The Joint Commission challenges healthcare providers to continuously improve the quality of care that they offer (“Joint Commission International”, 2014). The Commission has identified a number of key metrics that are used to assess how prepared a facility is to attend to the needs of its customers. Facilities need to have the equipment needed to deliver quality care. It is also important for facilities to be adequately staffed (“Joint Commission International”, 2014). Once it is satisfied that a facility has satisfied its requirements, the Joint Commission proceeds to issue the facility with accreditation. The Nightingale Community Hospital is among the facilities that are pursuing accreditation. This facility has instituted a number of initiatives through which it hopes to improve service delivery. The progress that the facility has made is encouraging. However, if the facility is to be accredited, more reforms and improvements are needed.
Current compliance status
The Joint Commission recently evaluated Nightingale Community Hospital. The findings from this evaluation are essentially an indictment. This is because the hospital has failed to fully comply with the standards and guidelines that the Joint Commission issues. This commission requires proper and careful planning of treatment (“Joint Commission International”, 2014). After the evaluation, the Joint Commission established that while the hospital encourages its practitioners to work together, it has failed to develop a plan of care that brings together professionals from different disciplines (“Joint Commission Survey Results”, n.d). It was also determined that the hospital failed to use the progress that patients were making to prioritize the services that they offered. The Joint Commission proceeded to advise the hospital to conduct routine evaluations of its care goals to ensure that they are achieved.
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Adequate assessment of pain in all patients is another requirement that the Joint Commission expects hospitals to satisfy (“Joint Commission International”, 2014). The Commission found that Nightingale Community Hospital has not complied with this requirement. The Commission particularly observed that the hospital fails to assess how severe the pain that its patients are experiencing is (“Joint Commission Survey Results”, n.d). The Commission added that this failure makes it difficult for the hospital to determine if any pain has resulted from the treatment that it offers its patients. Patient education is another requirement that a hospital must satisfy to receive accreditation from the Joint Commission (“Joint Commission International”, 2014). The Commission noted with concern that the Nightingale Community Hospital has fallen short (“Joint Commission Survey Results”, n.d). It was observed that the hospital does not maintain records of the level of education, learning preference and the educational needs of its patients. These failures hinder patient education.
In an effort to enhance accountability, the Joint Commission challenges hospitals to ensure that all high-risk procedures are properly documented. When it evaluated the Nightingale Community Hospital, the Commission concluded that the hospital does not fully satisfy this standard. The Commission noted that out of the 21 records that it examined, two did not have notes which detailed the progress that patients had made following high-risk procedures (“Joint Commission Survey Results”, n.d). The Joint Commission encourages hospitals to effectively manage its services, programs and departments. Regarding this requirement, the Commission noted that the hospital fell short. After conducting interviews with the hospital’s staff, the Commission found that the hospital’s leadership had failed to clearly communicate (“Joint Commission Survey Results”, n.d).
Hospitals need to exercise great care when carrying out high-risk procedures (“Joint Commission International”, 2014). The Joint Commission admits this in its standards. It calls on hospitals to develop careful plans for the procedures. To determine if the Nightingale Community Hospital had complied with this guideline, the Commission examined patient records. It found that two of the records indicated that the hospital failed to reevaluate the patients right after they had undergone sedation. (“Joint Commission Survey Results”, n.d) This failure is indeed worrying and limits the chances of the hospital receiving accreditation. The failures also suggest that the hospital does not take patient safety seriously. All the failures discussed above suggest that the Nightingale Community Hospital needs to institute far-reaching reforms urgently.
Trends hindering compliance
The discussion above has examined some of the failures that will make it difficult for the Nightingale Community Hospital to receive accreditation from the Joint Commission. In addition to these failures, there are numerous trends which hinder compliance. One of the guidelines that the Joint Commission has issued concerns the need for hospitals to take steps to prevent and control infections (“Joint Commission International”, 2014). While Nightingale Community Hospital has taken some steps, trends at the hospital indicate that it has failed to go far enough. Hand-washing is among the measures that the hospital has adopted. The purpose of this measure is to promote hand hygiene and prevent infections. In Year 3, the hand-hygiene compliance stood at 93. In the following year, the figure dropped to 92 (“Safety Reports”, n.d). While this drop is not massive, it indicates that the hospital has lowered its commitment to patient welfare. This could harm its chances of receiving accreditation.
That Nightingale Community Hospital carries out audits to determine the progress that it is making is clear indication that the hospital desperately wishes to comply with the Joint Commission standards. One of the issues that the hospital conducts audit on is moderate sedation. The audit reveals that for the most part, the hospital takes great care when sedating its patients. However, there are a number of worrying trends which hamper compliance. The fall in the rate of monitoring vital signs is among this. In the first quarter, this rate stood at 92. In the subsequent quarters it rose to 95 and 94 (“Safety Reports”, n.d). The rate dropped to 93 in the fourth quarter. Another issue that registered a decline is VS monitoring every 30 minutes. It dropped from 92 in the first quarter to 88 in the fourth quarter (“Safety Reports”, n.d). These drops suggest that the hospital is endangering the lives of its patients. It needs to keep a close eye on its patients to safeguard their wellbeing and comply with the Joint Commission guidelines.
Falls are among the greatest hazards that patients face. They can cause injuries which compromise the wellbeing of patients (Grant, 2013). Nightingale Community Hospital carries out monthly audits where it examines the number of falls which occur and cause injuries. The audit reveals worrying trends. In January, the hospital reported zero falls that led to injuries. This number increased and peaked in August when 4.5 falls were recorded per 1000 patient days (“Staffing Effectiveness Report”, n.d). At the end of the year, the number stood at 3.8. It is clear that Nightingale Community Hospital needs to do more to shield patients against falls. It could be that the hospital’s floors are too slippery or it has failed to provide support to patients who encounter difficulties when they walk.
Performance improvement standard
It has been established above that Nightingale Community Hospital is not doing enough to enhance the wellbeing of its patients. Falls are among the hazards that the patients at this hospital face. There appears to be a relationship between staffing and the number of falls recorded. In the discussion that follows, the staffing patterns at the Nightingale Community Hospital are examined. A staffing plan for minimizing falls is also provided.
Staffing patterns
In its staffing effectiveness report, the Nightingale Community Hospital sheds light on the number of hours that its nurses work. According to the report, the nurses deliver variable amounts of care to the patients. For example, in January, the nurses attended to a patient for just over 11 hours (“Safety Reports”, n.d). This changed throughout the year as the patients received varying amounts of care. Another key pattern that one needs to note is that the nurses at the hospital appear to work overtime. This indicates that the nurses are truly committed to delivering service to the patients. However, it also raises questions regarding whether the nurses are in the right state of mind and health to deliver quality care. It has been noted that nurses usually suffer fatigue when they work for long hours (Caruso, 2014). The fatigue hinders their capacity to deliver quality care. Accidents are known to have occurred when nurses are exhausted yet are still required to continue offering services. The fact that its nurses work overtime is an issue that the Nightingale Community Hospital needs to review. The hospital should determine if the overtime hampers or promotes the wellbeing of the nurses and the patients.
Staffing plan
As noted earlier, there appears to be some correlation between the staffing at Nightingale Community Hospital and the number of falls reported. It seems that the patient falls increase on days when nurses deliver care for fewer hours. For example, in the 3 East Oncology unit, the number of falls increased when the number of nursing care hours that patients received decreased (“Safety Report” n.d). The lowest number of falls was recorded in mid-October when the number of nurse care hours was at its highest. The hospital recorded the most falls in mid-April (“Safety Report” n.d). During this time, the number of nurse care hours was slightly lower than that in mid-October. One obvious plan that the hospital can adopt is to increase the number of hours that the nurses deliver care. If the trend that has been observed is anything to go by, the hospital will register a general decline in the number of falls that are reported.
Nurses are usually required to perform a number of different roles. Clerical duties are among these. These duties limit the capacity of nurses to spend time with their patients. It has been recommended that hospitals need to spare nurses of certain duties so that they have more time to offer personal and adequate care and attention to patients (Grant, 2013). This measure promises to help hospitals minimize the number of patient falls. The Nightingale Community Hospital needs to urgently review the job description of its nurses. It should reassign roles that do not necessarily require the involvement of nurses to other staff. As it does this, the hospital will be placing its nurses in a position from where they can monitor patients and respond to all their needs.
While increasing the number of nursing care hours promises to reduce the number of falls, it is not enough. Nightingale Community Hospital needs to supplement this measure with other staffing interventions. One of the factors that have received blame for causing patient falls is nurse failure to respond to bell calls (Butcher, 2013). When a patient is in distress and requires the urgent intervention of a nurse, they usually make a bell call. The nurse failure to respond to this call could cause the patient to fall. It is possible that some of the falls that Nightingale Community Hospital witnesses are the result of the nurses failing to respond to bell calls promptly. The hospital needs to train the nurses on the need to attend to patients with urgency. The implementation of this plan will allow the hospital to significantly reduce the number of falls.
In conclusion, the Joint Commission aims to promote the health and wellbeing of patients. To achieve this, the Commission requires hospitals to fulfill a number of requirements. The requirement range from taking action to prevent infections to instituting measures aimed at enhancing accountability. Nightingale Community Hospital has attempted to comply with these requirements. However, for the most part, the hospital has failed. One particular area of failure is in the prevention of patient falls. This failure can be blamed on poor staffing practices that the hospital has adopted. To minimize falls and comply with other standards that the Joint Commission has developed, the hospital needs to move with speed and implement reforms.
References
Butcher, L. (2013). The No-Fall Zone. Retrieved 5 th November 2017 from https://www.hhnmag.com/articles/6404-Hospitals-work-to-prevent-patient-falls
Caruso, C. C. (2014). Negative Impacts of Shiftwork and Long Work Hours. Rehabilitation Nursing, 39 (1), 16-25.
Grant, L. (2013). Make Time for Nurses to Reduce Patient Falls. Retrieved 5 th November 2017 from https://www.nursingtimes.net/making-time-for-nurses-to-reduce-patient-falls/5063197.article
Joint Commission International Accreditation Standards for Hospitals. (2014). Retrieved 5 th October 2017 from
https://www.jointcommissioninternational.org/assets/3/7/Hospital-5E-Standards-Only-Mar2014.pdf
Joint Commission Survey Results. (n.d).
