Читать книгу Kelly Vana's Nursing Leadership and Management - Группа авторов - Страница 270

Tina is caring for a patient with pulmonary emboli. She reviews the medication orders to administer 80 units of heparin per kilogram by intravenous bolus, followed by 18 units per kilogram as an hourly infusion. Tina knows her patient weighs 161 pounds, or 73 kg. She correctly calculates and administers the initial dose of 5,840 units. Tina calculates the continuous infusion rate at 1,314 units per hour. When programming the pump, however, her finger slips and she enters the numbers 11,314 into the pump. Because the programmed dose is beyond the normal range for heparin, the pump does not administer the drug, and Tina receives an error message from the pump. She quickly identifies and corrects the programming error. An independent double check from a peer for this high‐risk medication would also catch this programming error before it reaches the patient.

Answer these questions:

1 What factors may have contributed to this programing error?

In this scenario, the IV pump caught the error because the dose was excessive. What other strategies could Tina use to catch a programming error before it reaches the patient?

In an HRO, health information technologies help facilitate and sustain quality improvement efforts to improve patient safety. Using health information systems to document care and gather quality and safety information is essential. Additionally, health care information systems provide a method for reporting errors and near misses. The lack of health information systems can impede progress to an HRO. Health care organizations are challenged to devote scarce resources to implement information systems that require significant capital expense and ongoing maintenance costs. In addition, hospital leaders sometimes apply technology to faulty health care processes. Technology can only help improve health care processes when applied appropriately. As part of technology implementation, safe health care processes must be designed and technology must be used to support and sustain the improvements. As seen below, telehealth technology can also be used to make resources available to patients and clinicians remotely (Figure 4.7).

FIGURE 4.7 Four senior nursing students at Purdue University Northwest demonstrate how to use a Telehealth cart.

Sources: Joshua Kocoj, Amber Mills, Jonathan Miskus and Riley Wayco.

Informatics can also help organizations to identify events that cause harm to patients in order to select and test changes to reduce harm. The Institute for Healthcare Improvement Global Trigger Tool (IHI, 2017) helps health care organizations get a clearer understanding of the safety of care by measuring risk and harm at the hospital level. The Global Trigger Tool (GTT) uses specific patient care triggers as indicators that an adverse event may have occurred. Using GGT to identify adverse events (AEs) is an effective method for measuring the overall level of harm from patient care in a health care organization. GTT provides an easy‐to‐use method for accurately identifying AEs (harm) and measuring the rate of AEs over time. Tracking AEs over time is a useful way to tell if changes being made are improving the safety of the patient care processes.

More than 50 triggers are consolidated into categories on the GTT related to the provision of surgical, ICU, perinatal, medication, and emergency department care (Institute for Healthcare Improvement, 2018). For example, transfer to a higher level of care is one of the Global Triggers. Consider a situation where a patient is transferred from a medical–surgical unit to the ICU due to a rapid drop in blood pressure and decreased level of consciousness. This event would activate a trigger. The patient's EHR would be reviewed to determine what happened to the patient, when it happened, and if it could have been avoided. In an HRO, investigation results and the GTT results are shared with health care providers and process improvement changes are put into protocols, policies, and procedures to reduce the chance of future safety problems occurring. In an HRO, a multifaceted reporting approach is needed that is comprehensive and provides accurate measurements of errors and near misses.