Clinical audit can be defined as the systemic review conducted involving all the elements of the clinical care provided in the health care facility as compared to the quality benchmarks and its predetermined criteria (Peng et al., 2016). The primary aim of the clinical audits are to monitor the quality and appropriateness of the care services provided and identifying areas of improvement. In most cases the clinical audit is completed in a cycle of quality improvement and enhance the performance standards of the facility providing periodic recommendations. This response will involve nursing responsibilities and the strategies that a nursing professional can take in case of any breach in the best practice standard care delivery
The scenario selected for this response module focuses on a care facility where I have identified the care intervention provided to the patient has not been according to the best practice standards. Although, human being cannot be above committing errors, the impact of the clinical errors due to not meeting standards are associated with considerable harm to patients (Agedcare.health.gov.au, 2018). In my personal opinion, care interventions provided to the patient must always strictly follow the best practice standards, as these standards are curated and developed addressing each and every aspect of safe, effective and patient centred care need of the patients. As mentioned by Aacqa.gov.au (2018), the consequences of care interventions not adhering to best practice standards can result in a varied range of different adverse events in the clinical care, which can lead to exacerbation of the presenting health issue of the patient. Delving deeper into the issue, such exacerbation events can result in prolonging the hospital stay for the patient, adding on to the care costs and even fatal consequences for the patient depending on the severity of the adverse event.
Hence, in this situation, the first plausible action that I ought to be taking as a graduating nurse in practice will be to document the incident and possibly intervene in the care implementation process, communicating with the care professional explaining where he or she might be violating the best practice standard in care and correcting them. I will require to report the incident with proper documentation to my supervisor to have this mishap investigated and adequate actions to be taken to enhance the professional competence of the care staff engaged in the incompetent care intervention implementation (Safetyandquality.gov.au, 2018). Along with that, I will take the responsibility of reviewing the patient involved with the scenario and ensure that there is no risk of harm to the patient due to the improper care delivery. Lastly, I would also ensure advocating the need for periodic clinical audits quarterly each year and discovering any care staff in need of training and professional skill enhancement to ensure best practice standards being adhered under all circumstances (Ullman, Ray-Barruel, Rickard & Cooke, 2018). For my personal development and growth I will be taking additional efforts to enroll myself in continuous professional development to ensure being up-to-date within the recent best practice standards and be competent to implement them in my practice, I will also incorporate reflective practice as well to discover my strengths and weaknesses and provide safe and effective care.
Diabetes in one of the greatest public health priorities and is also one of the leading causes to mortality among individuals, close to 1.7 million of the Australian population has been reported to be living with either type of diabetes (Diabetesaustralia.com.au, 2018). Diabetes is the non-communicable disease which demands a number of lifestyle modifications and it is crucial for the patients suffering from the diabetes to understand these self-management techniques, especially for chronic illnesses. This response will involve strategies that a nurse can implement to enable the patients to effectively manage their diabetes.
I would like to mention that diabetic patients have a number of self-care needs and the need for them to understand self-management techniques and implementing them adequately is integral to enhance their own quality of living. Although, the patients have the aid of the diabetes educators to undertake self-management training of the patients; although, after shift ending finding them to provide diabetes self-management education is difficult. In such cases, the nurses have to step up to the role of educator and provide diabetes self-management education. Referring to the registered nurse practice standards by NMBA, the standard 3.2 states, information sharing and patient education to enable and empower the patients to take control of their life is an integral professional role of a practicing nurse (Nursingmidwiferyboard.gov.au, 2018). Hence, the diabetes self-management education also is undoubtedly is to be completed by a practicing nurse, preferably utilizing certain strategies to engage them and ensure optimal outcome of the session.
Enablement is a very common strategy taken by the nurses to implement health promotion, which focuses on educating and empowering the patients to manage and cope with their diseases and the changes facilitated by it in their lives. Hence, enablement strategy can be utilized by the nurses to educate the diabetic patients with respect to self-management tricks. Furthermore, developing personal skills is one of the action areas of Ottawa charter, and is a very important aspect of health promotion, and for diabetic patients needing self-management education, development of personal skills is a strategy that is needed to be taken by the nurses to complete this (The Ottawa Charter for Health Promotion, 2018). The nurse can take the assistance of best practice evidence and digital smartphone based interactive teaching plans to educate the patients the self-management techniques in simple and easy to understand format (Pal et al., 2018). Another very effective strategy to ensure the patients have understood the self-management techniques effectively is the teach-back method, where the patients will be needed to teach the nurse back the tricks and tips on their own which will help the nurses evaluate their depth of understanding (Dinh et al., 2016).
However, I believe that the responsibility of the nurses providing education does not end after a successful teach-back implementation. The patients often forget what they have been taught regarding the self-management techniques, especially the complicated blood sugar measuring, taking insulin shots or similar medication (Fumagalli, Radaelli, Lettieri & Masella, 2015). Hence, it is necessary for the nurses to provide brochures to the patients so that they have a simple set of instructions always for future references. Considering the impact on the nurses, often the nurses are not equipped with the systems knowledge of patient engaging innovative strategies to ensure optimal patient education. As a result the nurses have to employ enhanced time and efforts in educating patients and still not being able to extract optimal results and yet leading to extreme burnout and dissatisfaction. Hence, there is need for skill enhancement of the nurses in patient education taking the aid of agencies and personnel specializing in technologies in engaging patients more optimally in patient education programs (Baldoni et al., 2017).
Aacqa.gov.au. (2018). Failure to meet the Standards — Australian Aged Care Quality Agency. [online] Available at: https://www.aacqa.gov.au/providers/residential-aged-care/copy_of_processes/failure-to-meet-the-standards/failure-to-meet-the-standards [Accessed 15 Sep. 2018].
Australian Commission on Safety and Quality in Health Care. (2018). Retrieved from https://www.safetyandquality.gov.au/
Baldoni, N. R., Aquino, J. A., Sanches-Giraud, C., Oliveira, C. D. L., de Figueiredo, R. C., Cardoso, C. S., ... & Baldoni, A. O. (2017). Collective empowerment strategies for patients with Diabetes Mellitus: A systematic review and meta-analysis. Primary care diabetes, 11(2), 201-211. Doi: 10.1016/j.pcd.2016.09.006
Diabetesaustralia.com.au. (2018). Diabetes in Australia. [online] Available at: https://www.diabetesaustralia.com.au/diabetes-in-australia [Accessed 15 Sep. 2018].
Dinh, T. T. H., Bonner, A., Clark, R., Ramsbotham, J., & Hines, S. (2016). The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI database of systematic reviews and implementation reports, 14(1), 210-247. doi: 10.11124/jbisrir-2016-2296
Fumagalli, L. P., Radaelli, G., Lettieri, E., & Masella, C. (2015). Patient empowerment and its neighbours: clarifying the boundaries and their mutual relationships. Health Policy, 119(3), 384-394. Doi: 10.1016/j.healthpol.2014.10.017
Guide for reporting reportable assaults | Ageing and Aged Care. (2018). Retrieved from https://agedcare.health.gov.au/ensuring-quality/aged-care-quality-and-compliance/guide-for-reporting-reportable-assaults
Nursing and Midwifery Board of Australia - Professional standards. (2018). Retrieved from https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx
Pal, K., Dack, C., Ross, J., Michie, S., May, C., Stevenson, F., ... & Murray, E. (2018). Digital Health Interventions for Adults With Type 2 Diabetes: Qualitative Study of Patient Perspectives on Diabetes Self-Management Education and Support. Journal of medical Internet research, 20(2). doi: 10.2196/jmir.8439
Peng, F. S., Lin, H. M., Lin, H. H., Tu, F. C., Hsiao, C. F., & Hsiao, S. M. (2016). Impact of clinical audits on cesarean section rate. Taiwanese Journal of Obstetrics and Gynecology, 55(4), 530-533. Retrieved from https://www.hqip.org.uk/wp-content/uploads/2018/02/maximising-ncapop-data-for-cqc-inspections-optimal-data-flow.pdf
The Ottawa Charter for Health Promotion. (2018). Retrieved from https://www.who.int/healthpromotion/conferences/previous/ottawa/en/
Ullman, A. J., Ray-Barruel, G., Rickard, C. M., & Cooke, M. (2018). Clinical audits to improve critical care: Part 1 Prepare and collect data. Australian Critical Care, 31(2), 101-105. Doi: 10.1016/j.aucc.2017.04.003
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