Concepts In Clinical Outcomes Nursing Essay

Concepts In Clinical Outcomes Nursing EssayAvedis Donabedians specimen presents an across-the-board specimen of the relationship amid variables that contribute to eccentric of safekeeping, health commission be and health status. Donabedians (1988) classical approach to the assessment of the forest of patient trouble inside a hospitalization setting is comprised of three shares, which include structure, play, and outcome. The starting two variables, structure and change, are labeled indirect variables by Dr. Tim Postema, beca wasting disease of their boilers suit signifi croupce and contribution to the third variable, outcome (2005). To better understand Donabedians model, a brief overview of each variable will follow. The structural component is defined by the setting, which includes the attributes of material resources (such as facilities, equipment, and money), of human resources (such as the number and qualifications of personnel), and of organisational structure ( such as medical rung organization, methods of peer review, and methods of reimbursement) (Donabedian, 1988, pg. 1745). Examples of structural component may include but is not limited to the physical works environment itself, staffing mix and balances of patients to nurse, and the organisational glossiness itself (institutional policies). The structural component of the model emphasizes characteristics of nurses involved in each patients rush, accredited characteristics of the patient as hygienic as the organizational structure of the hospital in which the patient care was received (Duffy Hoskins, 2002). The second variable of consideration in Donabedians model (1988) the performance component, which he defines as giving and receiving care (pg. 1745) is the specific intervention or interventions that are applied, which includes patient and supplier participation. Finally, the third component of Donabedians model (1988) for assessing the type of care is the outcome compone nt of the model which is defined as the personal effects of care on the health status of patients and populations ( pg. 1745). Now that the square variables waste been defined, a discussion of their relationship and how they apply to the assessment of patient tincture of care will follow.Donabedians model efforts to explain health care quality in terms of outcomes that are measurable by the interrelationship between the structure, process and opposite attributable variables such as the approach in a patients health status and satisfaction (1988). Donabedians model plays a significant role in the assessment of quality of care from the patients perception and is a high priority in the pay for performance reform that has occurred within the past decade (Wachter, Foster, Dudley, 2008), specifically from the Centers for Medicare and Medicaid Services (CMS).There is a standoff of evidence to support Donabedians theory relative to the interrelationship between the process component s, such as the care provided, and the outcome of the patients health leading up to their discharge from the hospital (Duffy Hoskins, 2003). Research posits that the three-part approach to the assessment of a patients quality of care is legitimately rooted in the relationship among the variables set out by Donabedian structure, process, and outcome (Duffy Hoskins, 2002). Donabedian proposed that good structure increases the chances of good process, and good process increases the chances of good outcomes (Donabedian, 1988, pg. 1745). Additional look intoers substantiate this further in their research (Duffy Hoskins, 2002 and Postema, 2005). The set aboutings of these researchers substantiated Donabedians exemplar through a variety of methodological approaches, yet were able to find the overarching correlations between factors of structure to produce positive outcome measures among patients. Thus, it can be concluded that utilization of Donabedians approach to the assessment of quality of care among hospitalized patients can assistance in producing higher quality outcome measures, such as the problem facing numerous institutions relative to the number of medicinal drug errors.Donabedians model of structure, process, and outcome will be used to facilitate my endeavors in lessen medicinal drug errors on the Psych-Med Unit (PMU) at St. Marys Health fretfulness System. A detailed discussion of the appropriate variables will follow to provide a more thorough understanding of how the application of this theory will assist in the decreasing the number of medication errorsStructure component flirt with characteristicsThe combination of higher education and years of experience in treat improves health care outcomes, which include decreased medication errors, level peg rates, and reducing mortality rates (Tourangeau et. al., 2006 Blegen, Vaughn Goode, 2001). writings has place studies that confirm that these certain nurse characteristics (higher educa tion and experience) are related to better patient outcomes (Aiken, Clarke, Sloane, Silber, 2003 Tourangeau, Cranley Jeffs, 2006). Tourangeau et. al.s research (2006) found that more years in care for experience has a significant and beneficial effect on patient health specifically on 30-day mortality rates in hospitals. Aiken et. al. (2003) found a statistically significant effect which postulates that with an increase in baccalaureate nurses in staffing which is associated with an increase consciousness of the culture of safeguard, on that point was a decrease in mortality of patients within 30 days of admission. Nursing units with experienced nurses had lower medication error rates (Blegen, Vaughn Goode, 2001).Patient characteristicsPatient characteristics include polypharmacy and multiple diagnoses, including twain medical and psychiatric diagnoses. Comorbid diagnosis are associated with the regard for the patient to memorize more medication to manage symptoms and in turn, increases the risk of drug interactions, say-so side effects and thus, the need for more medications, errors in the boldness of medication, as fountainhead as difficulties with compliance upon discharge from the hospital (World Health Organization, 2011). tally to the Joint Commission on Accreditation of Healthcare Organizations (JACHO), polypharmacy can cause an increase risk for falls, hospitalizations and confusion and/or disorientation (2008, pg. 8). Dr. Joseph Parks, a director for all-inclusive psychiatric services for the Missouri Department of Mental Health, commented that, polypharmacy issues within abnormal psychology occur because one provider does not know what the other provider is prescribing and is a significant factor that diminishes the overall patients quality of care base on effectiveness side effects and uncomely interactions (JACHO, 2008, pg. 9). Literature has identified that with multiple physicians prescribing medications for one patient, thithe r is increase in chance for medication errors and thereby, diminishing the patients overall quality of care. (Tamblyn, McLeod, Abrahamowicz Laprise, 1996). This issue is reliant upon patient report, as well as doctor inquiry and thus, the burden falls upon some(prenominal) parties in order to ensure high quality of care.Organization characteristicsThe organizational structure characteristics including staffing ratios, staffing mixes, hospitals policy on medication disposition and the organizational culture itself can influence the outcomes of care (Duffy Hoskins, 2003). Throughout the years numerous studies bind been conducted that show that a higher registered nurse mix was related to lower mortality because that demonstrates the professionalism and integrity of registered nurses (Tourangeau et. al, 2006, pg.5). Studies have shown that an increase in nursing staff providing care resulted in decreased mortality (Tourangeau et. al., 2006), which supports the necessity of higher ratio of registered nurses mix in staffing patterns. The Robert Wood Johnson Foundation (2008), whose mission is to improve health and healthcare for Americans, found that hospitals and health governances across the country have been working to achieve the culture of their organizations to develop supportive work environments that encourage nursing retention and improved quality of patient care. With a keen awareness of culture of golosh often attributed to nursing professionals with higher educational degrees, there is an enhanced awareness that the resort of patients is the purpose priority and is highly valued on an organizational level. Because of the value placed on the culture of safety by health organizations and hospitals each year, staff and other health professionals need to continue to focus on improving their precision and skills utilized darn caring for patients. In doing this, they become not only aware of possible medication errors, but also avenues to implement interventions to eliminate the tendency of potential risk all together (ISMP, 2006).Process componentBar canon seeAs stated previously, process components is the giving and receiving of care (Donabedian, 1988). comparative to the ascribed problem outlined in this paper, the solution that has proven to improve medication organisation and thus decrease medication errors is with hindercode see governing bodys for dosing and medication judicial system (ISMP, 2002). The ISMP (2002) asserts their confidence in the barcode scanning system by encouraging the use of the engineering science in any setting which medications are administered. The Institute of practice of medicine released a report in 2001 that suggested ways to use info engineering science to come through with a safer, more efficient way to keep medication errors and improve healthcare quality with the automation of patient-specific clinical information (pg. 5). Medication administration errors are responsible for one-third of the errors (ISMP, 2002). According to the ISMP a bar coding and scanning system is a promising attempt at the reduction of errors in the stage of medication administration base on the accountability and accuracy of this engine room (2002). At a patients bedside, bar code scanning identifies the patient, lists the medications ordered, checks for allergies or alerts for medication interactions, and electronically signs the patient track record for the nurse (ISMP, 2002).Donabedians Assessment of Patient Quality Care St. Marys Health Care SystemSt. Marys in Grand Rapids already has this bar code scanning system. The issue on the PMU is the work arounds nursing professionals have implemented to receive their medication administration easier. These work arounds are ways nurses can tranquillise administer medications without scanning the medication and/or patients identification band patronage the benefits it provides to the staff, it raises a variety of risks for the p atient and puts them at greater danger for adverse medication reactions, multiple dosing, incorrect dosing, and so forth. There are other issues reported by nurses that make the work arounds essential, such as the all-too-common issues face with the use of technology, that being technological malfunctions, limited availability despite the necessitate for the equipment, and sometimes merely, the time it consumes to find the equipment making the use of such technology more time consuming.As a registered nurse for over tight 30 years, I can see that the bar code system has proven advantageous and significant in the quality of patient care based on the mere assumption that under hospital care, the utmost elite care is to be provided including medication administration. The bar code scanning procedure implementation enables nurses to look at the (medication/dosage) order, when it was last administered , the dosing, as well as if there are any potential medication interactions to be o n the alert for, medication allergies, and whether there are any safety or physical maladies due to missed doses or inaccurate administration (ISMP, 2002). Finally, the technological advances provided for nursing professionals are implemented in order to better account for patient care and safety. The bar code and scanning system is computer-oriented and therefore, supplies a database and record for future use in the event there is any debate about the procedure utilized while hospitalized or even during hospitalization at an alternate hospital.Outcome componentLiterature has identified that there is an alliance between professional nursing care and positive health outcomes (Duffy Hoskins, 2003). Identifying ways to improve the process of medication administration can improve medication errors. Bar code scanning technology offers a productive way to avoid medications errors and increase patient safety (Begliomini, 2012). Measuring medication errors can be courtly using many differ ent processes but with computer analysis of the patients information, measurement becomes much easier and more capable and feasible than error reporting or reviewing charts for purposes of accountability, prevention, and ongoing improvement of both process and clinical practice (Classen Metzger, 2003, pg. 41). In summary, the literature reinforces the head that a decrease in patient medication errors is best accomplished by use of the bar code scanning for medication administration and therefore a responsibility for the nurse.