Dashboard Analysis and Nursing Plan
In order for health care facilities to enhance and improve the care they deliver to their patients, they rely on data collected within their facility and from surveys sent out to patients. The information collected is formatted into a quarterly dashboard where goals are set for each quality indicator and then interpreted if the facility met those goals. Through the use of dashboards and quality indicators proactive decisions can be made based on actual events occurring, rather than changing the plan of care based on assumptions. The dashboard is effective in determining particular areas in which improvements would be beneficial to not only the care of the patient but the overall morale of the health care facility. The dashboard is also helpful in strategic planning, where the assessment of performance can be undertaken (Tomlinson, Hewitt, & Blackshaw, 2013). The overall objective of this paper is to analyze areas where the facility excels, and determining a plan of action to improve negative performance by utilizing evidenced based practice.
After carefully analyzing the data presented in this week’s dashboard, communication between the nurses and the patients excels. Nurses develop a good rapport with the majority of their patients and give thorough explanations of the care provided. However, their promptness and attention to detail needs to be an area addressed to improve patient outcomes. Thus, could also be the result of negative data reflected on the dashboard that represents patient safety measures such as falls, pressure ulcers, mislabeled specimens and uncontrolled pain. Patient safety is crucial in the plan of care and if not carefully addressed could lead to adverse events and outcomes.
Paying attention to details is important for avoiding errors, maintaining efficiency, preventing injuries, making a good impression and analyzing information. Attention to detail improves accuracy in performing tasks. Preventing errors is valuable when providing care to all patients. Careful management of details contributes to overall efficiency and success in the healthcare facility. Reducing errors also contributes to patient satisfaction. By developing a nurse-patient relationship you are able to address needs and concerns of the patient, as well as pick up on detail-oriented cues that will need implemented for each individual patient in order to maintain a balance of trust and communication during the patients stay.
Attention of detail leads to patient safety. Patient safety throughout the hospital should be developed by the leadership. Leadership assumes a role in establishing a culture of safety that minimizes hazards and patient harm by focusing on processes of care. The leaders of the organization are responsible for fostering an environment through their personal example; emphasizing patient safety as an organizational priority; providing education to medical and hospital staff regarding the commitment to reduction of medical errors; supporting proactive reduction in medical/health care errors; and integrating patient safety priorities into the new design and redesign of all relevant organization processes, functions and services (IHI, 2017).
There are many quality indicators that fall into the category of patient safety such as: medication errors or adverse events, pressure ulcers, falls, restraint use, nosocomial infections, VTE, etc. Various tools can be set in place to ensure adequate monitoring of these areas to protect the patients and the facility. Conducting a thorough head-to-toe physical examination on admission is a high priority. Patients come into the hospital and we treat their presenting symptoms, however many times there may be an underlining problem that needs addressed to ensure an optimal outcome and patient experience. A full physical assessment gives you a thorough picture of the patient’s condition.
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Best practice would be to conduct a fall risk assessment and a skin risk assessment on each patient every shift or as needed if there has been a change in the patient’s condition. With a fall risk assessment, it can determine what interventions need put in place to ensure patients are free from physical injury while in our care. The fall risk assessment we use at our facility is similar to the one presented by John Hopkins, called the JHFRAT (Hopkins Medicine, 2017). The fall risk assessment tool addresses various patient safety indicators such as: age, history of falls within 6 months, elimination of bowel and bladder (incontinence, urgency or frequency), medications (PCA/opiates, anticonvulsants, antihypertensive, diuretics, hypnotics, laxatives, sedatives, psychotropic, etc.), use of patient care equipment (IV infusion, chest tube, indwelling catheter, SCDs, etc.), mobility (unsteady gait or needs assistance), sensations (decrease in hearing, vision, etc.), and cognition (impulsive behavior, sedation, or altered mental status). If the patient scores greater than 6 then they are required to wear fall risk socks, fall risk bracelet, and bed/chair alarms are put in place. This is a great tool as we can reassess it multiple times throughout the day to ensure the safety of the patient and decrease the rate of falls on our dashboard to improve quality indicators. It also shows the patients that we are concerned for their safety and are putting all measures of safety in place to ensure a positive outcome.
Another best practice tool we can utilize would be the skin risk assessment to prevent and manage pressure ulcers. The Braden Scale for predicting pressure sore risk is a clinically validated tool that allows nurses and other health care providers to reliably score a patient/client’s level of risk for developing pressure ulcers. It measures functional capabilities of the patient that contribute to either higher intensity and duration of pressure or lower tissue tolerance for pressure. Lower levels of functioning indicate higher levels of risk for pressure ulcer development (NLM, 2013). The Braden Scale uses various categories to determine the patient’s skin risk such as: sensory perception (ability to respond meaningfully to pressure-related discomfort), moisture (degree to which skin is exposed to moisture), physical activity (degree of physical activity), mobility (ability to change and control body positions), nutrition (usual food intake pattern), and friction and shear risk. A score of 18 or below alerts the nurse that the patient may be at risk for pressure areas, a score 9 or less determines that the patient is high risk. Interventions should be put in place to prevent pressure ulcers for at risk patients. The nurses should be required to inspect patients skin each shift, manage moisture on the skin, conduct a skin risk assessment each shift or as needed if there is a change in the patient’s condition, minimize pressure to bony prominence by reposition patient every 1-2 hours, increasing nutrition intake and hydration (if the patient is unable to consume these orally then intravenous methods need to be implemented). By completing each of these steps for all patients it will prevent secondary diagnosis and prolonging of patient stay. Maintaining skin integrity will increase the patient’s outcome and satisfaction.
Through the use of quality indicators and data collection we have the ability to improve our patient satisfaction and the care we deliver on a daily basis. By utilizing best practices to maintain patient safety and recognizing the needs and concerns of our patients we can achieve high standards. We must realize though that perfect scores across the dashboard is unrealistic. Health care and evidenced-based practices are always changes and the care we are providing is becoming more acute. By continuing our education and having our patient’s safety as our number one priority we will continue to excel in the health care continuum.
Tomlinson, P., Hewitt, S., & Blackshaw, N. (2013). Joining up health and planning: How Joint Strategic Needs Assessment (JSNA) can inform health and wellbeing strategies and spatial planning. Perspectives In Public Health, 133(5), 254-262. Retrieved from: http://dx.doi.org/10.1177/1757913913488331
Institute for Healthcare Improvement. (2017). Patient Safety Plan. St. Francis Health System: St. Joseph Medical Center. Bloomington, Illinois. Retrieved from: http://www.ihi.org/resources/Pages/Tools/PatientSafetyPlan.aspx
Hopkins Medicine. (2017). Fall Risk Assessment: JHFRAT. The Johns Hopkins University, The Johns Hopkins Hospital, and Johns Hopkins Health System. Retrieved from: http://www.hopkinsmedicine.org/institute_nursing/models_tools/fall_risk.html
National Library of Medication. (2013). Braden Scale. National Institutes of Health, Health & Human Services. Retrieved from: https://www.nlm.nih.gov/research/umls/sourcereleasedocs/current/LNC_BRADEN/
Also check: Hospital Acquired Pressure Injuries