Lack of accountability
Lack of safe staffing levels
Hospitals should not take unnecessary risks by cutting staff in Recovery
Accreditation for hospitals and nursing homes follows a simplistic, sometimes irrelevant approach. Things documented tend to be non clinical, like checking building codes or managing the spillage of dangerous drugs.
Fire hydrant on the premises? Tick. Beds fitted with side rails? Tick. Drug safe in pharmacy? Tick.
Most of the people employed by the health bureaucracies responsible for hospitals have no qualifications or work experience in healthcare.
Medical, pharmacy and nursing associations are very powerful organisations, and don’t like to have their work publicly scrutinised. It opens up legal risks for their members and makes staff who fail to follow them vulnerable to being sacked.
So the way patient care is actually delivered, in terms of drug doses, patient observations or discharge planning is undertaken is rarely recorded. The ‘nuts and bolts’ of patient care is not nationally agreed upon, standardised or compulsory.
Clinical Guidelines are created by individual medical specialties and are kept under the control of the association that creates them.
Some hospitals create their own ‘in-house’ clinical standards setting out broader issues like patient education and discharge planning. Others don’t.
The general public would have no idea that these documents exist or know where to start looking for them.
Imagine the aviation industry not having compulsory, standardised guidelines for the building, maintenance and monitoring of both aircrafts and pilots?
Health care funding is not currently linked to improved patient outcomes. Good and bad care and good and bad hospitals receive identical funding.
One of the most important factors affecting patient care, is staffing levels. Staff wages are the largest component of any hospital budget.
While cutting staff can improve the budget, it can also decrease the quality of patient care. When hospitals are expected to run as a profit driven business, this becomes an issue impacting patient care.
Recovery is the part of theatre where patients ‘wake up’ from their anaesthetic. The recovery process is a vital part of patient safety.
Patients often come out of theatre with a temporary airways still in place. They are asleep, full of drugs and have to be continuously monitored.
They are at risk of aspirating from their own saliva. They could roll over and the airway could fall out or it could be pulled out. Patients can also vomit from the side effect of anaesthetic drugs. If this they have to be quickly turned on their side, suctioned so their airway is clear. The airway is only removed when they are able to cough spontaneously. They have to be suctioned at the same time as the airway is removed, as saliva gathers around the airways device.
Their vital signs should be done every 10 minutes or so. Sometimes patients stay for an hour in recovery. The criterion for going back to the ward is being able to do deep breathing and coughing, swallow, have their pain managed and have nausea or vomiting well under control.
Their wound should not be bleeding, any drains should be checked and output monitored.
Recovery is where patients are stabilised before they leave an acute area of the hospital, and go back to the wards.
An agency nurse was employed to do a late shift (1pm to 9.30pm) in a small hospital. On this day, patients were being taken into theatre for major surgery late in the afternoon. However most of the nursing and medical staff were sent home a after 5pm to save the hospital paying penalty rates.
A patient was due to come out into recovery at 9pm after a total hip replacement. The agency nurse was the only staff member in recovery. The nearest doctors and nurses out of sight, in another area of the hospital.
The agency nurse refused to accept the patient from theatre into recovery. This meant that the patient had to stay in theatre, tying up the anaesthetist and surgery nurses. The agency nurses rational that if the patient deteriorated and had an airway blockage, she could not care for him safely. The doctors and nurses in theatre were frustrated, their time was being wasted and the hospital manager was called in.
“Nothing had ever happen in the past”, she assured the agency nurse. “It is perfectly safe”.
The managers overwhelming concern was controlling the hospital budget and keeping the private surgeons happy. Private surgeons bring in private patients, who payed the hospital bills. Every operation they performed meant more money. Delayed surgery meant unhappy surgeons and lost income.
She demanded an explanation for theatre being held up. The agency nurse explained the link between inadequate staffing and risk to patient safety. The managed dismissed the concerns and was angry with the agency nurse for not doing as she was told. She explained to the agency nurse that it was a common procedure in this hospital for one nurse to be alone in recovery, caring for patients who had just come out of a full anaesthetic.
The agency nurse still refused to take the patient on her own, and was subsequently sent home. She was never reemployed by this hospital again.