Organizational Culture and Patient Safety

Organizational Culture as it relates to patient safety.

Culture of safety is always at the forefront of our organization. The nurse’s role in patient safety, their experiences, their knowledge impact patient care and safety and facilitate better strategies (Farokhzadian et al., 2018).  Ongoing education of staff, observing their skills, and facilitating patient first has resulted in a positive culture. Staff must communicate the day’s events as they relate to the patient so that everyone is aware of any unusual occurrences and risk factors to be aware of.  Quality indicators on falls, skin breakdown, nine-plus medications, abuse, weight loss, monitored monthly, and these measures assess quality, process, outcome, and patient experience (Rios-Zertuche et al., 2019). Our ethical duty is to ensure patient safety; our culture comes from the top-down; trust, respect, teamwork, and fun all make for a loving environment at our organization.  Quality indicators provide us with trends and ongoing issues that need addressing. As a leader, identifying areas of concern is crucial to the safety of our patients. Early identification focuses the team on safety areas that need to be addressed and fixed. Using information technology to track and trend quality indicators help providers quickly share information and improve quality and safety (Sharma et al., 2018). Constraints in staffing and cost make it difficult to keep all patient safety concerns at the top. Having a leader who can manage implementation and bridge the knowledge between the staff and developers of HIT can impact culture (Feldman et al., 2018).

An opportunity to improve patient safety outcomes

An opportunity to improve patient safety is the management of falls. The elderly are at increased risk of falls due to a decline in mobility, comorbidities, dementia, and other chronic health conditions. Falls are the second primary cause of unintentional deaths after unintentional road accidents (Alshammari et al., 2018). Health and environmental factors impact and play a part in falls.

Strategy for the implementation of this improvement initiative.

Ongoing physical activities and exercise play a positive role in helping the elderly maintain their balance and reduce their risk of falls.  Implementing a designated time on a routine basis for activities by a professional physical therapist would be a good strategy, except it would not be cost-effective for a smaller organization. A better strategy would be to train all staff on providing mobility and gait training. Cipherrounds is a technology-based tool that assists nurses in making rounds with a script that identifies environmental falls risk (Ramano, 2021). Because this technology is automated, it provides a consistent script prompting consistent questions for each patient, decreasing the miscommunication between staff (Ramano, 2021).

Current technology used to support patient safety. Potential unintended consequences of this technology. Solutions to address these potential consequences.

Current technology used to manage falls is a chair alarm which alarms when the patient attempts to get up unassisted.  The unintended consequence includes staff becomes overly complaisant and reliant on the alarm to alert them. The chair alarm may need a new battery and not an alarm; the alarm may malfunction and not alarm. All falls are reported to the quality assurance team verbally to track. Quality indicators are reviewed monthly and assessed by the quality assurance team, and the root cause of the falls is identified and a plan of action initiated. A potential solution to the risk of falls is educating and training staff to conduct cipher, rounds a digital rounding tool (Ramano, 2021).

Compromised patient safety due to volume-based care.

Volume-based care is a fee-for-service model that reimburses healthcare providers for services they have provided; it gives providers the incentive to provide more services to receive increased payments and ethical decisions. Volume-based care encourages physicians to see more patients in less time, which leads to suboptimal outcomes. Due to self-imposed time limits to spend with patients, a physician may not spend enough time to identify what the root cause of the issue is and focus on treating the symptoms vs. treating the root cause of the symptoms. An example of this would be a patient complaining of dizziness and a quick diagnosis of vertigo. If the physician had spent time to assess previous concerns or medications, they might have identified the root cause as the blood pressure medication causing the dizziness.

References

Alshammari, S. A., Alhassan, A. M., Aldawsari, M. A., Bazuhair, F. O., Alotaibi, F. K., Aldakhil, A. A., & Abdulfattah, F. W. (2018). Falls among elderly and its relation with their health problems and surrounding environmental factors in Riyadh. Journal of Family & Community Medicine25(1), 29–34. https://doi.org/10.4103/jfcm.JFCM_48_17 (Links to an external site.)

Farokhzadian, J., Dehghan, Nayeri, N., Borhani, F. (2018). The long way ahead to achieve an effective patient safety culture: Challenges perceived by nurses. BMC Health Service, 18, 654. https://doi.org/10.1186/s12913-018-3467-1 (Links to an external site.)

Feldman, S.S., Buchalter, S., Hayes, L.W. (2019). Health information technology in healthcare quality and patient safety: Literature review. JMIR Med Inform,  6(2) DOI: 10.2196/10264.

Rios-Zertuche, D., Zúñiga-Brenes, P., Palmisano, E., Hernández, B., Schaefer, A.,  Johanns, C.K., Gonzalez-Marmol, A., Mokdad, A.H., Iriarte, E. (2019). Methods to measure quality of care and quality indicators through health facility surveys in low- and middle-income countries. International Journal for Quality in Health Care, 31(3), 183- 190. https://doi.org/10.1093/intqhc/mzy136 (Links to an external site.)

Ramano, L. (2021). How technology can help reduce patient falls. Cipherhealth. https://cipherhealth.com/blog/how-technology-can-help-reduce-patient-falls/ (Links to an external site.)

Sharma, A., Harrington, R. A., McClellan, M. B., Turakhia, M. P., Eapen, Z. J., Steinhubl, S., & Green, E. M. (2018). Using digital health technology to better generate evidence and deliver evidence-based care. Journal of the American College of Cardiology71(23), 2680-2690. https://doi.org/ 10.1016/j.jacc.2018.03.523

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