Patient Falls and Medication Errors Essay

Issue/Problem of Interest sack atomic keep down 18 the cooperate intimately reciprocal adverse event within wellness palm institutions following medication errors, and an estimated 30% of infirmary-based move reply in hard reproach. The severity of this problem led the vocalize Commission to make reducing the assay of patient role injuries from go a home(a) patient safety goal for infirmarys in 2009 (AHRQ, 2006). fall are a leadership cause of hospital-acquired injury and a great deal keep and implicate hospital stays and result in poor feel of life, change magnitude costs, and unanticipated admissions to long-term portion out facilities. Changes in wellness armorial bearing financing in the 1990s were accompanied by a variety of cost-cutting measures in hospitals across the joined States. Common cost-cutting strategies included reducing the extreme number of nursing hours per patient mean solar day and reducing the percent get on with of hours supplied by registered halts (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 timbre of care, the American Nurses Association (ANA) launched the Patient gumshoe and Nursing Quality Initiatives in 1994 to quotation the impact of health care restructuring on patient care and nursing. To facilitate the initiative, ANA establish the National Database of Nursing Quality Indicators (NDNQI) in 1997, with two goals (1) to develop a database that would abide empirical monitoring of the impact of nurse staffing on patient safety and quality of care across the nation, and (2) to provide psyche hospitals with a quality improvement mari unrivalledtte that includes national comparisons of nurse staffing and patient outcomes with like hospitals (Hart and Davis, 2010).Selection RationalePatient falls impact hospitals both financially and in regulatory body status . In 2005, in response to disturbing and widely cited findings by the Institute of Medicine about the prevalence of life-threatening conditions acquired by patients in U.S. hospitals, telling authorized the Centers for Medicare and Medicaid Services (CMS) to implement retribution changes designed to encourage the prevention of much(prenominal)(prenominal) conditions. Under an amendment to the Social Security coiffe that was enacted on January 1, 2007, the secretary of Health and humanity Services was occupyd 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 bow as a secondary diagnosis and that could reasonably be prevented through the diligence of evidence-based guidelines (New England Journal of Medicine, 2009).The CMS worked collaboratively with the Centers for Disease Control and taproom (CDC) a nd on October 1, 2008, enacted new payment supply Medicare will no longer reimburse 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 elbow grease 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 later 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 lavishness 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 stateThe target universe chosen consists of patients admitted to the checkup and working(a) floors at two life size teaching hospitals. The first hospital is a 1,000 bed not-for-profit teaching hospital placed in Dallas, Texas with an average day-by-day census of 917. This organization consists of 12 medical exam exam and operative floors with a join bed cogency of 428. Each floor consists of the nurse manager, registered nurses, aware nursing assistants, and unit secretaries. Patients most frequently cared for on the medical floors at this installment 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, stomachal bypass surgery, abdominal explorative surgery, neurovascular surgery, gestate kidney and liver transplant patients, and those patients recovering from gynecologic operations.The population of patients universe cared for at this hosp ital comprise mostly of patients 55  historic period 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 massive assistance, and 50% require peculiar(a) assistance. The second hospital system, marriageShore 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 tack 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 top medical DRGs include congestive heart distress (CHF), pneumonia, respiratory, acute myocardial infarction (AMI), and CVA. The top surgical admissions include ort hopedic occasion 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 plebeian and may lead to negative outcomes such as injuries, prolonged hospitalization, and legal responsibility. Falls can also have sober effects on a persons 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 unsuitable patient event (Steven, 2004). Patient falls are the second most general cause of harm in hospitals and are the leading category of reported incidents in hospitals affecting approximately three to 20% of patients during their hospitalization (Sutton &ump Wallace, 2005). The frequency of patient fa lls, as recorded in the literature, ranges from 25% to 89% of all hospital adverse incidents, depending on the patient population studied (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 bailiwick by the National Council on Aging, 30% of these incidences result in serious injury (Stevens, 2004). Another significant consequence of falls is that they are expensive and contribute to the change magnitude 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 developing atmosphere of pay-for-performance, initiated by CMS, hospitals directly have a major financial stake in reducing the number of fall-related injuries. The CDC estimates that the cost of fall injuries will pass away $23 billion within the nigh few years (Tzeng, 2008).