Indicator of Patient Quality and Safety in Nursing

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Individual indicator of patient quality or patient safety
According to the National Safety and Quality Health Service Standards (NSQHS)
proposed by the Australian Commission of Safety and Quality in Health Care (ACSQHC)
(2012), prevention of the Hospital Acquired Infections (HAIs) falls under the standard 3 for
the maintenance of quality and safety in the healthcare service. Thus HAIs is an important
indicator of the patients’ quality and safety in the healthcare system. Rajaram et al. (2015) are
of the opinion that HAIs are common under the healthcare settings and it mainly spreads
through the touch contact that is from the infected or non-sterilised hands of the nursing
professionals who spend majority of the time with the patients. The chances of getting HAIs
are higher among the ICU units. The reason behind this is patients in the ICUs are immune-
compromised, making them vulnerable in getting affected with the HAIs or noscomial
infection. Moreover, the patients’ in the ICU are mainly treated through intravenous
injections or are surgical patients. The surgical cites or site of intravenous injection channel
are regarded as the point of entry of the bacteria into the body of the patients.. The HAIs or
the nosocomial infection is mainly caused by multidrug resistant bacteria that increase the
overall morbidity and mortality of the patients while increasing the cost of care, increased
length of stay at the hospital and decrease in the overall quality of care (Khan, Baig &
Mehboob, 2017). One of the common indicators of the HAIs that help to ascertain the degree
of the patients’ safety in the ICU is pneumonia. The early signs of pneumonia include high
fever, sudden cold and cough, purulent sputum in the cough and abnormal chest auscultatory
findings. The abnormal chest findings are defined by decreased breath sounds along with
crackles or wheezes or labored breathing (Herkel et al., 2016). In order to use pneumonia as
an important indicator of the HAIs in order to measure the overall outcome in the patents’
care, the ICU patients are monitored regularly. The preliminary monitoring is done with the

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help of the pulse oxymetry in order to keep a track of the level of oxygen saturation in the
blood (SpO2), the respiratory rate and pulse rate. Kalil et al. (2016) stated that older adults or
the patients who are admitted under the ICU settings mainly exacerbate signs of decreased
oxygen saturation in the body (less than 90%) as an important indicator for monitoring of the
any possible signs of pneumonia. Monitoring of the chest auscultations, movement of the
diaphragm and measurement of the blood parameters and body temperature is used to detect
any possible signs of infection with the body. If the body temperature is found elevated with
high levels of white blood cells then immediately sputum test is conducted followed by the
measurement of the C-reactive protein (CRP) in the blood in order to confirm the presence of
pneumonia (HAIs) is any. The CRP and WBC count or high fever also act indicator for other
HAIs like blood stream infection (Gadsby et al., 2016).
Literature Review
According to the reports published by the World Health Organization (WHO) (2019),
approximately 15% of the hospitalized patients suffer from hospital-acquired pneumonia
commonly known a ventilator-associated pneumonia. Other important hospital acquired
infections highlighted by WHO (2019) include blood stream infections, surgical site infection
and catheter associated urinary tract infections and central line infection. The main
nosocomial pathogens that are responsible for the spread of the HAIs like ventilator-
associated pneumonia are multi drug resistant bacteria. The review conducted by Rosenthal
(2016) stated that during their stay in the ICU of the hospital, the patients are exposed to
numerous pathogens through different sources environment, along with healthcare
professionals and other infected patients. Tansmissions of these infections or the spread of the
bacteria causing pneumonia must be prevented for the effective prevention of the HAIs
(ventilator-associated pneumonia) and thereby helping to increase the overall safety of the

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patients. Hsopital waste serves as a potential source of pathogens leading to the 20 to 25%
occurrence of the HAIs like ventilator-associated pneumonia. Thus, for the effective control
of nosocomial infection, the nursing professionals and the other healthcare associated staffs
must practice proper infection control programs. This must be associated with keeping a tract
of the usage of the antimicrobial and its simultaneous resistance in adopting the antibiotic
control policy (Murni et al., 2015). Efficient surveillance system also plays an important role
in controlling HAIS. Not only the nursing professionals but also the efforts must be taken by
all the stakeholders in order to prevent and control the nosocomial infection and thereby
increasing the level of patients’ safety (Khan, Baig & Mehboob, 2017).
A 24-month long observation longitudinal survey conducted by the Parisi et al. (2016)
highlighted that one of the important indicator of the ventilator-associated pneumonia (VAP)
is lack of proper training and education among the nursing professionals. There was found
lack of awareness in the domain or proper usage of the hand hygiene and the use of the
personal protective equipments and sterile nasal masks for the patients in the ICU. This lack
of awareness leads to poor professional standards of practice. Moreover, nurses due to lack of
proper education about the pneumonia pathogeneses fail to identify the initial signs of the
spread of infection like fever and cold/cough. This increases the tendency of getting affected
with VAP and at the same time increases the severity of the disease. Observation study
highlighted that proper education of the nursing professionals who are assigned to install the
oxygen through nasal canula can help to reduce the chances of the VAP (Parisi et al., 2016).
Braun (2019) stated that a registered nurses who have underwent a training of one month
about the HAIs and use of the personal protective equipments are more likely to increase the
level of patients’ safety by reducing the chances of HAIs or VAP. Arefian et al. (2016)
argued in favor of the trained nursing professionals as an important parameters for increase in
the overall quality in patients’ care in VAP. Arefian et al. (2016) further indicated that from