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Saturday, January 17, 2009

Patient Safety

Patient safety is a current issue in medical service that most pressing health care challenges to give professional services. It is a responsibility for each health care in hospital. According KKP-RS (Yahya, Adib, 2006) patient safety is a system ini hospital to create the patient care most be secure. This system make serious efforts to prevent patient injury that caused by mistake of intervention or nothing intervention to take by a good right.

There are something that concerned with patient safety: risk assesment, identification and managing case that concerned with patient risk, report and incident analisis, capability to learn and follow up from the incident , and implementation of solution to minimalized at risk. Condition that concerned with patient safety, are there:

  • Near Miss

A situation in which a patient had a narrow escape from a serious complication

( National Steering Committee on Patient safety in Canadian Health Care ,2002)

  • Adverse Event

    An unintended injury or complication that results disability at the time of discharge, death or prolonged hospital stay and that is caused by health care management rather than by patient's underlying disease process ( Baker et al. 2004)

  • Nursing error

    The failure of a planned action to be completed as intended or the use of wrong plan to achieve an aim ( Reason, 1990)

  • In nursing care, those condition may be present and happened a patient oftentimes, although not always caused by nurse. In this matter can be happen by condition in wards and/ or system applies in the hospital. The condition hospital can affected error of care are a lot of patient number, limited of nurse, condition of patient care ( total care), planning of a doctor and laboratorium or radiology examination.

    Yale University School of Medicine make a study evaluation to 18.473 patient in recovery room. As the result showed general average complication at patient is 26,7%. The complication after anestesi around 23,7% and than 5,1% complication at intraoperative (Tilton, 2002).

    Research by Tessler & Covert (1999), from 335 inpatient showed 76 % patient late transfer to wards , 26% waiting 30 minutes before transfer, and 28 % not ready to transfer so bringing on patient LOS (lange of stay) is long.

    In nursing areas, patient safety dependent on individu competence to give professional service and effective health system. Canadian Health Care supported this case, that explain realization of patient safety is accountability of registered nurse and other health care.

    In Indonesia, to realization patient safety will be done national movement " Hospital Patient Safety" and to make Hospital Patient Safety Committee (KKP-RS) whit the vision to improve patient safety and quality hospital services, and than mission of this committee are develop standart of patient safety based on research and knowledge, collaboration with multiple institute that a purpose to improve patient safety and quality of hospital service

    Organitation that concerned with patient safety are:

    • AHRQ: Agency for Healthcare Research and Quality (http://www.ahrq.gov/)
    • JCAHO: Joint Comm.On Accreditation for Healthcare Organization
    • APSF:Australian Patient Safety Foundation Inc. ( 1989)NSCPS: National Steering Committee on Patient Safety ( Canada)
    • ACEN:Academy of Canadian Executive Nurses

    Evidence-based nursing as the foundation for professional nursing practice. Evidence-based practice has become a prominent issue in international health care. Rising health costs, the management principle of doing things right and the desire for quality improvement have created a climate for the evolution of evidence-based health care (Rycroft-Malone, Bucknall, Melnyk, 2004)

    "The aim of evidence-based practice is to reduce wide variations in individual clinicians' practices, eliminating worst practices and enhancing best practices, thereby reducing costs and improving quality" (Tanner, 1999).

    "Evidence Based Nursing is the process by which nurses make clinical decisions using the best available research evidence, their clinical expertise and patient preferences". Three areas of research competence are: interpreting and using research, evaluating practice, and conducting research. These three competencies are important to EBN. (http//evidence.ahc.umn.edu/ebn.htm)

    Nursing intervention is planning of implementation nursing intervention that make by a nurse to help finishing of patient problems.. intervention in order of goal will be arrived. The nurse needs equal of intellectual capability and knowledge to determine a good nursing intervention to finishing a problem of patient that related with health. PICO method is a one of the alternative to make appropriate nursing intervention.

    Structuring A Question

    • PICO Method
      • P= patient/problem
        • What are you trying to address
        • Does gender/age influence clinical care
      • I=Intervention
        • What will you do for the patient?
        • Drugs, surgery, diet, exercise
      • C=Comparison
        • Alternatives to your chosen intervention?
        • Against other interventions, gold standard, or no treatment
      • O=Outcome
        • What will be improved for the patient?
        • Less risk of fracture, fewer hospitalizations, etc

    Bibiliography

    1. ACP Journal Club 1996 Nov-Dec;125:A14–6.
    2. Cochrane, A. (1976). Effectiveness and Efficiency. London: The Nuffield Trust.
    3. Estabrooks, C. A. (1998). Will evidence-based nursing practice make practice perfect? Can J Nurs Res, 30(1), 15-36.
    4. Haynes RB, Sackett DL, Gray JAM, et al. Transferring evidence from research into practice. The role of clinical care research evidence in clinical decisions [editorial
    5. Kittson, A. (2004). The state of the art and science of evidence-based nursing in UK and Europe. Worldviews on Evidence-Based Nursing. 1(1), 6-8. www.blackwellpublishing.com/wvn.
    6. Kleiber, C., & Titler, M. G., (1998). Evidence based practice and the revised Iowa Model. Fifth national research utilization conference (April 23-24). Iowa City, IA: University of Iowa hospitals and Clinics.
    7. Peden-McAlpine, C. (1999). Expert thinking in nursing practice: implications for supporting expertise. Nurs Health Sci, 1(2), 131-7.
    8. Rycroft-Malone, J., Bucknall, T., Melnyk, B.M., (2004). Editorial. Worldviews on Evidence-Based Nursing. 1(1), 1-2. www.blackwellpublishing.com/wvn.
    9. Sackett, D.L., Richardson, W.S., Rosenberg, W., Haynes, R.B. (1997). Evidence-based medicine: how to practice and teach evidence-based medicine. London: Churchill Livingstone.
    10. Stetler, C. B. (1994). Refinement of the Stelter /Marram model for application of research findings to practice. Nursing Outlook, January/February, 15-25;

    Stetler, C. B., Brunell, M., Giuliano, K. K., Morsi, D., Prince, L., & Newell-Stokes, V. (1998). Evidence-based practice and the role of nursing leadership. J Nurs Adm, 28(7-8), 45-53.

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