increasing public knowledge of psychiatric/psychological problems; and expanding and better educating geriatric mental healthcare workers. These endeavors offer a sound basis for tackling key challenges pertaining to aged persons’ mental health. The steps that follow serve as the groundwork for the project: determination and dissemination of important policy and initiative- related problems; performance of key research works; creation of clinical practice guidelines; and the organization of local, state and national coalitions and geriatric consumer groups. Several attempts have been backed and implemented using funding from local, state, and national governments and foundations (Department of Health and Human Services Administration on Aging, 2001).
Intervention for Patient Safety
Numerous single interventions exist that have the potential to arrest certain adverse events’ progress, thereby reducing harm. But experience reveals that clinical system reliability and safety improvements call for action at several levels. Thus, for making real progress with regard to improving mental health patient care safety within hospital settings, one will probably require complex interventional packages as opposed to distinct steps. A prior complex conceptual system may be easily applicable to the problem, taking into account the following 7 safety levels: task factors, patient/client factors, staff or individual factors, organizational context factors, environmental factors, institutional factors, and team factors (George, Long & Vincent, 2013):
Task factors. Patient safety is reliant on well- defined, rigorous task design as well as protocol access and utility and requisite patient- connected information. It is imperative to take note of and work on the latest growing tendency of including more aged and frail patients within clinical trials, for developing a sounder evidence pool for optimal patient health management. Increased employment of centralized EHRs (electronic health records) with multiple healthcare stakeholders having access to relevant patient details potentially hard to procure in the initial acute hospitalization stages will improve psychiatric patient safety as well.
Patient/client factors. The golden practice standard at staff and patient levels is the National Mental Issues Strategy (NMIS)- promoted ‘patient- focused strategy’. This involves valuing individuals suffering from mental health problems, cultivating a positive climate for them, regarding them as an individual, and viewing care systems from their standpoint. Respecting patients, showing empathy, and cultivating a suitable environment for them contributes positively to both quality and safety. Hospitals often tend to over- stress mental ailments’ medical components as compared to their psychological and emotional elements. A large number of elements of the complex, delirium- specific ‘Inouyes’ intervention concentrate on the above patient factors. In simple terms, those ailing from mental health problems exhibit far lower likelihood of becoming delirious in the event their care gets directed to aiding them in seeing what they do and hearing what goes on around them, moving around, eating/drinking enough, and getting adequate sleep, within an environment in which individuals talk to them and make them aware of what is happening.
Staff or individual factors. Staff qualities, conduct and competencies which have demonstrated their ability to improve patient safety prove especially vital in mental health patient care and ought to be developed as well as promoted. Communication skills prove especially crucial; training on distinct ways whereby people may efficiently interact with those suffering from cognitive impairments for gaining accurate information, identifying issues and formulating personalized management decisions and plans ought to be made common practice.
Organizational context factors. A fair amount of research evidence reveals that organizational culture improves geriatric care outcomes. The success of any safety program, perhaps, requires organization- wide promotion with the involvement of leaders at the clinical as well as board levels. Clearly, an increasingly broader social appreciation exists of the fact that seeing to vulnerable aged individuals’ needs ought to be prioritized. NMIS implementation and the appointment of Hospital Clinical Leads (HCLs) is a timely intervention. But establishing national- level emergency care targets may, at times, divert resources and time from focusing on relationship and communication improvements to improving mental health patient care.
Environmental factors. Mortality rates may decline through bringing about improvements in hospital environments for mental health patients, improving care quality, and enhancing patient and carer satisfaction. Increasing research works address the practical facets of care environment design for enhancing safety of mental health patients and the part played by the environment when it comes to psychiatric conditions.
Institutional factors. A commonly recommended resolution of the issue of caring for mental health patients within acute healthcare contexts is increasing nurse staffing in wards. While highly acceptable, this strategy will probably not work in isolation if organizations fail to simultaneously increase education and training, and alter acute care service organization. Evidence exists of improvement in outcomes owing to improvements in patient care organization through employing specialized practitioner teams. Examples of creative ways to transform systems and improve care provision to weak elderly individuals include developing Acute Care of the Elderly Units that concentrate on inclusive geriatric evaluation and complex mental condition prevention. The discrete development of acute and psychiatric healthcare facilities, typically on discrete sites, may be considered a historical accident. Constructing joint psychiatric/geriatric wards for combining expertise and improving management of mental health patients may prove valuable.
Team factors. Proofs of team factors’ contribution to improvements in mental healthcare quality and safety deals with efficient multidisciplinary evaluation and in- depth geriatric evaluation that brings about improvements in mortality and every other outcome. Paradoxically, mental health patients have, on occasion, been considered to be lacking rehabilitation potential though they can benefit the most from multidisciplinary, problem- solving strategies. Staffing pressures and time constitute key obstacles to effective teamwork.
The intervention put forward will succeed in case of aged psychiatric patients due to the fact that it covers elements which would improve geriatric patient safety. The improvement model, which encompasses the PDSA cycle, would guide TCAB efforts of nursing practitioners and the remaining frontline healthcare workers. They will volunteer and test ideas for practice/process change, measure outcomes, amend models if required, retest amended changes, and implement successful change all through their units. Subsequently, participants will aid with dissemination of effective changes across other healthcare units. The following points summarize outcome measures which may be assessed:
· Dependable, safe care: Daily fall frequency linked to moderate- to- severe injury may be the measure monitored here.
· Collaboration and validity: Here, the outcome measure used may be voluntary nursing staff turnover.
· Value- added healthcare processes: In this case, the outcome measure may be the time devoted by nursing staff in direct care delivery.
· Client- focused care: Patient satisfaction evaluation may be founded on how willing they are to recommend a given healthcare organization to kith and kin. A second client- focused care outcome measure could be rate of re- hospitalization within a month of discharge (Rutherford et al, 2009).
Elderly patients are much more susceptible to AEs (adverse events, whether preventable or not) when hospitalized than younger ones (Merten et al. 2013, Long et al. 2013, Thornlow 2009, Soop et al. 2009, Kable et al. 2008, Brennan et al. 1991). Literature identifies numerous potential preventable AE predictors specific to the geriatric population. Knowledge of these predictors can help healthcare workers within hospital settings in identifying highly- vulnerable elderly patients and adopting preventive measures wherever possible (Steeg, 2016).
Inpatient care ought to be offered under a care continuum, with aged individuals only being shifted between units after spotting clear admission indications; also, whenever possible, the hospitalization environments ought to be suited to geriatric population needs. This must encompass opportunities of functional patient separation in case of patients having highly dissimilar care needs (for instance, frail patients and patients depicting major behavioral disturbances). I will ensure multidisciplinary staffing, equipped with specialized skills as well as provided with leaders possessing specialized competences in the area of geriatric mental healthcare provision. Inpatient consultation- link mental healthcare services for geriatric populations suffering from mental ailments within general hospital units may improve their QOL (quality of life), decrease hospitalization duration, and improve healthcare costs, on the whole (McKay & Casey, 2015). Institutional leaders must implement efficient strategies for accelerating the dissemination of creative ideas and effective change from pilot department to other healthcare system or institutional sites. The heads of healthcare facilities taking part in the venture ought to pledge requisite resources to support and sustain TCAB- connected innovations, for ensuring permanent incorporation of innovations into the institution’s way of working on surgical- medical units. Hospital heads need to accept the responsibility of spreading effective TCAB practices across the entire organization (Rutherford et al, 2009).


References
American Psychiatric Association. (2009). Integrated care of older adults with mental disorders. Retrieved from https://www.psychiatry.org/.../Psychiatrists/Directories/.../rd2009_IntegratedCare.pdf
Brennan, T. A., Leape, L. L., Laird, N. M., Hebert, L., Localio, A. R., & Lawthers, A. G. (1991). Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. N Engl J Med, 324(6), 370-376.
Department of Health and Human Services Administration on Aging. (2001). Older adults and mental health: Issues and opportunities. Retrieved from https://www.public-health.uiowa.edu/icmha/training/documents/Older-Adults-and-Mental-Health-2001.pdf
George, J., Long, S., & Vincent, C. (2013). How can we keep patients with dementia safe in our acute hospitals? A review of challenges and solutions. J R Soc Med, 106(9), 355-361.
Kable, A., Gibberd, R., & Spigelman, A. (2008). Predictors of adverse events in surgical admissions in Australia. Int J Qual Health Care, 20(6), 406-411
Long, S. J., Brown, K. F., Ames, D., & Vincent, C. (2013). What is known about adverse events in older medical hospital inpatients? A systematic review of the literature. Int J Qual Health Care, 25(5):542-54.
McKay, R., & Casey, J. (2015). Psychiatry services for older people. Retrieved from https://www.ranzcp.org/Files/Resources/Reports/RPT-FPOA-Psychiatry-services-for-older-people-revi.aspx
Merten, H., Zegers, M., De Bruijne, M. C., & Wagner, C. (2013). Scale, nature, preventability and causes of adverse events in hospitalised older patients. Age Ageing, 42(1), 87- 93.
Rutherford, P., Moen, R., & Taylor, J. (2009). TCAB: The how and the what. AJN, 109(11). Retrieved from http://forces4quality.org/af4q/download-document/3571/Resource-TCAB__The__How__and_the__What_.3.pdf
Soop, M., Fryksmark, U., Koster, M., & Haglund, B. (2009). The incidence of adverse events in Swedish hospitals: a retrospective medical record review study. Int J Quality Health Care, 21(4), 285-291.
Steeg, L. (2016). Improving safety and quality of care for older hospitalized patients A mixed methods approach focusing on delirium and e-learning. Retrieved from https://www.nivel.nl/sites/default/files/bestanden/Proefschrift_improving_safety_quality_care_older_Steeg.pdf
Thornlow, D. K. (2009). Increased risk for patient safety incidents in hospitalized older patients. Medsurg Nurs, 18(5), 287-291.