Accreditation Audit

NPA spells out any formal action the board may take, and it usually requires clear convincing evidence

Nightingale Community Hospital identified a recent sentinel event involving the ambulatory surgical center. A sentinel event is defined as an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof (http://www.jointcommission.org/sentinel_event). A three year old female presented to the hospital on September 14th for a planned outpatient procedure. The child was accompanied by her mother. The mother registered the patient with the registrar prior to the procedure. The patient and her mother went to the pre-operative area to complete the informed consent and the necessary physical assessment. The pre-operative nurse obtained the necessary contact

During procedure nurse is usually passing instruments, making sure equipment is set up and ready to go, assisting with taking radiographs, taking care about patient’s escort during taking radiographs, making sure patient is comfortable and calm, processing x-rays, also working length have to be recorded in the patient notes either paper or digital or both

Several errors and hazards can be identified as possible factors leading to the sentinel event. The ER appeared to be terribly understaffed that day with only one ER physician, one RN, one LPN, and a secretary.

Before a procedure begins, the nurse anesthetist will discuss with a patient any medications the patient is taking as well as any allergies or illnesses the patient may have. This must be done so anesthesia can be safely administered. Nurse anesthetists then give a patient general anesthesia to put the patient to sleep so they feel no pain during surgery or they may administer a regional

3) Surgeon: Was directly involved in the events leading up to the sentinel event. The surgeon was responsible for all activities taking place in the surgical suite and directly related to the surgery of the pediatric patient. The surgery was completed safely and successfully; however, the surgeon had relevant information in the patient chart at his office yet did not share this information with the hospital. He also did not supply an appropriate or accurate H&P that would have included custodial status for the pediatric patient to the hospital. The surgeon is greatly concerned in the events that lead to the sentinel event and wants to ensure that his patients will be cared for and safe at Nightingale Community Hospital.

Patient satisfaction is a big nursing-sensitive indicator that has a lot of room for improvement within this patient scenario. Patient satisfaction can also refer to patient’s family satisfaction in most cases because they are both the customer. The certified nursing assistant taking care of Mr. J could have approached the daughters concerns in a more appropriate and professional manner. She could have begun by validating the daughters concerns followed by notifying the RN, who in turn could have implemented certain interventions to prevent further harm. Honesty and better communication could have resulted in improved patient satisfaction in the last part of this scenario. If the staff would have been honest with Mr. J’s daughter by communicating the mistake and given her an action plan as to what they are going to do in order to never allow this to happen again, she may not have complained to the hospital administration. Nursing can improve patient safety and outcomes by better understanding and incorporating nursing-sensitive indicators such as restraint prevalence,

a. Have all employees sign an acknowledgement form that they understand the new policy and corresponding procedures, and received training within 14 days of establishment of the new policy

Communication, this is the key focus area that is evaluated in this summary. Communication is a key focus area of the joint commission audit and is also a key area in which Nightingale Community can make enhancements. Communications must be a two way free flow of information. The information exchanges occur between providers, staff, and patients or clients. This was an area that needed improvement was noted in the previous accreditation audit. Some noted prior issues from 2 years ago included patient and family education and information not being properly disseminated to the nursing staff. These are areas where we have targeted and currently meet. Some areas that we continue to work on are as follows.

VASNHS Surgical Specialty Outpatient department has a designated pre-operative management unit that oversees the patients undergoing surgery. The predicaments stem from various guidelines or protocol originating from numerous surgeons and clinics. At present, the pre-operative nurses abide simple pre-op instructions (NPO protocol, medications, what to bring, during the surgery, transportation, cancellation instructions) for the entire Surgical Specialty Outpatient department. Surgical procedures are being canceled due to lack of communications and cancelations of patients prior to surgery date.

As defined by the Joint Commission (2014) a sentinel event is an unexpected occurrence involving death, or serious physical, psychological injury, or the risk thereof. With this said Nightingale community Hospital recently experienced a sentinel event

5. The Patient Safety Officer will train the risk assessment team members on the proactive risk assessment process and how to conduct a proactive risk assessment, including the assessment of risk, itself.

" The environment surrounding registered nurses (RNs) has been described as a fast-paced and unpredictable, and nurses' cognitive load as exceptionally heavy" Kalisch& Aebersold, M. (2010). The Pre/Post Op is a fast-paced unit where the nurse has 30-45 minutes to get the patients ready for the surgery. During this limited time my preceptor has to get vital signs, some medical history, IV assessment, get the patient consent, check his/her medication, pregnancy test if a female (18-54), check potassium level and answer the patients or family member questions. Moreover, there is kind of interruption when the nurse anesthetist and anesthesiology have to step in and do their assessment.

First everyone had to put on a mask, wear surgical head covers, proper scrubs, and shoe covers. Inside the operation room, the surgeon and scrub tech had to put on a sterile attire, which included sterile scrubs,gloves, and equipment because they were the first people to have contact with patient. The circulator or documenting nurse and anesthesiologist were around the sterile field (aseptic technique) without any contact with the patient whatsoever. As you would have guessed, the surgeon was the one who performed the surgery with the help of the scrub tech and monitored by the circulator nurse and anesthesiologist. The main duties of the circulator nurse was to document everything during the surgery from what medications used to how many sterile dressings were used, proving supplies to the surgeon and the scrub tech as needed,and making sure the room was prepare for the assigned surgery. This nurse also provides conform measurements for the patient while in the operation room. For instance, there was a patient who was too big for the operation bed, so the circulator nurse had to find additional supplies that would prevent the patient from sliding down the bed. Nurses always provide the finest education towards their line of duty but also take the time to teach those people who starting the nursing

The Occupational Outlook Handbook (January 8, 2014) describes how medical-surgical nurses provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients and their family members (“Registered Nurses,” para. 2). The interviewed medical-surgical nurse, Carolina Rojas, stated how takes care of patients who come into the hospital with serious surgical procedures. She normally, “...assesses a patient from head to toe, finds the issue, takes inventory of the patient, coordinates the care between the different doctors and other healthcare workers needed, and makes sure that I follow the orders of the doctors and healthcare providers” (Rojas 2015). This being said, medical-surgical nurses must often use