Quality Improvement Through Clinical Governance Assignment Sample

Pressure Ulcers

The purpose of the process of clinical governance is to provide safe and high-quality health care services to patients and consumers. The goal of an effective clinical framework plan can be achieved by describing the important suggestions to be implemented to ensure the effectiveness of the plan. This can be easily done by improving the quality of the services provided thus, bringing the focus on the quality issue involved and the ways through which it can be further improved. The quality improvement initiative or plan, therefore, holds an important place in providing the suggestive measures to be taken under the clinical governance mechanism so that the burden on the patients and their families could be decreased and also the clinical structure could be made more efficient. Pressure ulcers are a common medical issue in Australia and other parts of the world. However, in Australia, the issue holds a significant place due to a higher number of pressure injuries that occurred in the Australian general hospitals in 2015-16 (Safety and Quality, 2018).

Pressure injuries or pressure ulcers occur due to prolonged pressure on the skin or the tissues under the skin over a bone as a result of pressure, or a combination of friction and pressure. Depending upon the position of the patient during the hospitalization process, the most common areas where the occurrence of the pressure ulcers can be seen are the tailbone, shoulder blades, and spine, back of arms and legs in cases when the patient is on a wheelchair and the back and sides of the head, the shoulder blades, the hip, lower back or tailbone, and the heels, ankles and the skin behind the knees in cases of patients lying on the bed (Mayo Clinic 2020). In Australia, the pressure injuries in the hospitals have been seen occurring with a rate of 9.7 injuries per 10,000 hospitalized patients in 2015-16. The patients when hospitalized for longer periods develop such pressure injuries which are long term injuries that turn out to be painful. Such injuries affect the quality of life that the person might live including the daily routine and the mood and sleep cycle being affected. Also, such injuries during hospitalization increase the duration of treatment which creates a financial impact on the patient and their families (Safety and Quality, 2018).

The causes of the pressure injuries can be better identified by the root cause analysis (RCA) tool as it identifies the factors impacting the involved quality issue of pressure ulcers. The RCA is used to find out the reason behind the occurrence of the issue involved. For instance, in the case of pressure injuries, the role of RCA will start with the identification of the injury by observing the type and nature of the wound occurred. After finding out the causes of the wound, the RCA then focuses on the process of care which was provided at the time when the injury occurred. Finally, the identification of the issues that resulted in the occurrence of such injury is addressed by the RCA, so that necessary changes could be done in the existing process to reduce the risk of such injuries in the subsequent future. Considering an example of a deep tissue pressure ulcer (DTPU) that occurred in the left foot of a 65-year-old woman who was hospitalized following a total knee replacement. She had a history of hypertension, osteoarthritis, obesity, and type 2 noninsulin-dependent diabetes for 15 years. After her surgery, she was recommended with compression devices and elastic stockings along with the physical treatment in the form of bed exercise and ambulation due to which a purple heal was discovered on the second day of hospitalization post-surgery and the RCA for the same began on the next day. The RCA was conducted at different levels dealing with different issues for the exact determination of the root cause of the injury. At level 1 RCA, the initial identification of the skin was conducted to determine whether the injury was a pressure injury or not. Due to the involvement of elastic stockings and compression devices, it was considered that the injury might have occurred due to the pressure of the spinal block that was used during the surgery of the knee replacement accompanied by the compression devices and the friction of the elastic stockings. Since the patient had a history of diabetes, she was more prone to such injuries and by the examination of the wound, the time of the injury was also determined. Then, at level 2 RCA, further investigation was done regarding the past history of any skin diseases which was not found at the time of admission. The Braden scale score at the time of admission and post-surgery was found to be 21. The RCA team also observed the patient’s room and the medical record which provided a study of the processes of care exercised during the treatment process and it was found that during the surgery the foot was held in a boot to keep it steady which might have caused the damage to the underlying tissue while keeping the skin intact. Moreover, the hospital policy identified the DTPU as a form of pressure injury and also a possibility that it could have occurred during the ambulation process. Since pressure injuries were quite common in the orthopedic unit, the hospital drafted the correction plan for the injury since the reasons for the occurrence of the pressure ulcer were identified. At level 3 RCA a staff meeting was conducted in which the nurses were re-educated on how to remove and apply the boot during the surgery and the stockings during the treatment process. The nurses were also asked to review the injury and avoid such injuries as they cause unbearable inconvenience to the patient. The solutions to the problem were identified and their effectiveness was kept under review considering the need for amendment in the same (Black 2019).

The Australian Commission on safety and quality in health care has provided some guidelines to be followed for the improvement of the clinicians and the health system managers thus, resulting in the outcome of better policies for the public in cases of health care. The hospitals are provided with the primary guideline to reduce hospital-acquired complications arising out by avoiding the provision of patient care thus mitigating avoidable risk to the patients. The clinicians are suggested to conduct thorough and comprehensive skin inspections at regular intervals to prevent the occurrence of nay pressure injury. Along with this, the suggested best practices include the installing of systems for the prevention of pressure injuries and wound management that are consistent with the best practice guidelines provided to the hospitals and the clinicians at regular intervals. The National Safety and Quality Health Service (NSQHS) standards have been drafted to ensure the delivery of safe health care to the patients and also provide the advice that should be followed by the health care organizations or hospitals while delivering health care services to the patients. The advice includes compliance with the clinical governance structures and the quality-improvement processes supporting the healthcare of the patients, development of a comprehensive care plan for the patient, effective implementation of the comprehensive care plan to minimize the specific harms caused to the patient. The quality-improvement processes include the best practices to be followed to ensure the management of the pressure injury. The most important suggestion provided is the training of the workforce involved in the clinical governance structure. The efficiency of the workforce decides the effectiveness of the complete framework. Quality improvement can be ensured by the implementation of quality-improvement strategies to reduce the reoccurrence and the harm from the pressure injuries followed by the audits of the patient clinical records and other data to provide the effectiveness of the mechanism (Safety and Quality 2018).

The suggestions for the quality improvement of the management of the pressure ulcers can be ensured by implementing the best practices such as the skin assessment at admission and daily, with documentation of lesions at regular intervals, assessment of the risk of pressure ulcers at the time of admission and repositioning of the patients every 1 or 2 hours and the promotion of the patients to the highest levels of mobility, and daily round assessment of the patients. Apart from these, various educational recommendations have also been made to ensure the prevention of the mutating varieties of pressure ulcers. The effectiveness of the action items shall also be ensured to evaluate the effectiveness of the new processes suggested for modification or improvement of the performance of the health care organization. The development of a plan of action in cases of non-compliance to the guidelines shall be done followed by the feedback suggestions to all the stakeholders involved in the clinical governance framework with the objective of self-analysis. Additionally, surveillance and determination of the prevalence of the healthcare-associated pressure injuries shall be done to evaluate the new process outcomes of the technique. Regular monitoring and evaluation of the performances shall be done regularly to sustain the achieved improvements (ARHQ 2016).

The quality improvement plan over the quality issue of pressure ulcers can be effectively drafted about the clinical governance framework after observing the suggestions and the guidelines provided by the Australian Commission on safety and quality in health care. The NSQHS standards ensure the effectiveness of the guidelines to be followed by health organizations, hospitals, and clinicians. The tools available for the analysis of the reasons or the causes of the injury in the patients can be chosen as per the case study but the root cause analysis (RCA) technique turns out to be more effective due to the detailed and stepwise investigation and research procedure involved. The best practices to be followed ensuring the reduction of cases of the pressure injuries during hospitalization have been observed as effective in providing relief to the patients and their families by reducing the extension in the treatment duration and the inconvenience caused to the patients because of such pressure injuries. The proper implementation of these best practices also ensures the efficiency of the clinical framework and also reduces the additional financial burden on the patient due to this additional injury occurring during the treatment procedure.

References for Quality Improvement Through Clinical Governance

ARHQ (2016). Preventing pressure ulcers in hospitals, a toolkit for improving quality of care. Agency for Healthcare Research and Quality. Retrieved from http://www.ahrq.gov/professionals/systems/long-term-care/resources/pressureulcers/pressureulcertoolkit/index.html

Black J.M. (2019). Root Cause Analysis for Hospital-Acquired Pressure Injury. Journal of Wound Ostomy & Contingence Nursing.46(4), 298-304. Retrieved from https://nursing.ceconnection.com/ovidfiles/00152192-201907000-00007.pdf

Mayo Clinic (2020). Bedsores (Pressure Ulcers). Retrieved from https://www.mayoclinic.org/diseases-conditions/bed-sores/symptoms-causes/syc-20355893

Safety and Quality (2018). Hospital-Acquired Complication: Pressure Injury. Australian Commission on Safety and Quality in Health Care. Retrieved from https://www.safetyandquality.gov.au/sites/default/files/migrated/SAQ7730_HAC_Factsheet_PressureInjury_LongV2.pdf

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