Patient Safety Culture (Psc) Amongst the Staff at the National District Hospital (Ndh)

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The health worker tended to a critically ill patient which was on bedrest. This patient was riddled with pressure ulcers due to nurses not rotating bedridden patients. This incident was just the trigger needed to evaluate other concerns like patient safety. The identified problem was poor patient care. A research study was done by Mayeng and Wolvaardt (2015). This research then identified the inadequacies with PSC and gives health professionals clear directive to develop strategies to ensure a PSC that nurtures quality patient care.

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Interventions implemented to enhance patient care. The department of health initiated an all-encompassing National Policy for Patient Safety Incident Reporting and Learning (2016) in the South Africa health system.Initiatives that was taken to address the problem of poor patient care includes workshops where the issue was addressed, different speakers were invited to speak about the National Policy for Patient Safety and Incident Reporting and Leaning and the need for quality patient care. Lectures were also given on the importance of positioning of bedridden patients. The causes for this problem may be that nursing staff are not aware of the problem, it could be that they are not aware of methods to prevent pressure ulcers. Another fact that must be considered is that the nursing staff is assumes that pressure ulcers is a normal occurrence in bedridden patients. To address the problem. Other interventions include:

  1. 1. Identify all bedridden patients suffering from pressure ulcers so that remedial action can be taken.
  2. 2. Daily recording of any changes pertaining pressure ulcers to prevent a recurrence.
  3. 3. Test the knowledge of health workers about the protocols for patient positioning and rotation of bedridden patients.
  4. 4. Provide training to all health workers of the Critical Care Unit (CCU) pertaining to the protocols for patient position and rotation.

The aim is to assess the situations, establishing how many patients suffer from pressure ulcers in the CCU. The ultimate objective is to gradually treat those that are affected and prevent the patients that do not suffer from pressure ulcers from developing pressure ulcers. This will be accomplished by documenting details of every patient in the CCU to formulate objectives and implement a plan to reach the goal. In order to measure progress, an evaluation process will indicate daily progress.

The prevention of pressure ulcers is an important nursing intervention in every healthcare setting. According to EPUAP and NPUAP (2009), each health care setting should establish own policy for risk assessment. They should have a structured approach to risk assessment relevant to that healthcare setting, targeting clinical areas including the timing of the risk assessment and reassessment, documentation of risk assessment and communication of required information to the wider healthcare team. In addition, the recently published Finnish research foundation’s HOTUS guideline is also addressing the importance of social and healthcare organizations having operational guidelines regarding the assessment of risk for pressure ulcers, including a skin and tissue assessment procedure.

Skin assessment and prevention of bed-related pressure ulcersSkin assessment and prevention of medical device-related pressure ulcers Skin assessment should be comprehensive and regular. It should include identifying redness, blanching response, localized heat, oedema and hardness of the skin. It should be known that people with darker pigmented skin are in greater risk of pressure ulceration. Individuals should be asked about for any discomfort and pain since the pain over the site can be a precursor to tissue breakdown. Accurate monitoring is essential for monitoring the progress of the individual, especially when there is any pain possibly related to pressure damage. Any medical devices should be chosen so that they cause a minimal damage due to pressure or shear and while attaching any tubes, the focus should be on avoidance of pressure to tissues in question. The position of the patient and medical devices should be such where the pressure is evenly distributed and shear is alleviated. If it is possible, the patient should not be placed directly on top of any medical devices. The position of medical devices should always be adjusted and altered when possible. (HOTUS, 2015).

Repositioning and early mobilizationIn addition to a risk and a skin assessment, key priorities in prevention are also repositioning and the use of preventative devices. In NICE Guidelines (2014) adult patients at risk of developing a pressure ulcer should be encouraged to change position frequently, at least every six hours. Adults at high risk should be encouraged or assisted to change their position frequently and at least every four hours. There is pressure distributing devices available and they should be used in adults who have been assessed as being at high risk of developing a pressure ulcer or patients undergoing a surgery or patient who sits for prolonged periods.

Documentation of pressure ulcer care

Documentation of pressure ulcer care Documentation provides evidence that the care planning is appropriate and serves as a basis of the patient monitoring. A structured approach should consist of combining the risk assessment scale with a comprehensive skin assessment and clinical judgement.

The establishment of skin-care teams, education programs and care protocols together with risk assessment can reduce the incidence of pressure ulcers. Risk factors identified should always lead to an individualized care plan. Recording all occurrences of pressure ulcers graded two or above to the patient safety reporting system as a local incident can help improve the clinical practice and patient care. (Chamanga, 2011). Documentation in a structured way may promote the consistent recording of pressure ulcers, which in turn improves the follow-up of nursing results and efficiency. This can improve the nursing efficiency and level of knowledge. (HOTUS, 2015).

Nutrition is an important part of comprehensive care and the prevention of pressure ulcers. The body needs an adequate intake of calories, protein, fluids, vitamins and minerals to maintain skin integrity and preventing tissue breakdown. Known risk factors for pressure ulcer development are compromised nutritional statuses such as unintentional weight loss, undernutrition, protein-energy malnutrition and dehydration. Other risk factors associated with an increased risk of pressure ulcers are a low body mass index (BMI), reduced food intake and impaired ability to eat independently. (Dorner, Posthauer & Thomas, 2009).

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