ImprovingCompliance with Two Patient Identifiers
ImprovingCompliance with Two Patient Identifiers
Accurateidentification of patients is one of the key measures that canresolve the highly debated issues of medication errors. This isbecause identifying the correct patient for any given diagnosis andtreatment procedures ensure that all clients receive health careservices that address their specific medical needs. This can beaccomplished by the use of at least two patient identifiers.According to The Joint Commission (2012) two patient identifiers havetwo major roles, including reliable identification of persons who areintended to receive the treatment and matching treatment to intendedpatients. This paper provides a discussion of how compliance can beenhanced using two patient identifiers. The use of two patientidentifiers is the most effective way of ensuring that the healthcare professionals comply with patient safety standards.
Identificationof the problem using the IOM Aims
Healthcare problems related to inaccurate identification of patients can beresolved using the six aims of quality health care services developedby the Institute of Medicine. The institute was motivated by theincrease in the number of patient injuries and medication errors toformulate “the aims” of patient safety. Conducting the wrongtreatment procedures on wrong patients, especially in the ICU is amajor threat to clients’ safety in the contemporary health caresetting (Slonim & Pallack, 2005).
Criticalhealth care services are highly variable between health careinstitutions and practitioners, and this account for existingdifferences in the effectiveness of delivery of health care services.These variations have allowed some health care facilities andpractitioners to be more lenient in the process of patientidentification before medical procedures are conducted.
Third,the overall quality of health care services has reduced following theuse of substandard and discriminating patient identifiers (such asthe insurance status, income, and ethnicity) to identify patients.This reduces equity in the delivery of health care services, whichnecessitates the use of professional approaches (such as the twopatient identifiers) to identify patients.
Fourth,timeliness is an important factor that determined the effectivenessof clinical procedures. These aims focus on effective, timelycommunication, and wait times. According to Slonim & Pallack(2005) patients treated in the wrong hospital units are more likelyto receive more injuries compared to those who are served in thecorrect units. This implies that correct patient identificationduring admission and transfer can play a major role in reducingtreatment errors.
Fifth,patient centeredness in health care services help in characterizationof interactions between patients and health care providers. Healthcare personnel are expected to have traits that facilitate highquality health care, including compassion, empathy, and respect. Thehealth care providers with such traits focus on the needs of theirclients, which implies that they are willing to do all that isnecessary (including the proper identification of patients) to avoiderrors.
Thelast aim is efficiency, which is based on the notion that health careresources should be delivered in efficient and cost effective manner,without jeopardizing the quality of those services. For example, thevalue of health care for a patient in the ICU can be increased byensuring that the desired outcome is achieved, while maintainingcosts at minimum. In this case, proper identification of patientsreduces the occurrence of treatment errors, thus decreasing the costof treating medical complications that result from those errors. Italso ensures that patients recover within the shortest time in orderto avoid the cost of prolonged hospitalization.
Failureto comply with the requirements of two patient identifiers is apatient safety concern because it increases the probability of theoccurrence of treatment errors and injuries. This result from thedelivery of wrong treatment services to the wrong patients. Accordingto Mollon & Fields (2009) many health care providers fail to usetwo patient identifiers because they consider the process to beunnecessary and time consuming. This is a breach of quality andsafety standards established by the stakeholders in the health caresector. For example, the fourth standard developed by the CareQuality Commission (2014) states that clients should receive safe andappropriate health care that addresses their needs and providessupport for their rights.
Theissue of failure by the health care professionals to use the twopatient identifiers is measured using the patient identificationobservation audit. Mollon & Fields (2009) used the patientidentification observation audit tool and identified an improvementin full compliance among the licensed nurses from 23 % to 30 % afterposter education and 68 % after in-service education an improvementin partial compliance from 37 % to 40 % after poster education and adecline to 10 % after in-service education full compliance among thenursing assistants increased from 50 % to 67 % after in-serviceeducation and declined to 14 % after poster education. These findingsindicate that there is a high rate of noncompliance with acceptedprocedures for patient identification, but this can be resolvedthrough poster education and in-service education.
Theactual cost of safety and quality issue can be assessed bydetermining the cost of medical errors that result from improperidentification of patients. According to National Health Service(2014) about 7 % of prescription items, 2.7 % of dispensing, and 3 %of medicine administrations are erroneous. This costs the UnitedStates about $ 1 trillion annually (Goedert, 2012). The high cost oferrors results from the medical services administered to counter thecomplications resulting from these errors.
Focusarea: the “5 Ps”
Themain purpose of the intensive care unit (ICU) is to provide care forchronically ill patients. The ICU addresses health problems ofpatients in critical conditions. Patients with acute illnesses arenot treated in the ICU. Some of the health care services provided inthe ICU include heart attack, pulmonary embolism, brain injury, andsevere trauma. Some of the professionals who serve in the ICU includedoctors, nutritionists, respiratory therapists, pharmacists, physicaltherapists, and case workers. Processes: Some of the common practicesdone on a regular basis in the ICU include fixing of breathingmachines, feeding tubes, intravenous injections, and monitoringpatient recovery. However, these processes are accomplished incollaboration with other professionals. For example, nurses monitorthe recovery progress of patients. Patterns: An increase in thedifficulty of identifying patients in the ICU is one of the commontrends that are expected in the ICU. This is because most of thepatients are unconscious, which means that health care providerscannot identify them through interrogation.
Progressmade in resolving the issue of patient identification
Currently,the ICU administration has stopped relying on relatives of theadmitted patients or asking the clients their personal details as ameans of patient identification. This is because some treatmentprocedures are administered in the absence of relatives and some ofthe clients admitted in the ICU are unconscious, which means thatthey cannot answer questions. This has increased the tendency ofhealth care providers to rely on their familiarity with patients inidentifying them. However, reliance on providers’ familiarity withpatients has not resolved the issue of medical errors that resultfrom the wrong identification of patients. This means that thepatient identification has to be done in a more effective way. Thetwo patient identifiers is the most appropriate alternative. The ICUdepartment has managed to provide educational programs on two patientidentifiers to all the ICU members of staff. However, there still ahigh rate of non-compliance with procedures of the two patientidentifiers by the ICU staff. This means that a follow-up program isneeded to ensure that the ICU members of staff follow procedures oftwo patient identifiers. The clinical practice guidelines will beused to find a sustainable solution to the problem of non-compliancewith procedures of two patient identifiers. The guidelines focus onthe level of available evidence, the quality of the evidence,strength, and relevance of the evidence (National Health and MedicalResearch Council, 1999).
Benefitsof using the EBP model
Thereare three benefits that will be obtained from the use of the EBPmodel of EBP. First, the model facilitates the incorporation of themost recent evidence into health care services (Tangient LLC, 2014).This will lead to an improvement in the quality of health care aswell as treatment outcome in the ICU. For example, the use of the EBPmodel will provide an up-to-date solution to the issue of lack ofcompliance with the two patient identifiers protocols (Nathan, Nawa,Rosales, Schwerin, 2014). Secondly, use of the model to improve thequality of health care services in the ICU will enhance the nurses’adaptability, skills, confidence, and ability to make decisions, andthink logically (Tangient LLC, 2014). Third, the application of themodel encourages teamwork, which is needed in nearly all processesthat are conducted in the ICU. This implies that the EBP model willenhance collaboration among the health care professionals.
Thefive IOM Aims (including safety, efficiency, effectiveness,timeliness, equity, and patient centeredness) provide a usefulframework for the identification and resolution of the issue of poornoncompliance in a health care setting. The five Ps of the ClinicalMicrosystems Model enhances the understanding of the ICU as an areaof focus. The ICU department has shifted from the use of relativesand patient interrogations as a means of patient identification tothe use of familiarity, but this should be replaced by theapplication of two patient identifiers. The use of the EBP model willprovide up-to-date information that will help in adoption of the bestpractices in patient identification. The model will also enhancecollaboration among the health care providers.
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