Written Essay: 3803NRS Inter-professional Practice & Patient Safety
Word Limit: 2000 words
Due Date: Monday April 8th, 2019, 5pm
The purpose of this essay is to enable you to critically evaluate current research on the topic of ‘Failure to rescue’ as it relates to the deteriorating patient in the acute healthcare environment. You will examine nursing strategies that can be used to prevent this occurrence in a hospital including the role of inter-professional practice in promoting patient safety.
This assessment item will address all three (3) learning outcomes for this course.
For this task you need to write a 2000-word essay. Using failure to rescue as the topic of your essay, you are required to critically evaluate this issue. Your analysis should include a discussion of incidence, consequences and then prevention strategies. The analysis should include the discussion of two (2) nursing strategies that involve interprofessional practice and the identification of barriers that affect the implementation of such strategies. Patient safety needs to underpin this analysis & discussion.
Your essay MUST include the following components:
- An introductory paragraph that identifies the aim of the assignment.
- A definition of failure to rescue.
- A discussion of the incidence of adverse events linked to failure to rescue in Australian hospital settings.
- An analysis of the consequences of failure to rescue for the patient, the patient’s family and the health care system
- A discussion of the potential barriers (discuss TWO) that can result in registered nurses failing to rescue in a hospital setting.
- A discussion about how registered nurses may overcome these potential barriers (TWO chosen) in a hospital setting to promote patient safety.
- A critical evaluation of TWO nursing strategies involving inter-professional practice that may be used to prevent registered nurses from failing to rescue.
- A conclusion with a final paragraph summarising the central points of your essay.
- A Reference list formatted to APA6 style.
- Reference to a minimum of 10 journal articles no more than five years old.
Note that the term critically evaluate “sometimes called critically analyse or review means to show the essence of something by breaking it down into it is components parts, examining each part in detail and explaining issues…” (Griffith Health Writing and Referencing Guide, 2018, paragraph 1). It also means making connections and seeing relationships between information. The term critically evaluate also implies to weigh up strengths and weaknesses and judge the worth of the argument or position (Griffith Health Writing and Referencing Guide, 2018).
- Refer to the Health Group Writing and Referencing Guide for all presentation, referencing and formatting guidelines. This is located on all course sites.
- Word limits for all assignments needs to be strictly adhered to. The word limit for an assessment item includes in text citations, tables and quotations. The word limit does not include the reference list. Please note the marker will cease marking your submitted work once they have reached the allocated word limit.
- Ensure that you use scholarly literature (digitised readings, research articles, relevant Government reports and text books) that have been published in in the last 5 years.
- Write in the third person and use academic language
- Submit your assignment online as per the instructions on your [email protected] course site.
- Refer to the marking criteria when writing your assignment. This will assist you in calculating the weightings of the sections for your assignment.
MARKING CRITERIA WRITTEN ESSAY
CRITERION ONE: Introduction
- Concise, opening paragraph that identifies the aim of the assignment
CRITERION TWO: Knowledge & Context
- Clearly and correctly defines the issue & term ‘Failure to rescue’
§ Thorough discussion of the incidence of adverse events linked to failure to rescue in Australian hospital settings
- Thorough analysis of the consequences of failure to rescue for the patient, the patient’s family and the health care system
CRITERION THREE: Critical evaluation
- Thorough discussion of 2 potential barriers that can result in registered nurses failing to rescue in a hospital setting
- Thorough discussion about how registered nurses may overcome these potential barriers in a hospital setting to promote patient safety
§ Critical evaluation of two (2) nursing strategies involving inter-professional practice that may be used to prevent registered nurses from failing to rescue
Note: each strategy critically evaluated will be worth up to 12 marks. You should include the patient safety element in each strategy.
CRITERION FOUR: Presentation and Structure
- Conforms to the Health Group Writing and Referencing Guide.
o Presents essay in a logical manner
o Adheres to word limit of 2000 words
o Uses academic language throughout
o Essay is well presented, with correct spelling, grammar, and well-constructed sentence and paragraph structure
CRITERION FIVE: Referencing5
▪ Essay is supported with no fewer than 10 scholarly relevant sources from the last 5 years.
▪ In-text citations are appropriate and correct
CRITERION SEVEN: Conclusion
- Has a concluding paragraph that summarises the overall argument in the assessment.
▪ Does not introduce any new information in the conclusion
[weighted at 50%]
Failure to Rescue
In the provision of care, one of the goals of registered nurses (RNs) is ensuring the safety of the patients. However, patient safety cannot be achieved by the RNs alone but through collaboration with other professionals in healthcare Cox et al., 2016). According to the World Health Organization (WHO), interprofessional collaborative practice arises from multiple health workers from different professional backgrounds working in unison with the patients, their families, carers, and communities in the quest to deliver the highest quality of care. As leaders, RNs are required to work as interprofessional collaborative partners in the creation of quality outcomes for not only their patients but also families and the communities (Hall & Zierler, 2015). However, according to Cox et al. (2016), in an attempt to manage the needs of multiple patients, RNs have found it challenging considering their low ratio compared to the patient populations. As a result, a failure to rescue (FTR) has occurred whereby generally hospitalized patients have developed complications and deteriorations which have ultimately resulted in various adverse outcomes. This paper evaluates the concept of failure to rescue in Australian hospital settings by defining it, adverse events arising from the failure, and an analysis of the consequences of failure to rescue. Additionally, potential barriers which make RNs fail to rescue and ways to address the barriers will be discussed. An evaluation will finally be made on two nursing strategies involving inter-professional practice which may be used by RNs from failing to rescue.
Failure to rescue (FTR) has rapidly become one of the national healthcare crises in Australia. Subbe & Barach (2017) define FTR as the inability of clinicians to save the lives of patients through timely diagnosis and treatment in the event of the development of a complication. The occurrence of FTR is demonstrated by health care providers failing to recognize patients’ symptoms of impending arrest and thus subsequently failing to take appropriate actions to stabilize the patients (Garvey, 2015). Additionally, when a generally health hospitalized patient develops complications and health deterioration which subsequently leads to adverse outcomes, then FTR is said to have occurred. Notably, the complications and deteriorations mostly involve subtle signs and symptoms which are dismissed by the RNs as not concerning enough or which are missed entirely (Simpson, 2016). Four key factors are responsible for RNs failing to recognize and use appropriate interventions to prevent clinical deterioration. One of those is when they fail to recognize the clinical deterioration (Subbe & Barach, 2017). The second factor is a failure to both communicate and escalate the clinical concerns. The third factor entails the RNs failing to physically assess the patients. Finally, FTR arises when RNs fail to diagnose and treat the patients appropriately.
Incidence of Adverse Events
Failure to rescue has been associated with the incidence of various adverse events in the Australian hospital settings. Notably, according to Twigg et al. (2016), adverse events can be defined as those incidents in which harm has occurred to a hospitalized person. FTR has been one of the leading causes of mortality, especially in the acute care settings. Additionally, FTR has resulted in increased rates of infections, high rates of falls, and resulting injuries (AIHW, 2019). In specific, when RNs have failed to monitor, assess, and timely treat the conditions of their patients, the patients have experienced increased infections which have resulted in the deterioration of their health. Additionally, the lack of surveillance; which is a key component failure causing FTR has led to increased rates of patient falls especially in the elderly and immobile patients, which have ultimately led to injuries (Subbe & Barach, 2017). As such, the rates of rehospitalizations have increased. FTR has also led to fatalities in the Australian hospital settings as most of the potentially preventable deaths have resulted from the failure of the RNs to recognize that their patient’s conditions are deteriorating and thus have failed to prevent any further deterioration (AIHW, 2019). More specifically, in acute care settings, FTR has been devastating as it has resulted in high rates of mortalities.
FTR resulted in adverse consequences to the patients but also their families and the entire healthcare system in Australia. Individual patients have been given poor quality of care due to FTR which has resulted in deteriorating health and complications. For instance, in the acute care settings, patients; who are victims of FTR, have experienced infections and their health and wellbeing has deteriorated (Twigg et al., 2016). As a result, their level of satisfaction has decreased, and their probability of recover deteriorated. However, their families have been forced to spend huge amounts of money on the treatment of their kin who have become subject to health complications and deteriorations. Apart from the financial consequences, families have lived in stress, and others have fallen into depression because of the complication and deteriorating health of their hospitalized relatives (Garvey, 2015). Moreover, the patient’s families have lost trust in the RNs which has further painted a bad picture of the healthcare system. Furthermore, FTR has resulted in high costs of care for the government especially through insurance because of the adverse events arising from FTR. Also, the healthcare system has experienced reputational damage because of failure to ensure that any health complications and deteriorations are addressed.
One of the potential barriers which have resulted in the RNs’ failure to rescue in a hospital setting is a nursing shortage. In specific, according to Garvey (2015), the patient census and acuity have exceeded the nurse staffing resources which have resulted in the making of both conscious and subconscious decisions by not only the RNs but also the nurse leaders and the charge nurses. The nursing shortage has led to patient care being prioritized with some of the serious health issues being overlooked (Simpson, 2016). Additionally, increased workload coupled with decisions being made under pressure has the potential of increasing the risk of patient harm especially when RNs overlook significant changes in patient conditions in the process of both care allocation and reallocation (Hravnak et al., 2017). The low number of RNs compared to the high census of patient population can lead to a decreasing ability of the nurses spending quality time at the bedside and thus poor monitoring of any deteriorating health and complications.
Lack of interprofessional collaboration and communication is another potential barrier which has led to RNs’ failure to rescue. Notably, when RNs have failed to effectively communicate with other professionals in healthcare such as the physicians and ancillary service providers, then a lack of coordinated care has occurred which has resulted in the failure to recognize the deteriorating health of the patients. When the RNs have failed to work as a team with other professionals, then the ultimate losers have been the patients as the care provided has not been seamless which has resulted in complications. Moreover, a lack of effective communication among the RNs and between them and the patients has resulted in poor decisions being made (Garvey, 2015). In specific, when there is poor communication between the RNs and the patients, then the correct assessment will not be made which could lead to patients experiencing complications and their health deteriorating in the hospitalized settings.
Overcoming These Barriers
To overcome the barriers of a nursing shortage, RNs should be well staffed to ensure that patient-centered care can be provided. Simpson (2016) notes that; to ensure patient safety, it is vital that there are enough RNs who can provide personalized attention to the patients. Overcoming the barrier of burnout and working under pressure due to staff shortage can be done through an increment in the number of RNs in hospitalized settings which can attend to the patients. According to Waldie, Tee, & Day (2016), decreasing the huge gap between patient to nurse ratio can ensure that there is an increased frequency of direct bedside care, and patient support and interaction which will lead to the identification of any complications and causes of deteriorating health. Additionally, Hravnak et al. (2017) assert that hiring more RNs in hospitals can ensure that the surveillance of the patients is increased. For instance, a low nurse to patient ratio can lead to hourly rounding being made which can ensure that the patients are assessed and any adverse outcomes addressed before they become complicated.
In addressing the problem of the lack of interprofessional collaboration, RNs should create trust, mutual respect, and teamwork with other professionals in healthcare to ensure increased patient safety. Garvey (2015) notes that one of the underlying reasons for the barrier of lack of teamwork and interprofessional collaboration is the lack of mutual respect and trust. However, when RNs trust the other professionals and work as a team with a shared vision of ensuring patient safety, then the problem of failure to rescue can be addressed. Moreover, acquiring effective communication skills across different cultures can be vital in interprofessional collaboration. As such, RNs should do refresher courses to sharpen their communication skills and hence ensure that they can effectively assess and address the problems faced by their patients before they deteriorate and lead to complications.
Nursing Strategies to Prevent Failure to Rescue
One of the nursing strategies involving inter-professional practice which may be used in the prevention of failure to rescue by RNs is increased surveillance of the patients. In specific, according to Hall & Zierler (2015), the RNs should work in collaboration with other professionals towards ensuring that the patients are closely monitored to make sure that their health does not deteriorate and any complications are noted and addressed at an early stage. One of the advantages of surveillance is that there will be a constant monitoring of the health condition of the patients which will ensure that any issues are noted and addressed. Additionally, various professionals such as the physicians and the ancillary service providers will collaborate with the RNs to ensure the attainment of the shared goal of patient safety (Cox et al., 2016). However, the limitation of surveillance is that it will lead to increased costs of hiring additional staff members to make the surveillance a success.
The other strategy which can be deployed in interprofessional practice to ensure that HNs do not fail to rescue is getting interprofessional education. In specific, the members of the different professions in healthcare should be engaged in learning with, from, and about each other (Ghaferi & Dimick, 2016). In such a case, they will share the skills and knowledge which will allow for a proper understanding of each other, foster shared values and respect, and thus; be able to work together towards maintaining the health and safety of the patients (Hall & Zierler, 2015). Education on the value of working within the interprofessional teams will result in a team-based, collaborative approach which will not only improve patient outcomes but also the quality of care.
In conclusion, interprofessional practice results in different professionals in healthcare working together towards the attainment of shared goals of patient safety. Whereas RNs have been focused on the adoption of strategies towards the provision of quality care, failure to rescue has arisen from the challenges of staff shortage as well as lack of interprofessional collaboration in hospitalized settings. Notably, failure to rescue refers to the inability of the RNs to save the lives of patients via a timely diagnosis and treatment after the development of a complication. In the Australian hospital settings, failure to rescue has resulted in increased rates of mortality, infections, and injuries to patients arising from patient falls. Addressing these changes require hiring more staff to reduce the patient to nurse ratio and interprofessional collaboration. Nursing strategies which can foster interprofessional practice and address the failure to rescue include increased patient surveillance and interprofessional education.
AIHW. (2019). Australia’s Health 2018: In Brief. Australia Institute of Health and Welfare. Retrieved from https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/table-of-contents
Cox, M., Cuff, P., Brandt, B., Reeves, S., & Zierler, B. (2016). Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Journal of interprofessional care, 30(1), 1-3.
Garvey, P. K. (2015). Failure to rescue: the nurse’s impact. MedSurg Nursing, 24(3), 145.
Ghaferi, A. A., & Dimick, J. B. (2016). Importance of teamwork, communication and culture on failure‐to‐rescue in the elderly. British Journal of Surgery, 103(2), e47-e51.
Hall, L. W., & Zierler, B. K. (2015). Interprofessional education and practice guide no. 1: developing faculty to effectively facilitate interprofessional education. Journal of interprofessional care, 29(1), 3-7.
Hravnak, M., Mazzoccoli, A., Bose, E., & Pinsky, M. R. (2017). Causes of failure to rescue. In Textbook of rapid response systems (pp. 95-110). Springer, Cham.
Simpson, K. R. (2016). Nurse staffing and failure to rescue. MCN: The American Journal of Maternal/Child Nursing, 41(2), 132.
Subbe, C. P., & Barach, P. (2017). Failure to rescue and failure to perceive patients in crisis. In Surgical Patient Care(pp. 635-648). Springer, Cham.
Twigg, D. E., Pugh, J. D., Gelder, L., & Myers, H. (2016). Foundations of a nursing-sensitive outcome indicator suite for monitoring public patient safety in Western Australia. Collegian, 23(2), 167-181.
Waldie, J., Tee, S., & Day, T. (2016). Reducing avoidable deaths from failure to rescue: a discussion paper. British Journal of Nursing, 25(16), 895-900.