Subdomain: Healthcare Operations Management, Essay Example

Introduction

As is the case with all professional healthcare institutions, such as NightingaleCommunityHospital whose overall goal is to create a healing environment, patient safety ranks as the most important attribute. One reason for this is the Patient Safety and Quality Improvement Act of 2005 which was created “in response to growing concerns about patient safety in the United States” and the Institute of Medicine’s 1999 report To Err is Human: Building a Safer Health System. In essence then, the foundation of these two entities is simple–to foster and encourage a nationwide culture of patient safety (Patient Safety and Quality Improvement Act of 2005, 2012).

Of course, patient safety is the main responsibility of those that provide patient care in a hospital environment, such as nurses and other on-site nursing personnel. This is especially relevant when dealing with patients that have undergone some type of serious and possibly life-threatening operation and/or procedure. For example, one of the most common surgical procedures in the United States is a hysterectomy with approximately 570,000 cases performed in 2006. The most common surgical approach is either vaginal or laparoscopic, both of which are considered as minimally invasive procedures as contrasted the abdominal surgical approach (Einarsson& Suzuki, 2009).

As noted by Jon Einarsson and Yoko Suzuki, vaginal and laparoscopic hysterectomies have been shown through extensive research studies to be “clearly associated with decreased blood loss, shorter hospital stays, speedier returns to normal activities, and fewer abdominal wall infections” as contrasted with the more traditional abdominal hysterectomy. Therefore, surgeons that specialize in hysterectomies must be made to understand that vaginal hysterectomies are almost always preferable to abdominal hysterectomies and that a “laparoscopic hysterectomy should be attempted when a vaginal hysterectomy is not possible,” to due to a number of existing physical obstacles or malformations in any given female patient. Einarsson and Suzuki also point out that the vaginal approach “may be challenging in patients with a history of an adnexal mass, endometriosis, pelvic pain, prior abdominal surgery, or . . . with a narrow pubic arch or poor vaginal descent” (2009).

Tracer Patient Case Summary

For this assessment, the tracer patient is a sixty-seven year-old female who had undergone a laparoscopic hysterectomy which was subsequently converted to an open procedure (i.e., an abdominal hysterectomy) because of excessive bleeding approximately five weeks prior to being admitted to the hospital. At this time, the patient developed fever and drainage which required that she be readmitted for possible post-operative infection. Consequently, the patient underwent additional surgery in order to treat abscesses that had developed as a result of her previous surgery. Also at this time, a central line was inserted as a way to administer long-term antibiotics. Rather than choosing re-admittance to the hospital for observation, the patient is scheduled to be sent home under the assistance of a professional home based nurse who will provide the patient with needed assistance related to antibiotic therapy and any possible future emergencies concerning additional abscesses and bleeding.

Patient Care Issues

• Patient Age Range–Due to the fact that the patient is sixty-seven years old, the surgeon and his/her team should have been made aware of the fact that invasive hysterectomy procedures in women over the age of sixty brings with it certain risks and side effects. Even though a radical hysterectomy has been shown to be highly effective as a treatment option for cervical and other types of cancer, most physicians have concluded that a hysterectomy is less preferable because of unexpected medical complications, such as abscesses and bleeding.
• Prepping the Patient–Because of the patient’s age, special considerations should have been made by the surgeon and his/her team members in relation to making internal observations on the physical condition of the patient’s uterus, ovaries, and other reproductive organs in order to determine their level of failure related to abscesses and bleeding.
• Abnormal Bleeding–This is also related to the age of the patient who at sixty-seven years of age has obviously ceased menstruating. In her case, excessive bleeding is not a normal condition and in some instances may indicate the existence of cervical or ovarian cancer. Therefore, the surgeon and his/her team members should have performed an endometrial biopsy and/or a D&C (dilation and curettage) which would have exposed some of the reasons for the abscesses and excessive bleeding.

Corrective Action Plan

As to devising an appropriate corrective action plan for the patient, the surgeon and his/her team members should have paid great attention to the following protocols:

• Pre-Operational Observations–This would have included observing and monitoring the internal physical condition of the patient’s internal reproductive organs. This procedure would have helped to guarantee that the internal condition of the patient was at sufficient levels for a successful laparoscopic hysterectomy.
• Cleanliness and Sterilization–As is the case for all forms of invasive surgical procedures, the surgeon and his/her team members should have thoroughly examined the patient’s internal vitality so as to help lower incidences of developing abscesses and excessive bleeding. Also, all of the findings should have been directed to the surgeon and all post-operative entities.
• A Thorough Re-evaluation–The surgeon and his/her team members should have conducted a thorough re-evaluation of the patient’s internal condition, especially related to the internal organs and systems that would be affected by the invasive application of a laparoscopic hysterectomy procedure.

Conclusion

As noted by the Joint Commission, most of the standards created by this important entity are directly related to patient safety and protocols, such as issues related to the application of medication, infection control, surgery and anesthesia, transfusions, restraint and seclusion, staffing, and staff competence (Patient Safety and Performance Measurement Fact Sheets, 2015). Thus, in regards to the sixty-seven year old tracer patient at Nightingale Community Hospital, all attending physicians, surgeons, and team members responsible for carrying out the laparoscopic hysterectomy should have been made fully aware of the Joint Commission’s 2014 Patient Safety Systems chapter of the hospital manual which describes “how hospital leaders can use existing requirements to achieve improved quality of care and patient safety” as a sort of road map for”implementing a fully integrated patient safety system”that allows surgeons and team members to work together to help eliminate the possibility of medical complications, especially when elderly patients are involved in a given medical procedure (Patient Safety and Performance Measurement Fact Sheets, 2015).

References

Einarsson, J., and Suzuki, Y. (2009). Total laparoscopic hysterectomy: 10 steps toward successful procedure.Reviews in Obstetrics and Gynecology (2)1: 57-64. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC 2673000

Patient safety and performance measurement fact sheets. (2015). The Joint Commission. Retrieved from http://www.jointcommission.org/about_us/patient_safety_fact_sheets.aspx

Patient safety and quality improvement act of 2005. (2012). AHRQ: Agency for Heathcare Research and quality. Retrieved from http://archive.ahrq.gov/news/newsroom/press-releases/2008/psoact.html