Clinical Project Report: Patient Safety Standards and Interventions

This clinical project report focuses on patient safety within a hospital setting, specifically addressing breaches of safety standards following a patient's admission. The report examines two key areas: fall prevention and the prevention of surgical site infections. It details the consequences of these breaches, such as a patient fall and subsequent infection. The project proposes interventions based on evidence-based research to improve healthcare practices, including the use of a PowerPoint presentation and focus group interviews to gather insights and evaluate the effectiveness of proposed solutions. The report outlines potential interview questions to assess staff knowledge and perceptions of patient safety protocols. Additionally, it reviews relevant literature to identify barriers and facilitators related to implementing clinical practice guidelines, emphasizing the importance of staff education, health literacy, and patient-centered care. The project aims to provide a framework for a comprehensive program to enhance patient outcomes and improve the overall quality and safety of care.

Running head: CLINICAL PROJECT
Clinical Project
Name of the Student
Name of the University
Author Note

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Executive summary
Patient safety is a field or healthcare discipline that focuses on measures that are adopted to
provide safety in healthcare programs. These safety measures illustrate reporting, analysis,
reduction and prevention of any medical error or lack of health literacy that can lead to adverse
effects in the patient. This report will focus on the safety standards that were breached following
admission of a patient to a hospital. It will try to design recommendations that will improve the
healthcare facilities. These interventions will be presented to the quality safety committee
following evidence based research approaches.

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Table of Contents
Section 1..............................................................................................................................3
Section 3..............................................................................................................................5
Section 4..............................................................................................................................6
Bibliography......................................................................................................................13

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Section 1
Two safety standards that could have been maintained on the concerned patient’s
admission to the hospital are prevention of surgical site infections and prevention of injury from
falls. Falls resulting in injury are a prevalent patient safety problem (Healy, 2016). Due to lack of
attendance by the nurse-in-charge, the patient suffered a fall and got severely injured. 4 days post
her surgery for the fractured femur, the nursing staff found an infection with distinct smell
around the wounded edges of the hip. In order to control this infection and injury from falls,
some strict policies should have been followed in her nursing care (Grealish & Chaboyer, 2015).
Any patient can be vulnerable to falls due to certain physiological changes related to
medications, nursing, surgery procedures that leave them weakened. Surgical site infection is
another common infection related to healthcare that occurs among patients and is responsible for
about 77% patient deaths (Rasouli, Restrepo, Maltenfort, Purtill, & Parvizi, 2014). This project
addresses the formulation or designing of interventions based on research and presenting them to
the quality and patient safety control policy makers to integrate the improvement outcomes into
making decisions on the treatment of such patients in near future.
The Quality and Safety Committee comprises of a Chief Senior Associate Medical
Officer, medical directors, clinical staff president, nursing staff president, departmental quality
officers, performance improvements representatives and some leaders appointed by the Chief
executive officer. They are responsible for identifying, prioritizing and monitoring the effects of
improvement activities, which include patient safety in the healthcare center (Parand, Dopson,
Renz, & Vincent, 2014). They make recommendations for improvements in clinical practice and

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for changes in surgical procedures. They serve as a forum where information on patient safety
and quality of the hospital is exchanged (Millar, Mannion, Freeman, & Davies, 2013).
In order to avoid any untoward incidents like the ones which occurred during the
patient’s stay in the hospital, certain health safety standards should be followed.
 The clinical project will utilize sustainable evidence-based approach that can be applied
on healthcare settings.
 It will assess the safety standards that had been breached on admission of the patient to
the hospital and will reinforce fall prevention and surgical site infection practices by
prioritizing patient safety needs (Mosadeghrad, 2014).
 It will provide a framework upon which a comprehensive and integrated program can be
delivered, which will reduce negative impacts on patient health during their stay at the
hospital (Lam, et al., 2016).
 This program will help to monitor and improve the quality and safety of patient care
delivered. This plan will support the organizational mission to provide clinical excellence
at a reasonable cost and to continuously improve patient outcomes (Damberg, et al.,
2014).
A Powerpoint presentation will be used to improve organizational practices
associated with patient safety. It will involve an oral presentation that will focus on key
points with the aim of facilitating learner’s achievement of the primary objective. The visual
displays and graphs used will enable the audience to gather effective information and
assimilate them for improving the health outcomes (Farrell, et al., 2014). The information
will have a greater visual impact and the necessary health issues can be confronted.

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Focus group interviews will be used as an evaluation tool. Focus groups are used in
healthcare research to explore patient perspectives related to their healthcare facilities. An
interview with the focus group will assist in identifying and clarifying their views on patient
safety measures. The interview will contain not only specific research based questions but
will also contain questions on sociological research related to the target group. Their shared
experiences and opinion will offer a large context of research content (Krueger & Casey,
2014). The responses will help to structure information on their perspectives and will help to
improve the establishment of recommended practices. The interview questions will be
arranged in such a way that a broadest response is obtained regarding needs of patient
priority and safety.
Section 3
The interview will act as a quality improvement process that will seek to improve
patient outcome through systematic review of care against explicit criteria and the
implementation of change. Aspects of the structure, processes, and outcomes of care are
selected and systematically evaluated against explicit criteria. Some of the questions to be
asked ion the interview are as follows:
1. What is the primary work area of this unit and how long has it been involved in the
area?
2. How are other members of the healthcare team communicated?
3. When a medical error or mistake in patient management is identified, how often is it
reported?

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4. When a breach of safety standard occurs, how often is it immediately rectified to
prevent negative impact on the patient?
5. Is patient safety sacrificed to get more work done?
6. What are the common ways by which surgical site infections can be prevented?
7. How do you know if the patient is VRE or MRSA? (Kiran, Murray, Chiuzan, Estrada,
& Forde, 2015)
8. What precautions should be taken to prevent infection in such patients?
9. Describe the steps that need to be taken while preventing infection while inserting
screws or plates in fractured areas?
10. Why should the staff wash their hands and wear gloves?
11. How do you know if the surgical instruments have been cleaned?
12. How can injury from falls be prevented?
13. How do you feel about patient falls in your hospital?
14. What do you perceive to be the real cause for these falls?
15. Is the nursing staff adequately trained to prevent such incident?
16. Where do caregivers document their assessment?
17. What should nurses do when such an incident occurs?
18. How effective will practicing of health standards be in maintaining patient safety?
19. Can you give examples of other interventions that might help such patients?
20. How soon should intervention strategies be adopted?
Section 4
Medical healthcare facilities are technically complex at the system level, individual
provider level and at national level. The huge amount of new knowledge that is generated every

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year due to evidence based clinical research is often applied directly on patients. This
knowledge can be used to overwhelm the physician and nurses who provide healthcare facilities.
Optimizing the care that is provided to patients is of prime importance. Patient safety is thus an
emergent discipline that is growing in the form of a trans-disciplinary system on research
literature. The terms and definitions, which are associated with patient safety are quite complex.
While maintaining patient safety emphasizes on proper report, analysis and prevention of
medical errors that can lead to adverse healthcare outcomes among patients, certain concepts of
risk factors, hazards and associated harm are involved with it. Furthermore, the lack of
comprehensive education system related to healthcare professions is another contributing factor
to performance deficiencies in the system (Jun, Kovner, & Stimpfel, 2016). In this review,
relevant literature will be critically examined to identify the factors that address the attitudes and
behaviors, integral to patient safety in hospitals. Several authors proposed a theoretical
framework for promoting a safe culture. The review will organize different properties of patient
safety by analyzing several studies and will provide evidence for a define safety model that could
act as a valuable tool in supporting hospitals to improve safety culture.
An analysis of patient safety standards require considering the potential hazards present
in the concerned healthcare setting. It also evaluates the risks linked to these hazards and the
possible consequences. If the hazards and their root causes are not properly considered, effective
solutions to minimize risks of their occurrence and causing harm in the patients cannot be
formulated. For this literature review, database searches were done using MEDLINE, CINAHL
and SCOPUS databases. Following the search, all papers that were considered applicable and
relevant to the purpose of this review were retrieved and assessed. Research provided evidence
for barriers that are associated with clinical practice. The most prevalent barrier is the

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unfamiliarity of nursing staff with clinical practice guidelines and resource material. Studies
proved that most of the medical staff was not aware of the guidelines that existed in relation to
prioritizing patient safety standards and providing a holistic care facility (Antunes, Harding,
Higginson, & EUROIMPACT., 2014). Staff usually confuses these guidelines with different
types of paperwork that includes regulations formulated by the state, the reports of incident,
nursing manuals, training tools and standing orders. Licensed practice nurses and other staff also
display lack of education facilities. The senior administrative nurses often expressed worry
regarding the fact there is limited scope of practice and training resources available with the
licensed or registered nurses. This hampers their ability to implement an accurate clinical
protocol or practice guideline. Limited health literacy among staff members is another barrier to
effective clinical practice. This suggests the need if simplified literacy tools that can educate the
staff on considering patient safety of utmost importance (Joseph-Williams, Elwyn, & Edwards,
2014). Often the scientific protocols are difficult to interpret by the staff. This creates a
hindrance in providing adequate care to the patients. Multiple healthcare providers like
physicians and nurses often reported that the protocols and guidelines are sometimes inconsistent
with the idea of providing patient centered and individual care. Moreover, these guidelines are
often placed inferior to the professional experience that they have.
The guidelines are not patient specific and need to be followed by focusing on each
patient requirement. Family members and residents sometimes act as a barrier and create
conflicts when the recommended clinical guidelines are implemented on patients. Most of the
patients show noncompliance to effective treatment methods. Appropriate management steps are
often not available to the nursing staff. This prevents implementation of strategies that can
improve quality of holistic care and its timelines (Devaraj, Sharma, Fausto, Viernes, & Kharrazi,

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2014). Following the protocol makes it difficult for the staff to look into the finer details of
clinical practice. Designing of a checklist would help in promoting thoroughness in patient
centered care. Practicing clinical guidelines makes the nurse-in-charge understand the rationales
that need to be applied for the recommended care in the patient. Memories of previous incidents
create a hindrance in continuing the practices based on the guidelines. These memories make the
staff practice ineffective clinical care practices that fails to promote healthcare. There are several
facilitators that enable prioritization of patient needs. Some studies focused on qualitative
analysis to produce a conceptual framework on the barriers and facilitators that are related to
efficient clinical practice guidelines. The facilitators were identified using semi-structured
interviews that assessed the attitude of healthcare staff towards the practice protocols. The staff
was made to describe the healthcare facilities provided to the patients and were made to explore
whether the guidelines were followed in each case (Taylor, Machta, Meyers, Genevro, & Peikes,
2013). 2 types of practice development facilitators exist: internal (insider) and external (outsider)
practice development facilitators. Studies have identified external practice development
facilitators as persons who are not a part of the healthcare organization (outsider). On the other
hand, staff and physicians who belong to the healthcare setting are internal practice development
facilitators. Both the external and internal facilitators were regarded to be caught in the middle
between managerial and clinical constructions. They have to strive to move in the direction of
synergy between bottom-up and top-down itineraries in the healthcare setting.
Effective clinical communication and teamwork act as facilitators for clinical practice.
This includes recording the context of the clinical incident, evaluating probable actions in the
healthcare unit, promoting reflexive practice, disseminating valid information and working
accurately. Careful assertion, listening to the woes of the patient and observing any challenges

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that arise from the practices promotes efficient maintenance of care standards (Gagnon,
Nsangou, Payne-Gagnon, Grenier, & Sicotte, 2014). Workplace culture, which refers to behavior
and accepted social norms helps in proper implementation of clinical guidelines. According to
one study, interprofessional collaboration amongst the staff and other team members depends on
leadership qualities. Therefore, an excellent leadership style is generally identified as a relevant
skill that the staff should posses. Several respondents who participated in the research studies
proposed that if a leader is able to and responsible for making decisions related to providing
quality care to the concerned patient, by collaborating with other team members, it acts as a
source of motivation and promotes clinical practice protocols.
Shared decision making and inclusion of all staff who are involved in the healthcare
setting empowers them to treat patients with care. Transformational leadership fosters
collaboration with others through shared power and shared decision making, which are also core
elements of the care environment and care processes (Légaré & Witteman, 2013). Through
transformational leadership everybody takes responsibility for quality of care. Effective time
management acts as another facilitator. All staff remains busy while working in clinical areas
and have high workload. When the staff was found to be less obsessed with their tasks, they
provided more time to care for individual patients. This resulted in a holistic approach to patient
centered care without any rush. Continuous evaluation and monitoring of the success, while
implementing the clinical protocols acts as a vital process in offering valuable information that
helps in improving care facilities (Keiffer, 2015).
When the evaluation processes are clearly planned and defined, they often identify
several data-management plans and responsibilities. These observations appear appropriate and
feasible methods during collection of data. When these resources are properly utilized, standards

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of clinical practice get improved. Staffs that evaluate patient records, compile them and adhere to
the guidelines are responsible for providing comprehensive data that assists in identifying any
gaps, which exist during implementing evidence based results. Therefore, these barriers and
facilitators should be properly put into action while recommending strategies for improving the
health outcome in the patient. Good working relationships need to be developed with the
healthcare providers and the systems located across the hospital setting. These evidence-based
approaches need to be taught to the concerned healthcare professionals. Availability of adequate
resource material will help them in improving the standard clinical protocols that is required to
be followed to reduce the negative healthcare impacts on the patient (Hebert & Glasser, 2014).
Conduct quality improvement efforts with targeted healthcare systems and provider practices to
improve health care processes and outcomes. Specific quality measures and patient panels
should be identified for each patient subgroup who is suffering from similar kind of health
condition. Monitoring and institutionalization of standardized or aggregated quality measures
should be available to all healthcare providers (Yevchak, et al., 2014). The concerned staff
should have 4-7 years of experience in the healthcare system. They should display a firm
understanding of practice workflow, care delivery and management.
Excellent interpersonal skills are required. The nurse-in-charge should pay more attention
to the reports of the family regarding the patient and provide extra supervision if required. The
root cause of delirium in patients should be identified and protocols should be accordingly
implemented. The staff needs to develop excellent decision-making skills, troubleshooting
abilities and self motivation. Outstanding written and oral communication skills will help them
to establish consultative relationships with the patient and the family members (Kelley, Kraft-
Todd, Schapira, Kossowsky, & Riess, 2014). Moreover, they should adhere to the guidelines that