Patient Falls and Medication Errors Essay

Issue/Problem of Interest travel argon the wink more or less mutual land unfortunate event within wellness distribute institutions following medication errors, and an estimated 30% of infirmary-based travel yield in dangerous injury. The severity of this problem led the sum Commission to make reducing the seek of longanimous injuries from water adjudicate a subject ara forbearing safety goal for infirmarys in 2009 (AHRQ, 2006). waterfall are a ahead(p) cause of hospital-acquired injury and often gallop and exposit hospital stays and declaration in poor whole t unrivaled of life, change magnitude appeals, and unanticipated admissions to long-term burster facilities. Changes in wellness feel for financing in the 1990s were accompanied by a variety of cost-cutting measures in hospitals across the coupled States. Common cost-cutting strategies included reducing the replete(p) number of nursing hours per forbearing solar day and reducing the percent historic period of hours supplied by registered curbs (RNs), the most highly paid group.The reduction in staffing led to widespread concern that patient care in acute care settings would suffer. In response to concerns about staffing and calibre of care, the American Nurses Association (ANA) launched the Patient gum elastic and Nursing Quality Initiatives in 1994 to grapple the impact of wellness care restructuring on patient care and nursing. To facilitate the initiative, ANA conventional the National Database of Nursing Quality Indicators (NDNQI) in 1997, with two goals (1) to develop a database that would tide over empirical monitoring of the impact of nurse staffing on patient safety and quality of care across the nation, and (2) to provide case-by-case hospitals with a quality improvement pricking that includes national comparisons of nurse staffing and patient outcomes with akin(predicate) hospitals (Hart and Davis, 2010).Selection RationalePatient fall impact hospitals both fi nancially and in regulatory body status. In 2005, in response to disturbing and widely cited findings by the Institute of Medicine about the preponderance of life-threatening conditions acquired by patients in U.S. hospitals, carnal knowledge authorized the Centers for Medicare and Medicaid Services (CMS) to implement requital changes designed to encourage the prevention of much(prenominal)(prenominal) conditions. Under an amendment to the Social Security locomote that was enacted on January 1, 2007, the secretary ofHealth and kind Services was gestated to identify at least two hospital-acquired conditions by October 1, 2007, that were high-cost, high-volume, or both that resulted in the assignment of a case to a higher-paying diagnosis-related group (DRG) when they were stick as a secondary diagnosis and that could reasonably be prevented through the employment of evidence-based guidelines (New England Journal of Medicine, 2009).The CMS worked collaboratively with the Cent ers for Disease Control and legal profession (CDC) and on October 1, 2008, enacted new salary nutrition Medicare will no longer return hospitals for a higher-paying DRG when one of eight selected hospital-acquired conditions develops during the hospital stay. The CMS heralded this move as an fret to align financial incentives with the quality of care, thereby promoting both quality and efficiency. Hospital falls and trauma were included as one of the eight conditions that, the CMS argues, should not occur aft(prenominal) admission to the hospital. Three to 20% of inpatients fall at least once during their hospital stay these falls result in injuries, increased lengths of stay, malpractice lawsuits, and more than $4,000 in unnecessary charges per hospitalization. Thus, hospital falls represent a major patient-safety problem and may complicate a patients care and treatment (New England Journal of Medicine, 2009). Target creationThe target population chosen consists of patient s admitted to the health check exam and operative floors at two grownup teaching hospitals. The first hospital is a 1,000 bed not-for-profit teaching hospital regain in Dallas, Texas with an average day by day enumerate of 917. This physical composition consists of 12 health check and surgical floors with a entire bed capacity of 428. Each floor consists of the nurse manager, registered nurses, sure nursing assistants, and unit secretaries. Patients most often cared for on the medical floors at this eagerness consist of those suffering from exacerbation of continuing obstructive pulmonary disease (COPD), pneumonia, diabetes mellitus (DM), noetic vascular accident (CVA), and sepsis. Patients most frequently cared for on the surgical floors consist of those mend from orthopedic injury and/or surgery, stomachic bypass surgery, abdominal explorative surgery, neurovascular surgery, pole kidney and liver transplant patients, and those patients recovering from gynecolog ical operations.The population of patients beingness cared for at this hospital comprise mostly of patients 55 eld and older. Of the 428 patients being cared for on a daily basis at this organization, 15% of these patients require total assistance, 25% require lengthy assistance, and 50% require hold in assistance. The second hospital system, northShore University HealthSystem (NSUHS), is a comprehensive, fully integrated, not-for-profit health care system that serves the greater North Shore and Northern Illinois communities. NSUHS includes four hospitals with 795 piece beds with a total of medical/surgical configured beds at 495. The average medical and surgical daily census is 103.9. The medical/surgical occupancy is 62% of staffed beds on 19 units. Each unit consists of a clinical nurse manager, registered nurses, patient care technicians, and unit concierges.The surpass medical DRGs include congestive heart trial (CHF), pneumonia, respiratory, acute myocardial infarction (AMI), and CVA. The top surgical admissions include orthopedic sound out replacement, general surgery, and spinal surgery. The average age of patients being cared for in this system is 68.5 years. Of the 495 patients being cared for on the medical and surgical units, at least 50% require total assistance and 50% require limited assistance. SignificancePatient falls in the hospital setting are third estate and may lead to negative outcomes such as injuries, prolonged hospitalization, and legal responsibility. Falls can also look at heartbreaking effects on a someones ability to function as a productive member of their family, community, or society. These occurrences have long been documented as a significant, and potentially avoidable, type of undesirable patient event (Steven, 2004). Patient falls are the second most common cause of harm in hospitals and are the leading category of reported incidents in hospitals affecting approximately three to 20% of patients during their ho spitalization (Sutton &ump Wallace, 2005). The frequency of patient falls, as recorded in the literature, ranges from 25% to 89% of all hospital adverse incidents, depending on the patient population canvas (Hitcho, 2004).The rates vary from 1.9 up to 18.4 falls per 1,000 patient days depending on organization type, and according to a study by the National Council on Aging, 30% of these incidences result in serious injury (Stevens, 2004). another(prenominal)significant consequence of falls is that they are expensive and contribute to the increasing health care expenditure. An estimate of the average DRG payment for injuries sustained by a patient falling is $25, 643 (Hart, Chen, Rashidee, and Sanjaya, 2009). This is significant in that with the develop atmosphere of pay-for-performance, initiated by CMS, hospitals now have a major monetary stake in reducing the number of fall-related injuries. The CDC estimates that the cost of fall injuries will exceed $23 billion within the next a few(prenominal) years (Tzeng, 2008).