Chapter 1: Health Care Delivery for the 21st Century

1. Chapter 1: Health Care Delivery for the 21st Century

2. Workplace Reorganization (workplace redesign, restructuring, or re-engineering) Why? Workplace redesign was necessary because reimbursement for services was less than it had been previously What? Combining the services and departments Fewer workers provide a broader spectrum of care

3. Effect of Workplace Redesign • Nursing department’s responsibilities have been expanded • Nursing Assistance and unlicensed care providers are taught to provide advanced technical skills (Ex: cross-training) • Nursing Assistants learn additional technical skills and may be able to perform procedures and skills previously performed by other departments/nurses. (Ex: No longer a need for EKG tech or phlebotomist in the hospital)

4. Effect of Workplace Redesign The title of assistants has changed to reflect the changes in skill level Past: Nursing Assistants Present: Patient Care Technician Future: ?????? Why to hospital hire more PCT’s and nursing homes hire CNA’s?

5. Quality Assurance (quality improvement, continuous quality improvement) What? A department/program within a facility responsible for identifying problems or potential problems and finding solutions for improvement. The QA department reviews and evaluates care provided and practices used in the facility and makes recommendations to improve care Ex: restraint use, infections, pressure ulcers, infection control

6. Benchmarking What? An activity in which an organization establishes best practices by comparing what it is doing with what other, similar organizations are doing. Why? So the facility can improve its processes and achieve excellence Benchmarking does not involve copying what other facilities are doing Benchmarking uses critical thinking (problem solving) to identify and correct problems. = better outcomes

7. Quality Indicators What? Decision making and research tools that are used for tracking changes, recognizing potential problems, and identifying areas that warrant further study and research Quality Indicators are also a type of benchmark Quality Indicators provide information about patient outcomes, access to care, cost…..

8. Serious Events • Adverse Event: incidents, accidents, events, and injuries associated with patient care and services. Ex- falls and med errors • Close Calls: “near miss” situations that could have resulted in an adverse event but did not Catching the mistake at the last minute Present opportunity for learning and further study Are given as much attention as events that result in injury

9. Serious Events • Intentionally Unsafe Acts: criminal events, acts related to alcohol or drug abuse, intentional abuse/neglect • Sentinel Events: serious incidents that result in patient death or serious physical or psychological injury Ex- medication error, wrong surgery

10. Root Cause Analysis What? A process for identifying the cause or contributing factors associated with events. It is a review of unsafe acts, adverse events, close calls, or sentinel events. RCA :asks what? and why? identifies procedural changes to reduce future risks of events

11. Unlicensed Assistive Personnel ULP- unlicensed assistive personnel Individuals who assist the licensed nurse in the role of providing direct nursing care to health care consumers as delegated by and under the supervision of the licensed nurse Anyone providing direct patient care without a license

12. Role and Responsibilities of the Patient Care Technician (PCT) See chart on pg 7-8: Duties/Responsibilities Education Knowledge/Skills/Abilities Physical Requirements Reporting Responsibilities Working Conditions Ethics

13. Scope of Practice: PCT • Must be taught to perform procedures/skills first • Must be under direct supervision of RN • Laws regarding a ULP or PCT scope of practice may vary from state to state

14. Standards of Care • Are common health care practices based on laws, facility policies and procedures, information learned in class, job description, and published information • Applying standards of care means using the degree of care or skill that is expected in a particular circumstance or role • Standards are used to measure workers’ efficiency • Neglect: is failure to exercise the degree of care considered reasonable in a situation Ex: forgetting to serve a confused patient’s meal tray • Malpractice: is the failure to act according to the acceptable course of conduct, resulting in harm to patient.

15. Continuing Your Education • Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires health care facilities to ensure that workers are competent in their responsibilities. • Facilities must evaluate skills regularly • Health care workers are responsible for continuing education and keeping up with changes related to their area of work • Most licensed health care providers are required to complete a minimal number of CEU’s per yr. (continuing education units)

16. 5 Rights of Delegation Before delegating a task to a PCT, the nurse must decide if delegation is appropriate. 1.Right Task 2.Right Circumstances 3. Right Person 4. Right Direction 5. Right Supervision Pg. 11

17. Performing Delegated Activities • When a PCT accepts responsibility for a delegated task, you are responsible for your own actions • Never perform a procedure if you have not been taught or allowed to do it according to state law or facility policy • Always ask if you do not understand something • If you feel it is unsafe, discuss those concerns with RN • Report anything applicable observations about the patient to the RN • Notify RN immediately if the patient’s condition changes

18. Refusing Delegation When? If not within scope of practice, have not been taught procedure, you feel it may harm the patient, you do not feel comfortable performing the procedure, you do not have proper supplies Do Not Refuse- because the procedure is unpleasant How? Notify the RN as soon as you know you are going to refuse the delegation and give reasons why

19. Answering the Phone • Be courteous and polite • State name of unit, name, and title • Only a RN can take orders from a doctor over the phone • Do not give out personal information about patients over the phone • Thank the person for calling

20. Desirable Qualities of the PCT • Likes people • Takes responsibility seriously • Believes in the importance of the position • Teamwork • Good communication skills • Tact(the ability to say and do things at the right time) • Courtesy • Respect • Polite • Thoughtful ………………….refer to work ethic traits

21. Responsible Behavior • Reporting to work on time and using time well • Keeping absences to a minimal. Only when necessary • Keeping promises to patients and staff members • Following each patient care plan • Completing assigned tasks quickly and accurately • Treating patients with respect and dignity • Keeping patient info confidential

22. Professional Boundaries • Examples of not respecting professional boundaries: Discussing you personal problems w/ patient Being flirtatious with a patient Using offensive language Spending an inappropriate amount of time with the patient including off duty visits See pg 15-16

23. Communication • Verbal: choose words carefully, positive attitude, do not interrupt, use proper tone • Non-Verbal: posture, body language, eye contact Your words only represent 7% of your message 38% tone of voice 55% body language/facial expression

24. Sympathy vs. Empathy • Sympathy: feeling sorry for someone and taking on their feelings as your own • Empathy: is understanding how the patient feels. It involves connecting with and supporting a patient when he/she works through difficult times

25. Developmental Tasks • Infant(birth to 1yr) learns to trust • Toddler(1-3) learns to differentiate self from others • Preschool(3-5) develops initiative; self as part of family • School Age(6-11) develops physical and mental ability • Adolescence(12-18) develops a sense of identity/sexuality • Young Adult(19-25) establishes intimate relationships • Middle Adult(26-50) marriage, family, career • Late Adult(51-65) helps adult child, chronic dz, • Old Age(65+) reflective

26. Age Appropriate Care See pg 21-27 How might you communicate with a newborn? How might you provide a toddler with safety and security? What is the best approach to providing a preschooler with personal care and comfort? Vs. Old age?