Older people are the most vulnerable group of patients in the healthcare system. In the past few decades, life expectancy has been on the rise, while birth rates continue to decrease (Kruse et al., 2017). This notion, along with the prevalence of chronic illnesses in older populations, signifies the need for sustainable long-term care (LTC) facilities (Kruse et al., 2017). However, the current situation shows numerous insufficiencies in guidelines and policies regarding this sector of healthcare. Many nursing homes in the United States are below the average healthcare facility regarding almost all patient safety factors (Katz & Gurses, 2019). As the number of admissions to residential facilities in the United States continues to increase, the strain on the healthcare system calls for urgent changes in LTC policies to avoid future crises (Dyer, 2020). There is a definite need for further examination of this topic. This research paper overviews the quality improvement program discusses risks that affect long-term care facilities, ways of their mitigation, and proposes a plan of correction.
Evaluation of the Quality Improvement Program
In order to demonstrate how to alleviate the current issues that plague long-term care facilities, I have constructed a quality improvement program based on the most prevalent risk factors in this setting. The studied facility had numerous issues regarding standards and practices that were applied there. I categorized the most widespread risks that were present and identified that medication management and infection prevention were the most severely underdeveloped sectors.
Infection prevention and control is a crucial part of care activities and must be considered the top priority. While there were no critical incidents due to staff negligence of infection risks, even minor infections, while easily treatable, decrease the quality of life of a patient and increase the chances of health complications in the future. The issues with infections in LTC are not uncommon since, in the United States, there is no clear set of guidelines regarding infection prevention and screening procedures in the LTC setting (Katz & Gurses, 2019). By measuring the percentage of patients who acquired infections while in an LTC setting, the organization can evaluate the success of the program regarding this risk factor.
Medication issues can cause significant financial and reputational losses, as they can easily lead to an adverse outcome. The organization already had such an incident in the past, where it had to pay $2.4. mil. in damages after inadvertently causing a patient’s death. The situation is feasible, as many LTC facilities often face legal issues with timely or inappropriate medication administration (Harrington & Edelman, 2018). Furthermore, error reporting policies need to be updated as well to focus on gaining evidence for future prevention instead of assigning punishments. These reports will be used as an indicator of the program’s success.
Other issues consist of discrepancies of information transferred within the organization, inefficient management, insufficient attention to new technologies, and lagging treatment standards in the recent past. Healthcare facilities that operate in this sector indeed often have severe issues with personnel turnover and knowledge gaps, which lead to organizational problems and the inability to use innovations (Katz & Gurses, 2019). Moreover, LTC organizations experience a lack of funding and shortages of staff more often than other healthcare sectors (Katz & Gurses, 2019). To measure the reduction of organizational and financial problems within the company, it is possible to examine the number of errors due to miscommunication and shortages of the budget that have an adverse impact on the quality of care.
By implementing this program, the examined facility and many other ones can experience decreased risks of incidents, LTC personnel will be less exposed to stressful situations, and the quality of life of patients will be elevated. In addition, due to the potential savings from lower risk management expenditures, the organization can become more profitable. The quality improvement plan puts an emphasis on the increased standards of control over staff interaction with patients to address several issues. They include management of personal information, lacking procedure protocols, lacking attention to patients’ needs, and issues regarding medical reports. The facility needs to put more effort into providing safety and comfort to its patients and personnel by updating its policies, organizational structure, educating personnel, and, possibly, changing leadership positions. As the compliance rates increase, the quality of service will rise, and the company will see a higher return on investment, lower turnover rates, and its reputation will turn back to positive.
Risks and Their Indicators
Risk factors affect all involved parties: residents, personnel, and organizations themselves. It is essential for healthcare facilities to address issues related to all stakeholders to expect a noticeable improvement in service quality. The indicators can reveal what parts of the organization are insufficient and need to be reviewed to find their flaws and underdevelopment. By continually assessing these parameters, LTC facilities can achieve continuous quality improvement.
Falls are a common risk for patients, especially if their movement is already impaired. The majority of injuries in LTC facilities come from falls, which put a significant financial burden on the healthcare system and often result in severe damage due to the fragility of older people (Lopez et al., 2019). It is often linked with high staff turnover, which decreases the attention toward patients, and the lack of necessary precautions within the facility to prevent fall damage (Lopez et al., 2019). Many patients in LTC have low physical capabilities, signifying the need to monitor their movement.
Infectious diseases are also a significant issue for LTC that needs to be thoroughly reviewed. Katz and Gurses (2019) argue that in LTC facilities, “access to diagnostic tests is often limited, there is little or no antibiotic stewardship, and the patient population is more complex and fragile” (p. 95). Katz and Gurses (2019) state that, in some LTC facilities, “infection prevention procedures are seen as a ‘nuisance’ leading to inefficiency in completing a task” (p. 98). There is a strong need for a change of attitude toward infection protocols, and each healthcare facility needs to create and uphold these standards.
There are several factors that can be used as indicators of decreased quality of care. Residents of LTC facilities with underqualified personnel tend to develop mental health issues more often, depression is the most common among them (Chau et al., 2018). Despite this fact, measures taken against it are scarce, and research regarding this topic has not been conducted until recently (Chau et al., 2018). The primary reasons for depression in this setting are functional disability, loss of cognitive functions, declining physical health, feelings of disconnection and loneliness, and side effects from medications (Chau et al., 2018). By giving patients an opportunity to provide feedback, LTC facilities can assess the quality of service.
Neglect of patients’ needs and limitations can lead to various health complications. Pressure ulcers are a common issue among LTC residents, ranging from 2.2% of facility patients to 23.9% in the worst cases (Cowan et al., 2019). The increased rates of pressure ulcers in a facility signify the lack of attention that leads to this type of tissue damage. It can be viewed as a risk indicator, as it also indicates insufficient actions from staff. Another indicator is the usage of physical restraints on patients. It can occur due to the staff’s inability to control patients’ unpredictable actions, prevent their movement, and avoid harm they can inflict to others and themselves. However, this method is highly inadvisable, as it leads to both physical and mental damage, as restraints can damage impair blood flow, change their behavior to worse, and lead to a negative attitude toward staff (Lan et al., 2017). By analyzing the frequency of restraint usage, LTC facilities can measure the competency of their personnel.
Personnel is exposed to risks at work in the LTC setting as well. The relationships among personnel also play a crucial role in staff retention. LTC facilities need to assess the gap between physicians and nurses who interact directly with patients. The absence of direct communication between these two parties can create adverse incidents, such as inappropriate medication prescription, insufficient data regarding the patient’s condition and symptoms, and other factors that contribute to poor outcomes (Brophy et al., 2019). The culture within the organization must be assessed to determine if there is any hostility between staff members.
Moreover, staff in LTC settings tend to become a subject of physical violence and verbal insults. Volatile residents, when met with unfamiliar nurses, may become aggressive, and the lack of proper staff training can lead to an inability to peacefully resolve a conflict (Brophy et al., 2019). It is especially crucial to train LTC staff on dealing with patients with dementia, including security personnel, so they should be able to avoid triggering their outbursts or efficiently prevent any harm without causing damage (Brophy et al., 2019). Facilities must consider additional precautions when handling these patients and support their employees who may face physical injuries.
LTC organizations are also exposed to several risks that add to the unsatisfactory quality of service. High turnover rates and the lack of experienced personnel in LTC organizations can cause issues with acceptance of new guidelines, implementation of new technologies, and reputation losses. Due to unfamiliarity with their patients, fresh staff members have additional exposure to stress, which decreases their output and the quality of service. It is necessary for facilities to promote the organizational culture of proficiency and a forward-looking attitude and aim to support the functionality of their residents. These issues call for an urgent change of policies related to these facilities, otherwise, there will not be any improvement to the service quality. Quality reports can be used as an indicator of risks associated with the organization itself.
Plan of Correction
In order to begin the reformation for better quality, the company needs to address the low usage of technology. To resolve the issues with medication treatment, this facility can make use of the electronic health records system. Kruse et al. (2017) state that “the level of adoption of EHRs in the United States […] is low” (p. 2). EHR systems often include prescription checking utilities and tips and can be used simultaneously with barcodes and automated drug dispensing machines to decrease human errors further. Furthermore, Kruse et al. (2017) state that the usage of EHR increases “interprofessional integration, thereby improving the quality of care” (p. 5). Kruse et al. (2017) argue that “the EHR can improve quality of care in LTC facilities through a reduction in medication-related errors, improved clinical documentation and decision making” (p. 2). The unified record system can serve as a strong foundation for the optimization of the organizational structure and culture, as all staff members can access, share, and update the patient’s information (Kruse et al., 2017). This technology alone can solve several critical issues, however, it must come in conjunction with other measures.
It is necessary for the facility to create stringent standards for safety checks, improve staff’s knowledge and attitude toward this topic, and increase adherence to the hygiene protocol. There is a particular need to invest in personnel training regarding patient interactions. To ensure the continuous quality improvement of LTC, facilities need to recognize the importance of constant investments in training and education of staff members (Caspar et al., 2016). Moreover, this issue can also be alleviated by sharing patient data via EHR since it contains information regarding immunizations, past medical history, and laboratory reports. It is vital for LTC facilities to create and uphold an organizational culture that focuses on patient safety and comfort. Periodical surveys among both personnel and patients can help identify additional areas for improvement.
The management part of the correction plan includes several changes to the structure and culture of the organization. The focus of the treatment process must be on the patient and his or her needs, and all personnel must work toward this goal. It can be achieved by using better options for interprofessional communication and assigning and training team leaders to encourage teamwork. While the creation of individualized care plans for LTC residents is a basic standard practice, it is not often adequately utilized, if used at all (Caspar et al., 2016). These plans and similar approaches can help personnel with addressing patients’ needs.
In conclusion, there are numerous issues that plague long-term care facilities, and there is a definite need for a change of approach toward these healthcare organizations. The quality improvement program shows these insufficiencies and gives recommendations on the ways to reduce the adverse impact of the most prevalent issues within the LTC setting. It is necessary to implement changes in LTC guidelines to achieve the desired quality of service. While many facilities acknowledge this need, due to the complexity of this issue and various external and internal issues, such as inappropriate staffing or low financing, LTC organizations often lack quality improvement programs.
The quality of life of older patients must be included in the guidelines as the top priority for personnel. It is essential for LTC facilities to focus on the quality of life and individualized needs of its residents instead of prioritizing regulatory compliance to achieve more superior results regarding the quality of care. By using this quality improvement program, LTC organizations can transform this healthcare sector from mostly unsuitable for business into a prestigious specialization.
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