Applying NSQHS Standards in Domiciliary Care: A Case Study

This essay examines the application of the National Safety and Quality Health Service (NSQHS) Standards in a domiciliary care scenario, focusing on a patient, Mrs. Julia Brown, who has undergone a laparoscopic cholecystectomy and has a history of type 2 diabetes mellitus, osteoarthritis, and toe amputation. The essay selects NSQHS Standards 3 (Preventing and Controlling Healthcare Associated Infections) and 10 (Preventing Falls and Harm from Falls) and applies them to the patient's home care setting. It discusses the importance of antibiotic stewardship, infection control measures, and fall prevention strategies, considering the patient's post-operative condition and risk factors. The essay emphasizes the role of nurses in educating the patient and family, assessing risks, and implementing appropriate interventions to ensure patient safety and well-being in a home environment, including wound care, vital sign monitoring, and medication management, with references to relevant literature and guidelines.

Domiciliary Care
Name of the Student:
Name of the University:
Author’s Note:

Introduction
The National Safety and Quality Health Service (NSQHS) Standards were
developed to provide and maintain safety and quality standards in health service
provision and protect public health in Australia. Each of the ten standards contains a
standard, a statement of intent, a statement of context and a list of key criteria.
Assessment of the health service organisations is done by a three point rating scale:
Not Met, Satisfactorily Met and Met with Merit (National Safety and Quality Health
Service Standards | Safety and Quality. (2017). Mrs Julia Brown has undergone a
laparoscopic cholecystectomy and has a history of T2DM, OA and toe amputation.
This essay aims to choose two standards from the NSQHS Standards and apply
them in a domiciliary scenario with reference to Mrs Julia Brown.
The patient has undergone a laparoscopic cholecystectomy, which is a
common, minimally invasive surgical procedure to remove gall bladder from the
body. She is being prescribed IVAB’s via a PICC line and requires constant
monitoring of the wound area, assessment of vital signs and provision of general
education about her condition. Considering the type of surgery and her history of
Osteoarthritis and toe amputation NSQHS Standard 3 and 10 have been chosen,
which are Preventing and Controlling Healthcare Associated Infections and
Preventing Falls and Harm from Falls respectively.
Large numbers of patients suffer from health care related infection, at least
half of which can be prevented with appropriate measures and actions. Further,
patients who undergo invasive procedures and are on a wide range of antibiotics are
posed with a risk of acquiring antibiotic resistivity with prolonged exposure to certain
microorganisms that can eventually prove to be fatal for the patient (Percival,
Suleman, Vuotto&Donelli, 2015). Several core and developmental actions are
provided in the Preventing and Controlling Healthcare Associated Infections
Standard. The patient has undergone cholecystectomy and thus has an incision and
suture in the abdomen. If there is a breach in the first line of defence that is the skin
the patient is at high risk of acquiring an infection. However, as compared to a
hospital environment there is a lesser risk of coming in contact with infectious
microorganisms at home. The stewardship of antibiotics is the primary goal of
nursing care (Twigg, Duffield & Evans, 2013). The nurse must abide by appropriate

antibiotic stewardship program with proper access to therapeutic guideline of the
antibiotic used. Regular reviewing of the antibiotic effectiveness and resistance, if
any must be done. The nurse must assure that clean and hygienic environment in
the house is maintained by all the members of the family. Transmission-based
disinfection and sterilisation and appropriate use of protective equipment by all family
members must be ensured. Policies, procedure and protocols must be followed while
using invasive devices (Sievert et al., 2013), in this case needles and other devices
used in peripherally inserted central catheter for administration of intravenous
antibiotics. Regular wound dressing must be done following aseptic techniques and
control measures to minimise the risk of infectious agents.
Fall prevention is often one of the less prioritized topics in provision of nursing
care to patients. However, studies show that older adults above the age of 65, and
more frequently women fall and incur injuries and losses from the same. Further, this
statistics increase many folds in domiciliary care due to old age, lack of precaution,
chronic diseases and cognitive impairments and may result in fractures or tissue
damage or brain injuries (Miake-Lye, Hempel, Ganz&Shekelle, 2013). In this regard,
Preventing Falls and Harm from Falls Standard provides substantial guidelines and
prevention programs to be implemented as a part of nursing care practice. Nurses
play a key role in educating the family and the patient about the prevention of fall and
the measures to be taken as such. The criteria to achieve this standard include
assessment of the risk factors associated, preventing falls and injuries from falls and
proper communication with patient and her family. Considering that the concerned
patient belongs to a age group at high risk of sustaining falls, it is mandatory to
provide timely access to equipment and devices available to prevent such falls.
Further, the nurse must screen the patient and the household environment though a
screening tool or through clinical judgement procedure to assess the overall fall risk
of the patient and identify appropriate strategies to prevent such risks (Coppedge,
Conner & Se, 2016).
Conclusion
Considering the patient condition and priorities several care plans aimed to
manage the post-operative complications of laparoscopic cholecystectomyin home-
based scenario must be adopted, with main focus on infection and fall prevention.

Further, care must be provided to reduce breathing troubles, risk of aspiration,
impaired mobility and acute pain, which are common symptoms of post-operative
cholecystectomy.

References
Coppedge, N., Conner, K., & Se, S. F. (2016). Using a standardized fall prevention
tool decreases fall rates. Nursing2017, 46(3), 64-67.
Miake-Lye, I. M., Hempel, S., Ganz, D. A., &Shekelle, P. G. (2013). Inpatient Fall
Prevention Programs as a Patient Safety StrategyA Systematic
Review. Annals of internal medicine, 158(5_Part_2), 390-396.
National Safety and Quality Health Service Standards | Safety and Quality.
(2017). Safetyandquality.gov.au. Retrieved 22 August 2017,
fromhttps://www.safetyandquality.gov.au/publications/national-safety-and-
quality-health-service-standards/
Percival, S. L., Suleman, L., Vuotto, C., &Donelli, G. (2015). Healthcare-associated
infections, medical devices and biofilms: risk, tolerance and control. Journal of
medical microbiology, 64(4), 323-334.
Sievert, D. M., Ricks, P., Edwards, J. R., Schneider, A., Patel, J., Srinivasan,
A., ...&Fridkin, S. (2013). Antimicrobial-resistant pathogens associated with
healthcare-associated infections summary of data reported to the National
Healthcare Safety Network at the Centers for Disease Control and Prevention,
2009–2010. Infection Control & Hospital Epidemiology, 34(1), 1-14.
Twigg, D. E., Duffield, C., & Evans, G. (2013). The critical role of nurses to the
successful implementation of the National Safety and Quality Health Service
Standards. Australian Health Review, 37(4), 541-546.