The Joint Commission defines the Periodic Performance Review as an appraisal tool created to help wellness organisations improve and monitor their public presentation throughout the twelvemonth. This tool focuses on the procedures that influence patient attention and safety while supplying the construction for ceaseless criterions fulfilment. Nightingale Community Hospital is compliant with most criterions as set Forth by the Joint Commission. However. upon review and in an attempt to remain focused on conformity. our criterions commission has located a few disagreements that must be resolved to keep our accreditation with the Joint Commission.

Rather than concentrate on the disagreements found within each unit. we will look at the tendencies that affect the hospital’s conformity with the Joint Commissions recommendations sing patient attention. Armed with the tendencies. we will so research staffing forms and how they relate to patient attention in order to set up a program that will help our infirmary to minimise patient safety issues as they relate to falls. force per unit area ulcers. pneumonia. and the general safety of our patients.

NON-COMPLIANT Tendency

Although the Joint Commission criterions clearly define the demands for an organisation to stay in conformity with the patient attention and safety standard for accreditation. Nightingale Community Hospital’s policies are non being routinely followed throughout each unit. The policy that states verbal orders must be authenticated within 48 hours is non being followed in several units and at that place seems to be small. if any consistence throughout the infirmary with respects to policy observations. By and large. the conformity rate in the 2nd one-fourth was steady and the best of all quarters. while the 3rd one-fourth conformity consequences were really hapless. Policy must be reviewed and criterions improved in order to convey the infirmary into conformity. Policy that should be implemented include a signifier in which the nurse who takes the order must subscribe and day of the month the signifier and topographic point it on outside of the patients chart to alarm the doctor that actions are required of him sing this patient.

Merely two abbreviations were monitored in ICU. Telemetry. 3E. and 4E because they are the most often used out abbreviations. These out abbreviations are “cc” and “qd” . The audit revealed “cc” was most frequently used in the months of April and September. The abbreviation “qd” was used much more meagerly but was used most frequently during the months of June and July. The 2nd and 3rd quarters proved to be the quarters when the two forbidden abbreviations were used the most. To increase consciousness of forbidden abbreviations. a list will be posted in the nursing station in close propinquity to where the charting takes topographic point. Nurses and nursing staff will have instruction sing the usage of sanctioned abbreviations as set Forth by the Joint Commission. Additionally. everyone who paperss in the patients chart will be required to subscribe and day of the month the entry at the clip of certification.

The hurting appraisal audit was another criterion that was out of conformity with the Joint Commission recommendations. The ED. 3E. and PACU were the units focused on for this part of the audit. Clearly. the Emergency Department was the least compliant throughout the twelvemonth for hurting appraisal. This may be due to the urgency or life endangering events in which hurting appraisal is non a precedence. Regardless of the ground for pretermiting to measure for hurting. it is a demand for accreditation. Each appraisal should be documented in the patient’s record of attention and all forces responsible for patient attention must have instruction sing the necessity of the hurting appraisal. The Nurse Managers of each section has the duty of implementing a disciplinary action program based on the peculiar section criterion of attention.

The Joint Commission’s focal point is on safety. At Nightingale Community Hospital. safety is besides of import and the policies and processs are reviewed to guarantee the infirmary is compliant with the Joint Commission’s recommendations. The infirmary policy for fire drills requires one drill per displacement per one-fourth. The audit shows that there are some complaisance concerns sing the fire drills. During 3rd displacement. for the first and 3rd quarters. no fire drill occurred. Besides. there was no fire bore on the 2nd displacement during the 4th one-fourth. Obviously. there should be farther survey to find the cause for the complaisance issue vs. staffing lacks during 3rd displacement. Additionally. each section will hold a safety proctor assigned to guarantee the fire drills occur as per infirmary policy. The safety proctor will finish a signifier documenting the staff involved in the fire drill. day of the month. and clip the drill took topographic point and will maintain a transcript in the safety manual to be inspected monthly.

Other safety concerns that were identified during the PPR rounds include jumble in the hallways. fume wall incursions. maestro dismay panel for medical gasses was non tested. and the gift store did non hold the needed 18” clearance from the sprinklers. The care section director will necessitate to implement a disciplinary action program and be held accountable for the disagreements identified.

Additionally. the Moderate Sedation Monthly Audit of the Endoscopy Department shows some complaisance issues sing pre-procedure events. Mallampati categorization. ASA. Sedation program certification. and completion of reappraisal are systematically below 90 % for all four quarters. However. the actions that must happen during the process and station process rated at 90 % or higher with respects to the Joint Commission recommendations for complaisance. Per the Joint Commission. complaisance should idealistically be 100 % . hence. the bulk of the pre-procedure events are out of conformity and a disciplinary action program to better consistence must be implemented.

Patient falls continue to be a concern throughout the health care industry because many times the autumn consequences in hurt. Other concerns of patient safety that are addressed by the Joint Commission are related to force per unit area ulcers and ventilator associated pneumonia. The Intensive Care Unit had an addition in falls but no correlativity was found between the Numberss of falls to nursing attention hours. However. ventilator associated pneumonia increased this twelvemonth. Corrective actions were put into topographic point to better the VAP Numberss. On the Oncology Unit. 3E. both falls and force per unit area ulcer rates decreased. There were no tendencies identified with falls and ulcers in relation to nursing attention hours or overtime.

On 4E. patient falls and force per unit area ulcers increased when nursing attention hours increased. To find the causes of non-compliance. the commission should look into the events that occurred during the 4th one-fourth. While there are tendencies during the 2nd and 3rd one-fourth. the 4th one-fourth appears to hold been when the bulk of falls. force per unit area ulcers. and VAP’s occurred. Otherwise. hospital-wide. the tendency seems to demo a lessening in complaisance during the 3rd one-fourth.

STAFFING PATTERNS

The Joint Commission depicts staffing effectiveness as guaranting a proper mix of expertness and Numberss of adept staff necessary to efficaciously supply for the demands of the patient population in a infirmary scene. Although costs incurred due to staffing degrees consume a considerable part of the infirmaries gross. surveies have shown that sufficient staffing has a direct consequence on quality and safety. ( Joint Commission. 2010 ) Dall. Chen. Seifert. Maddox. and Hogan discovered fiscal benefits for increasing nursing staff degrees. They determined that nosocomial infections and hospital length of corsets were decreased when there was equal nursing staff available. They besides determined that mortality rates decreased as a consequence of increased nursing staff. ( Dall. 2009 )

Nursing hours indicate the measure and complexness of patients for each country in the infirmary. In order to find how many nurses and other nursing staff will be necessary to care for the patients. one must find the nursing hours per patient twenty-four hours. This is calculated by comparing the sum of nursing staff supplying attention to the entire figure of patients necessitating attention.

Nightingale Community Hospital has combined staffing effectivity with public presentation betterment in order to show sustained betterments throughout selected clinical units. The units selected are based on the clinical and human resource indexs such as patient population. historical staffing issues. and input from staff and bing informations. Traditionally. the clinical indexs have been falls. falls with hurt. force per unit area ulcer prevalence. and ventilator associated pneumonia ( VAP ) . Additionally. the human resource indexs include overtime and nursing attention hours. Although the Joint Commission has non directed specific staffing degrees or ratios. infirmaries and other organisations are expected to determine their ain degrees with respect to their experience and history.

Based on the information from 3E – Oncology. no tendencies were identified with respect to falls. falls with hurt. force per unit area ulcer prevalence. nursing hours. or overtime indexs. In fact. 3E experienced a lessening in falls and force per unit area ulcers. This may be the consequence of the nursing staff concentrating on these indexs due to their patient population. Besides. increasing consciousness. bettering instruction. and supplying a skin attention representative has improved patient safety.

The Intensive Care Unit ( ICU ) experienced an addition in falls without respect to nursing attention hours. However. the unit did demo an addition in ventilator associated pneumonia events. This occurred during the month of September when nursing attention hours decreased. Anterior months showed an addition in overtime hours for nursing staff which caused weariness and burnout to go noticeable subsequently. Due to additions in both falls and VAP’s. disciplinary actions were implemented to cut down these statistics for the approaching twelvemonth.

The Unit. 4E. informations proved merely the opposite as this unit encountered additions in both falls and force per unit area ulcer prevalence. Harmonizing to the day of the month obtained sing falls. it is evident that nursing attention hours showed a relational tendency with falls. In other words. when the nursing attention hours decreased. falls increased. In comparing. when nursing attention hours increased. the falls rate decreased. Drastic additions in falls occurred during June. September. November. December and February. Nursing hours during this clip averaged 15 hours per displacement. It appears the overtime hours occurred as a consequence of the vacation season and hence caused nursing burnout. Due to holidaies. vacations. and absenteeism. nurses are frequently required to work overtime. This form is obvious once more during the summer months when adjustments for holidaies are necessary.

However. the opposite is true with respects to coerce ulcers vs. nursing attention hours. When the nursing attention hours increased. the happenings of force per unit area ulcers increased every bit good. This is perchance caused due to increased overtime hours ensuing in the weariness and burnout. This is a perfect environment for mistakes or the possible to do injury. A more extended survey in the nursing attention hours must be implemented in order to set up an aggressive disciplinary action program to cut down the happenings of force per unit area ulcers and falls. If the survey shows the nursing staff to be working overtime. extra staff may be necessary as portion of the disciplinary action program. Hiring extra nurses will better patient attention. consequence in reduced turnover rates. and lead to increased occupation satisfaction which will finally take to positive results in patient attention.

STAFFING Plan

Hiring and retaining an equal figure of competent nurses is the greatest challenge facing infirmaries and other health care organisations. Nursing has to work with the human resources section to better hiring processs. Human resources should implement programs to enroll competent nurses with the accomplishments and instruction necessary to supply the attention Nightingale is known for. Human resources will execute an analysis to find the best qualities for nursing campaigners and will enroll harmonizing to that criterion. Additionally. alternate programs for extra staffing during known periods of absenteeism such as holidaies and vacations will be constructed. It is imperative that nursing coverage does non go impaired due to absenteeism.

In order to pull and retain the best nurses. Nightingale needs to better the benefit bundle. Nurses have frequently stated that caring for their patients is a joy. but administrative responsibilities. non-nursing activities. and hapless staffing patterns consequences in low occupation satisfaction. Increased occupation satisfaction in bend. consequences in improved patient attention and increased positive results. Surveies have shown that unhappy nurses have unhappy patients.

Other schemes that Nightingale Community Hospital can implement are to promote nurses to traverse train in multiple units in order to make full places in other units when staffing deficits occur. Inadequate staffing degrees can do considerable injury to the patients but is besides a fiscal load to the organisation. Adverse events are more common when staffing degrees are low which are associated with increased costs due to the demand for more intensive nursing attention. ( Stanton. 2004 ) The Utilization Guide for the ANA Principles for Nurse Staffing suggests the usage of patient categorization systems. ( Utilization guide for the ANA rules for nurse staffing. 2005 )

Using a patient categorization system provides guidelines for hard staffing issues by placing procedures and processs for improved staffing. Organizations benefit by back uping nursing judgement sing single patient demands. incorporating beginnings that reinforce criterions of nursing pattern. promoting nursing engagement measuring merchandises that may be used in staffing determination devising. and title-holder the usage of patient categorization systems.

Plants Cited

Dall. T. C. ( 2009 ) . The Economic Value of Professional Nursing. Medical Care. 97-104.

Joint Commission. ( 2010 ) . Management of Human Resources. CAMH: Comprehensive Accreditation Manual for Hospitals. Hr-1 – HR-10.

Stanton. M. R. ( 2004. March ) . Hospital Nurse Staffing and Quality of Care. Research in Action. Rockville. MD. USA: Agency for Healthcare Research and Quality.

( 2005 ) . Utilization usher for the ANA rules for nurse staffing. Washington. District of columbia: American Nurses Association.