Risk management in nursing facilities: communication, infection, and falls

Risk and Quality Management Assessment

This analysis focuses on three different types of risks that are commonly associated with a nursing facility.

Risk and quality management is an important aspect to many health care organizations. This is especially true in nursing facilities because of the level of direct patient interactions that occur on a daily basis. There are many potential risks that can emerge and a nursing facility. Three common risks were identified and introduced. One common risk deals with inadequate or ineffective communication and the problems associated with it such as medication errors. Another risk identified was the spread of infections in a hospital setting. The third risk identified was the risk associated with patient falls that are common and especially damaging to elderly patients. Organizations who properly plan for this risks can effectively improve their quality of care and provide an enriched healthcare experience to their patients.

Communication & Medication Error

One obvious nursing related risk that is prevalent in every organization is medication errors. Nurses have hectic schedules that often require them to multi-task. Therefore a common mistake is for them to somehow mix up a patience medication with another patients, provide medication at the wrong time, or skip a medication altogether. This can either be the responsibility of the nurse or a breakdown in communication by the nursing staff. Therefore it is important to design a quality management system in regards to this risk that has multiple checks to ensure that the medication is correct as well as being properly administered. It is really easy to make mistakes once in a while; therefore there must be a stringent system to eliminate the potential for errors in administering medications.

The quality management system that has developed in known as the bedside handoff in which the staff communicates together at the patient's location. Such an organizational strategy has proven effective in different situations and has most likely saved many lives (Federwisch, 2007). One of the primary advantages to this system is that it allows the hospital staff a better perspective of the patients treatment needs. It fosters improved communication that can decrease the likelihood of common errors such as medication errors. It allows the nursing staff to acquire a comprehensive overview of the patients status and prevents a staff member from "dropping the baton" during a shift change. Not only does it improve the quality of care that is provided, it also can improve communication and the way our team in general interacts on a daily basis.

Hospital Falls

Another common risk is fall-related injuries which can be some of the most common, disabling, and expensive health conditions encountered by adults; especially older adults (Simmons, 2010). There are specific risk factors that this type of risk that included factors such as environmental hazards, adaptive equipment maintenance, psychotropic drug use, physical therapy or exercise, staff education, post fall problem solving, and hip protectors (Colon-Emeric, et al., 2006). One study analyzed two wards that had implemented the Grol's five step implementation model for reducing falls with an aim of a reduction of thirty percent in fall incidence within a year (Semin-Goossens, van der Helm, & Bossuyt, 2003). Data on falls were extracted from nursing records and Incidence Report Forms (IRFs). Despite the implementation of quality management systems, the researchers found no durable decrease in monthly falls despite the use of a model-based procedure for implementing change nor did they observe any improvement in filling in IRFs. This makes the risk of falls a difficult factor to manage in a nursing setting.

Other research studies have provided similar results. Another evaluation of a quality improvement ad hoc multifaceted program was institutes in the attempt to improve structure, professional behavior, and outcomes related to falls prevention researchers studied a nursing home in Spain after a specific intervention to improve the incident rate (Zenewton, Medina-Mirapeix, & Pedro, 2011). A reliable evidence based approach was used to collect data in the study and the researchers found that despite a multifaceted approach and the baseline level of factors that are commonly known to lead to falls improving with the intervention, that the actual incident rate and adherence to the evidence-based recommendations were poor in their setting. However, the researchers found that the internal quality improvement measure was somewhat effective in ensuring safe practices which would likely provide better outcomes in a study of a longer timeframe.

Another study used thirty six participating community nursing homes also well as data from over three hundred nonparticipating nursing homes for a control measure in a data set to describe the changes in process of care before and after an evidence-based fall reduction quality improvement collaborative in nursing facilities (Colon-Emeric, et al., 2006). The data in this study found that even though many of the risk factors associated with falls were significantly reduced that the actual outcome of the post intervention fall rates were not significantly different than the control group. However, the group was able to make modest improvements in screening, as well as risk factor reduction, medication assessments, and significantly increase vitamin D prescriptions, decrease sedative-hypnotics, as well as tackle some environmental issues (Colon-Emeric, et al., 2006). However, this serves as yet another example of how quality improvement programs may still not have a significant impact on health outcomes.

Conclusion

Some common risks in nursing facility care were identified as communication or medication errors, risks associated with infection, and risks relating to patient falls were identified. These risks highlight the need for quality assurance measures. In regard to patient falls, even quality improvement programs may not have a significant effect on the patient health outcomes which illustrates the need for even further improvement. Many of these risks cannot be completely eliminated which requires that a risk management plan include a response to the emergence of the risk in order to help mitigate its effects.