Challenges for Patient Care in Acute Wards

Ch every(prenominal)enges for Patient C atomic number 18 in Acute WardsIt whitethorn seem a strange principle to enunciate as the in truth first requirement in a hospital that it should do the charnel no slander nightingale F (1863)With this statement in mind, light upon the study problems for hospitalised diligents in acute wards, in the twenty first century. For individually problem identified treat the role of suck ins in maintaining the condom, health and eudaemonia of unhurrieds.IntroductionHospitals of today atomic number 18 indeed a far holler from the hospitals of the era of Florence Nightingale in very m all respects, scarcely the direct principles of aspiring to be a safe and healing ingestn for the disquieted go offly need not changed over the years. One of Nightingales major crusades was the constant battle against infection which was rife in the wards of her day.To that extent, her mantra continues with the problems that iatrogenic infections get along in todays hospitals. It is worthy of note in passing, that Nightingale is credited with popularising the statistical analysis of problems. Her famous chart (Playfair 1847) that match the decimation of Napoleons army by disease as it pass on and and then retreated from Moscow, was a milest oneness in the arguments that she was advancing in the dangers of potential of communicable diseases in crowded environments.The title of this essay refers to Florence Nightingales famous remark which implied that in her day there was a real possibility of hospitals harming patients. Her remark, albeit made to address a adept customary health problem of the mid nineteenth century, has a resonance which is some(prenominal)(prenominal) deeper and more signifi providet than would first appear on face value. Her interpretation is affectually a paraphrase of a quote from Hippocrates some two millennia earlier in his exhortation to aspiring physicians, If you argon to become a physician, adopt the first rule that whatever else, you go forth do no harm. (Carrick 2000)The significance of this is that even two thousand years after the principle was first enunciated, it was palliate lived that healthcare professionals, whilst employing their best endeavours to bring to patients, were still able to inflict significant morbidity and even mortality on their patients.The main shake off of this essay is to demonstrate that even with the charge of a further one hundred and fifty years, it is arguable that the said(prenominal) premise holds good today. It is undoubtedly true that the advances in medicine and engineering generally render changed the perspectives and horizons far beyond those that Nightingale would have recognised, but this has done little more than to simply change the nature and display case of problem that healthcare professionals have to deal with. Iatrogenic morbidity is still a significant fact of life in our modern healthcare practice. (Sugarman S ulmasy 2001)The accredited work by Semmelweis (at ab extinct the similar time as Nightingale ) in the 1850s, (Semmelweis 1861) made major inroads into our knowledge of the transmission of pathogens well-nigh wards. This work was augmented by Lister and other(a)s with their work on asepsis and antisepsis. (Birte Twisselmann 2003). Over the intervening years this has been translated into Nursing practice on the wards by a multitude of protocols at both local and national levels. guile little hand washing among patient contact, is still regarded as one of the most expe fracturent ways of reducing cross contamination between patients, but is sadly still frequently overlooked as both a nuisance and even a hindrance when in a clinical situation. Some of the more recent National unravellines are encapsulated in the Government White Paper New Guidelines to cleaner hospitals published in 2004. This has been augmented by a statement to the House of honey oil by John Reid who has announc ed targets of cutting MRSA infection by 50% of new levels by 2008 (Reid 2004)One cannot work in the current healthcare ground and not be aware of the high profile that MRSA has attracted. Some may say that its profile is disproportionately large when compared to many of the other iatrogenic problems that would come under the umbrella of Nightingales original statement. The fact of the matter is that it is not solo a matter of patient morbidity and mortality, but it is also a matter of economic common sense as well.A recent study commissioned by the department of Health (Public Accounts Committee 2000) concluded that Healthcare Associated sullyions (HCAIs) are currently running game in excess of 8% of all acute hospital admissions in the UK. The economic cost is further expanded by the fact that a HCAI has the ability to delay discharge dates and thereby increase inpatient costs.The homogeneous study also concluded that For the NHS in England this represents 3.6 zillion bed age lost, with a projected cost of 1 billion a year. and then went on to observe that Implementation of all the measures suggested by the NPSA would release 147 million and save about 450 lives once target compliance rates have been met.We have commented on local chess openings and quote as an example the expansive project that has been run at local level through and throughout the awkward which seeks to apply render- aboded guidelines locally for the reduction of various healthcare associated infections. (Pratt et al 2001)When reckoning any significant healthcare issue, one should always reflect upon the evidence base that is available to assess ones own position on the subject (Gibbs, G 1988). Publications in peer-reviewed journals are perhaps one major plank in this evidence base. One must(prenominal) always be alert to differentiate between the weight to be placed upon the evidence in this type of publication when compared to others much(prenominal) as Government pronoun cements, bulletins and circulars, unless they are attributed and most are not and can therefore be affirm.On the issue of patient cross contamination and handwashing we would commend the excellent hug drug de force by Boyce Pittet (2002)In current nursing practice we can see the modern consequences of many initiatives aimed at reducing the cross-patient spread of infection. The teemingness of near-patient handwashing facilities (Donowitz 1997) and antiseptic soap dispensers (Graham 1990) is a testament to this fact as are the modern trend to single use equipment, dressings and aprons etc.The provision of much(prenominal) facilities are, by themselves, not totally effective as many studies have shown that there is an inherent resistance from some staff to measures as frank as handwashing (Teare 1999) and that additional measures such as poster campaigns and staff lectures pretend only transient behaviour changes(Kretzer et al. 1998)Another area where there is the clear potent ial to do harm to patients is the whole area of patient identification. Patients in hospital have investigations and treatments that are potentially dangerous. One hopes that for separately preventative a balance sheet has been drawn up, which weighs the potential hazards against the potential gains for for each one procedure. This is fine as long as the procedure is performed on the remunerate patient. If the wrong patient is identified for the procedure then it can have disastrous implications. (Williamson et al.1999)To give a specific example. Let us consider the case of railway line race transfusion. This is a very common procedure in our hospitals with many thousands of units of blood being transfused on a daily basis. condescension stringent protocols and guidelines in one typical year there were 197 serious adverse incidents resulting from incorrect patient identification, this included 42 cases of major morbidity and two deaths. (Mayor 1999)To combat this specific pr oblem (and to illustrate our argument) National guidelines for transfusion protocols have now been advised and should be implemented in all NHS hospitalsThe patients identity should be verified by two members of staff unitedlyThe identification should be carried out at the patients bedsideThe identity and quality of the blood pack and the prescription should be formally verifiedThe patients identity should be confirmed verballyThe patients identity band should be formally verifiedThe patients blood pressure, pulse, and temperature should be taken before and at regular intervals during the transfusion (as detailed in the committees get over)(Clarke et al. 2001).Many obtains reading this may think that this is already normal procedure and yet studies have shown that patient identification checks were carried out in only 63% of cases 46% verbally and only 60% against their wrist bands. Even more worryingly, only 25% of transfusion cases had their full of life signs recorded contem poraneously. (Clarke et al. 2001).Although we have used this particular situation to illustrate the potential ramifications of patient mis-identification (or simply poor practice), there are clearly countless other situations where patients are at risk. A typical ward nurse will know the majority of the patients on her ward. The majority of the medical and running(a) healthcare professionals will not. (Savulesuc et al. 1998). It follows therefore, that the ward nurse is ideally placed to wander if the patient who is being dispatched to the anaesthetic room is the right one for the mathematical process or appropriate procedure. In this respect the concept of patient protagonism falls heavily on the nurse.This argument can be broadened further. The majority of medical staff (by virtue of pressure of work and time), can only spend a short time discussing each case with each patient. The ward nurse will typically have longer to discuss wider issues with the patient and may therefor e be able to elicit or discover relevant facts which have not been discovered of recorded by the medical staff. The nurse is therefore again ideally placed to act as an advocate for the patient to ensure that relevant facts are brought to the worry of those who need to know (Bryant 2005).An example might be that a patient had not discussed particular religious beliefs or points of view with the doctor which the nurse may subsequently become aware of. (Kuhse Singer 2001).Here then, is the thrust of Nightingales message. Hospitals are places that are (generally) full of healthcare professionals who are intent on providing a good professional service for their patients. In the pursuit of that aim they have to employ technologies, medicines and techniques that have the ability to cause harm. This harm can occur through chance, calculated risk or just bad luck, but equally it can occur through bad practice lack of communication or sloppy procedure. It is the last mentioned that the nu rse is ideally placed to counter. Professionalism demands that the nurse should speak up whenever such eventualities are discovered. In doing so they can very much save accidents, hapless events or even disasters from occurring. If all members of the healthcare team follow the same mantra then Nightingales edict will become less relevant. (Veitch 2002)Having said that, it is not a situation where complacency can be allowed any room at all. The healthcare services are extremely complex organisations requiring the combined efforts of many thousands of individuals. The potential for mistakes is therefore enormous. One must always bear in mind that the nurse is generally long-familiar with the workings and procedures of the health service whereas the patient generally is not. The patient will typically accept on trust what he is asked to do and call down to, without the background knowledge of whether it is actually appropriate to his particular case. It is this basis that is often the scenario for avoidable incidents where harm is done to patients. The nurse must be forever and a day vigilant for the potential for mistakes in order to minimise the potential for harm coming to the patients in their charge.ReferencesBirte Twisselmann (2003) The Discovery of the Germ BMJ, Jul 2003 327 57.Boyce JM Pittet D. (2002)Guidelines for hand hygiene in Healthcare settingsHMSO Oct 25 2002 / 51 (RR 16) 1-44Bryant P 2005 None so ingenuous as the well meaning BMJ, Jan 2005 330 263Carrick P 2000Medical Ethics in the Ancient WorldGeorgetown University press 2000 ISBN 0878408495Clark P. Iain Rennie, and Sam Rawlinson 2001 Quality improvement report Effect of a formal education programme on safety of transfusions BMJ, Nov 2001 323 1118 1120.Donowitz LG. (1997)Handwashing technique in a paediatric intensive care unit.Am J Dis Child 1997 1416835.Gibbs, G (1988)Learning by doing A guide to Teaching and Learning methods EMU Oxford Brookes University, Oxford. 1988Graham M. (1990)F requency and duration of handwashing in an intensive care unit.Am J Infect Control 1990 187780.Kretzer EK, Larson EL. (1998)Behavioural interventions to improve infection gibe practices.Am J Infect Control 1998 2624553.Kuhse Singer 2001A companion to bioethicsISBN 063123019X Pub get out 05 July 2001Mayor S 1999 Review calls for improved patient identification systems for blood BMJ, Mar 1999 318 692.New guidelines to cleaner hospitals 2004NHS DirectiveHMSO, Tuesday 7 December 2004Playfair, William 1847The statistical Breviary,British Museum London, 1847Pratt RJ, Pellowe C, Loveday HP, Robinson N, Smith GW and the epic guideline development team Barrett S, Davey P, Loveday C, McDougall C, Mulhall A, Privett S, Smales C, Taylor L, Weller B and Wilcox M. (2001).The epic Project Developing National Evidence-based Guidelines for preventing Healthcare Associated Infections, Phase 1 Guidelines for preventing Hospital-Acquired Infections.J Hospital Infection 47 (suppl) S1-S82.Public Accou nts Committee.2000The management and control of hospital acquired infection in acute NHS Trusts in England (HC 306),HMSO House of Commons 2000. ISBN 0102695008Reid. Dr John, 2004Sec. Of State for HealthHansard Dec 10th 2004Savulescu J. , Rachel Marsden, Tony Hope, Michael Saunders, Ruth Carlyle, Pippa Gough, and George J Annas 1998 honourable debate Sex, drugs, and the invasion of privacy Respect for privacy and the case of Mr K exposition Hospital can never be home Commentary Silence may be the best advocacy Commentary Nurses should recognise patients rights to autonomy Commentary Patients should have privacy as long as they do not harm themselves or others BMJ, Mar 1998 316 921 924.Semmelweis IP. (1861)Die aetiologie, der begriff und die prophylaxis des kindbettfiebers. Pest, Wien und Leipzig CA Hartlebens Verlags-Expedition 1861.Sugarman J Sulmasy 2001Methods in Medical EthicsGeorgetown Univeristy put forward 2001 ISBN 0878408738Teare L, (1999)Handwashing Liaison Group. Hand washing a modest measurewith big effects.Br Med J 1999 318686.Veitch RM 2002Cross-cultural perspectives in medical ethicsJones Bartlett 2002 ISBN 0763713325Williamson, S Lowe, E M Love, H Cohen, K Soldan, D B L McClelland, P Skacel, and J A J Barbara 1999 Serious hazards of transfusion (SHOT) initiative analysis of the first two annual reports BMJ, Jul 1999 319 16 19.************************************************************************************************ 31.8.05 PDG.Word face 2,592