Risk Assessment: Patient Care and Safety
Introduction
The phrase “health care” is widely associated to the entire health
care industry wherein nurses deliver health care. It has been emphasized that
the entire health care system is responsible for the patients’ safety. In
addition, this responsibility of patient safety is of great importance be it in
a hospital, in the home, in a long-term care facility, in offices of physicians,
in educational settings, even in the marketplace or in the industries or
anywhere that a nurse provides patient care or patient support (Cummins, 2002).
Patient safety does not only involve nurses in general, but extends
to the whole medical system which includes physicians, patient care team
members, administrators, pharmacists and to all people who come in contact with
patients or work to maintain the health care system environment (Cummins, 2005).
The health care system in one complex model which must be characterized by
extraordinary demands on recognizing errors and consequently providing certain
solutions to prevent such errors. In addition, it must also involve
extraordinary communication, transparent error policy, individual honesty and
identification of the nurse’s responsibilities and duties to patients, to other
nurses and to improving the health care system (Cummins, 2002).
The current health care system has a culture of tolerance for
errors. This actually means that committing an error seems to be okay. They
have this “Omerta” type code of silence wherein professionals are discouraged to
speak of situations where errors occur. According to Cummins (2002), the health
care system’s reaction to error has been reactive instead of proactive.
Tolerance, silence and proactive policy has allowed the culture accept error.
But since the public expects the health care system to be perfect, the whole
system must be as much as possible safe and strong and error occurrence must not
be tolerated. This essay has been made in relation to health care and safety of
patients. This essay mainly focuses on risk assessment wherein risk assessment
is defined, analyzed and evaluated in terms of one aspect of health care of a
patient. In addition, the essay will undertake a literature review relating to
the chosen aspect for care evaluation. How the chosen aspect of health care will
influence the quality of nursing care and the patient will also be demonstrated
as well as how the whole content of the essay might influence future practice of
nurses.
Understanding and Managing Risk
Risk is defined by the National Patient Safety Agency (2005) as the
“combination of likelihood and consequence of hazards being realized.” Hazards
are any “situation with the potential to cause harm” (National Patient Safety
Agency, 2005). In simpler terms, risk in the chance or the probability that
something will happen that might damage or ruin a project (Martin, 2002).
Many risks can actually be foreseen. One might feel that risk management is
simply common sense. However, there will be lapses if risks are not thought of
carefully. Risk management is useful as some risks are not easy to predict. Risk
management is one way of planning sensibly and practically in order to lessen
disruption through the provision of measures that will respond to the most
probable and most damaging risks if not prevented.
There are several reasons as to why there are risks. Sources of risk may be
physical, technical, labor, political/social and liability. According to Martin
(2002), there are four stages upon risk management. The first stage is the
identification of the risk. It involves the identification of hazards that will
probably affect the system and the documentation of the characteristics of the
risk. The second stage is the impact assessment in which the risks are evaluated
and assessed in terms of possible outcomes and potential impact. The third stage
is the developing of plans that will reduce the impact of the most probable
risks and ensure that these plans are implemented when necessary. The final
stage is the ensuring of risks that they are kept in constant review and that
the suitable plans are made if there are changes in the type and chances of
impact (Martin, 2002).
Patient Safety Risk Assessment
Risk assessment has become a widely accepted
tool in the field of medicine (Fingeret, 2005). Using risk assessment in health
care will allow nurses and medical staff to take batter care for their
patients. According to the National Patient Safety Agency (2005), patient
safety risk assessments are “careful examinations of systems to identify factors
that could potentially cause or contribute to patient harm.” Harm, as defined by
the National Patient Safety (2005), may be injury, suffering, disability or even
death. Patient safety risk assessments are used to facilitate decisions as to
whether sufficient safety measures are being undertaken to ensure timely and
safer provision of care or if further precautions are necessitated to prevent
harm.
The goal of the patient safety risk assessment
is to ensure the patients’ safety as much as possible, making sure that they are
not harmed by the actions of the of hospital staff and unsafe conditions which
can result in complications, infections, longer hospital stays and unnecessary
pain and suffering for both the patient and their relatives. The whole process
of risk assessment seeks to respond the four simple questions: “What can go
wrong?”; “How bad?”; “How often?” and “Is there a need for action?” Please Refer
to figure 1 for the outline of the four questions.
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Figure 1: Outline of the Four Questions in
Patient Safety Risk Assessment
Source: http://www.npsa.nhs.uk/site/media/documents/948_HaN%20guide.pdf
As the hazard is recognized, one must decide
upon the significance of the hazard and if the suitable and sufficient
contingencies are in place to make sure that the risk will be efficiently
minimized or lessened (National Patient Safety Agency, 2005).
Cardiovascular disease
Cardiovascular disease, principally
heart disease and stroke is one of the leading causes of death in the world
regardless of gender and racial and ethnic groups. It is a class of diseases
that involves the heart and/or blood vessels (arteries and veins). Statistics
show that over 50 million Americans have cardiovascular problems and other
Western countries are currently facing high and rising rates of cardiovascular
disease. In the United States and most European countries, it has been reported
that cardiovascular diseases are the number one causes of death.
Various risk factors of
cardiovascular disease include the following: age, Diabetes mellitus,
Hypercholesterolemia, tobacco smoking, higher fibrinogen and PAI-1 blood
concentrations, elevated homocysteine, high blood pressure, obesity, genetic
factors or family history of cardiovascular disease, physical inactivity and the
male sex.
It is important to note that even though there
is higher rate for men to have cardiovascular diseases compared to women, women
also face cardiovascular disease as a number one health problem in highly
industrialized countries as after menopause, risk for women increases to the
rate the same for men.
Health Risk Assessment and its Development
The development of the health risk
assessment as a clinical tool for the practice and field of prospective medicine
has been widely used in worksite health promotion programs in order to identify
and recognize cardiac and other risk factors and to plan the necessary
preventive measures. A new technique has been developed to collect and analyze
individual risk for specific health outcomes. This new technique is called
Health Risk Assessment or Health Risk Appraisal (Zimmerman & Horton-La Forge,
1996).
According to Zimmerman and
Horton-La Forge (1996), the health risk assessment basically constitutes a list
of questions related to an individual’s basic behavior, demography, health
history, biometry (height, weight, blood pressure and cholesterol levels). A
computerized system is used to score the data, estimate the risks for specific
outcomes and produce personalized feedback results for respondents. The
individual results are a summary of changeable risks and suggested preventive
measures (Zimmerman & Horton-La Forge, 1996).
The health risk assessment was
originally introduced by Robbins and Hall as a tool that is supposedly used in
clinical practice of prospective medicine; however, it has expanded as a
component of worksite, university and community-based health promotion programs.
In addition, a national survey published in 1989 showed that health risk
assessment activities were presented in nearly about one third of all worksites
and at two thirds of large worksites in the United States. Accordingly, the
health risk assessments were usually used for needs assessment, health
education, or as a first stage toward enrollment in follow-up health promotion
and disease prevention programs (Zimmerman & Horton-La Forge, 1996).
Health risk assessment in suitably viewed as a
tool to increase awareness and create a “teachable moment,” an effective
approach to organize and prioritize health information which may be individual
or group education, and a tool for “triaging” individuals to suitable and
appropriate follow-up intervention programs (Zimmerman & Horton-La Forge, 1996).
Patient Care with Cardiovascular Disease
Caring for a patient with
cardiovascular disease involves reducing the patients’ risk factors for the
disease. As a nurse, you have to help your patient in terms of the sorts of diet
that he/she will take, his/her physical activity as well as weight management.
As a nurse, one must be aware of the medical history of his/her patient, in
addition to the data concerning the risk factors of cardiovascular disease.
Nurses may as well use the health
risk assessment to be able to be able to identify the risk factors of his/her
patient. Upon knowing the risk factors of his patient, the nurse can evaluate
and assess the condition and the status of his patient. Zimmerman and Horton-La
Forge (1996) notes that the health care system attempts to attain integration
and coordination across the continuum of care. Consequently, it requires
necessary tools to identify the prevention opportunities inside and outside the
acute care setting. The traditional technique to recount prevention strategies
is divided into three major categories: primary prevention, secondary prevention
and tertiary prevention.
According to Zimmerman and Horton-La Forge
(1996), primary prevention strategy involves on keeping people healthy such as
health education programs and the like. Secondary prevention, however,
recognizes the potential health problems at an early and more treatable stage.
Meanwhile, the tertiary prevention is concerned more on patient education for
the individual diagnosed with an acute or chronic condition such as a
cardiovascular disease.
As a nurse, one must be aware of these
prevention strategies to implement on their patients. Substantial educational
background and experience is needed. As mentioned earlier, wide knowledge on the
risk factors of the nurse’s patient will be helpful in identifying which
prevention strategy is to be implemented. If patient is not yet identified with
potential health problems, nurses are to ensure the health of their patient,
keeping them healthy by means of nutritional education, physical fitness, stress
management and safety programs. Moreover, they must also identify and encourage
alteration of behavioral risk factors such as inactivity, poor nutrition
practices and unsafe driving practices (Zimmerman & Horton-La Forge, 1996).
If patient is already identified with a
potential health problem but still at an early stage, as nurses, they must
conduct the secondary prevention strategy such as screening on blood pressure,
cholesterol and mammography. Accordingly, these screenings are performed inside
and outside the acute care setting (Primary prevention strategy is conducted
outside acute care setting.) (Zimmerman & Horton-La Forge, 1996).
Individuals diagnosed with an acute or chronic
illness required the use the tertiary prevention strategy. Tertiary prevention
is classified in an acute care setting and such prevention strategies include
cardiac rehabilitation, diabetes management and hypertension control programs.
Identifying Risks in Patient Care
The whole process of
patient care is usually involved and attached with risks. According to Ray
(1995), the management of the process of patient care has four key components
namely physician decision support, utilization management, consultations and
education. Some of the risk in patient care may be derived from these key
components. However, they are only risks of small impact to the safety of the
patient. Still, they are risks that need to be kept in constant review and be
provided with appropriate plans that will help reduce such risks.
One of the central
concerns in patient care is the safety of their patients. Consequently, health
care providers, nurses in particular, must be responsible for the health and
safety of their patients. One of the greatest risks in health care management is
errors committed by the health care providers which can result to harm to the
patient. This harm may be injury, suffering, disability and even death.
Health care providers are supposed
to care and ensure the safety and health of their patients, not harm them. In
addition, according to statistics, the health care system has developed a
culture that tolerates errors to occur which is wrong. Because in the world of
health care, they are basically involved in saving the lives of people. And
there should be no room for errors that might cause harm to the patient.
Therefore, errors should altogether not be tolerated in the health care system.
Errors should not be okay. As health care providers, one must aim for
perfection.
In addition, the current health care
system also has the “Omerta” type code of silence. Medical professionals are
discouraged to talk about situations wherein actual errors occur. This has made
the health care system reactive rather than proactive. If events are to occur
wherein some of the medical staff commits errors, this should be shared between
the medical personnel in order for assessment and lessening the probability that
such error will occur again.
Health care system should be
characterized by extraordinary communication, transparent error policy,
individual truthfulness and recognition of a health care provider’s
responsibilities and duties to their patients, to other nurses and to the
improvement of the whole health care system.
Conclusions
Society is more and more
attacked and bombarded with the consequences of modern medical treatment (Zalumas,
1995). Nevertheless, the work of a nurse is never change. It still focuses
primarily on the safety and care for the patient. Przymusinski (2003) once said
that nursing is humanistic profession. Nurses care and strive to save lives and
if they can’t, nurses provide dignity until the moment of death arrives.
Nursing and health care
are associated in such ways that it cannot be separated. It is the nurse’s job
and responsibility to provide care and safety for the patient. Upon the
conception of this essay, one can assess various aspects in nursing health care
that certainly needs to be modified such as tolerance, silence and proactive
policy which somehow breeds a culture to accept error.
Modifying this aspect in
the health care system is the first step for change. It will improve patient
safety and care. Nurses will be able to deliver the necessary requirements
needed in health care. How to modify these aspects of health care will start by
the implementation of change. It needs to be modified because as mentioned
earlier, there should be no room for errors in the health care system. Thus,
there is a need for aiming for perfection as the lives of the nurses’ patients
are in their hands. The nurses and the medical staff have the opportunity to
play as gods by holding the lives of their patients.
The modification of the
health care system will apply to all nurses in general. The whole culture for
tolerance of errors must indeed be stopped. In addition, there should be
extraordinary communication between the medical staff, including nurses,
physicians, administrators, pharmacists and basically all people whose work
involves patient safety and care and maintains the environment of the health
care system.
I repeat, there should
also be a transparent error policy in the health care system, as well as
truthfulness and recognition of a nurse’s responsibilities and duties to their
patients and to other nurses, too. With this, the whole health care system will
be improved and be able to bring out and provide the needs of their patients.
Upon concluding this
essay, as a nurse, I will strive hard to achieve perfection if the nursing
profession. In order to bring out and provide an ideal patient care and safety,
certain aspects in the nursing practice will also be greatly improved such as
accuracy of patient identification, efficiency in communication among other
medical staff, safety of using high-alert medications and of using infusion
pumps and clinical alarm systems. Moreover, there should be elimination of
wrong-site, wrong-patient and wrong-procedure surgery as well as lessening the
risks of health-care acquires infections.
Credit:ivythesis.typepad.com
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