Quality for ALS Patients

      In April of 2011 my mother was diagnosed with ALS (Amyotrophic Lateral Sclerosis), also known as Lou Gehrig's disease. Since the diagnosis and onset of symptoms there have been some radical changes. This particular disease impacts individuals differently in every case but is usually fatal in 3 to 5 years.

     The official website for ALS defines the disease as: “an incurable fatal neuromuscular disease characterized by progressive muscle weakness, resulting in paralysis. The disease attacks nerve cells in the brain and spinal cord. Motor neurons, which control the movement of voluntary muscles deteriorate and eventually die. When the motor neurons die, the brain can no longer initiate and control muscle movement. Because muscles no longer receive the messages they need in order to function they gradually weaken and deteriorate” (ALS Disease, 2012).

     ALS is my mom’s case began to develop in her throat and the first function lost was her ability to speak. The advancement of this disease and limitations of communication ability requires hospice services and allows for an inside look into quality control with a personally valuable interest. My family has been doing everything they can to take care of my mother’s every need and the most damaging aspect of this disease is falls that my mom has had. According to Montes (et. al., 2007), one of the most debilitating and costly aspects of the ALS disease are patient falls.

     Quality of hospice nurses for this ordeal has been very inconsistent and protocols vary from nurse-to-nurse. Three separate falls have dislocated my mom’s shoulder, sprained her wrist and ankle, and broken her nose. Two of the falls were done under supervision of hospice and the other was unsupervised in the beginning stages of the disease’s progression. Comprehensive and consistent training for handling of ALS patients should be a mandatory element of hospice nursing. Quality of the entire hospice organization is compromised from my family’s perspective and has made my mother fearful of venturing out even with supervision. Some of the nurses who work with my mom are very knowledgeable and skilled at their jobs. Hospice nurses are deployed all around the area and even upon request from my family and the nurse, they may be placed somewhere else. Hospice can increase the quality of services again by allowing individual cases to request certain nurses that they know can handle the individual patient obligations. The ALS disease or any fatal disease is not easy for the families of patients to manage. It is also difficult for hospice organizations to handle the variations in patient cases but quality of hospice can be improved dramatically, from an insider’s perspective. Quality can be improved for hospice by allowing nurses who are more knowledgeable about certain case disease requirements to work with those patients. They can further their quality by allowing families to request return services of nurses in hospice. If I were an administrator for the regional hospice in the area there would be a lot of changes made to improve quality and alter operations to increase patient satisfaction, nurse observation, responsiveness, training, and abilities.

References:

ALS Disease. (2012). The Official Lou Gehrig Website. Retrieved from:             http://www.lougehrig.com/about/als.htm

Montes, J., Cheng, B., Diamond, B., Doorish, C., Mitsumoto, H., & Gordon, P. (2007).The Timed Up and Go test: predicting falls in ALS. Amyotrophic Lateral Sclerosis: Official Publication Of The World Federation Of Neurology Research Group On Motor Neuron Diseases, 8(5), 292-295.

Patient Perspective

The entire purpose of health care is to administer preventative, or pertinent medical treatments to patients in order to cure, detour, or improve an illness or ailment. With any type of service where goods or services are exchanged, there are inevitably some instances that result in unfavorable outcomes for either the service provider or recipient. The main goal of health care is to keep a patient safe and free “from injury or illness resulting from the processes of health care” (Impact, 2012). A patient’s entitlement to be cared for in a safe and effective manner is extremely important because it is the sole reason for the existence of health care facilities and all of the staffs that inhibit and operate in it.

Patient harm can occur at several stages of treatment from a number of different sources. Health care facilities have an obligation to limit the possibility of harm to patients by monitoring qualified staff in multiple departments and lowering potential for negligence through environmental issues. Providing actual health care treatment can create issues in medical therapy such as procedural errors. Procedural errors can occur as unsanitary conditions, improper equipment utilization, and negligent or improper services rendered. According to the HSA6385 course powerpoint presentation on Patient Safety and Medical Errors, there are approximately 1.5 million injuries to patients that involve medication errors as well(Impact, 2012).

In some instances a doctor may feel as though a medical procedure has been a success while a patient does not find the treatment satisfactory. The majority of medical procedures require a consent form to be signed that has a liability disclaimer stating that unfavorable outcomes can result from the procedure. The medical community can view a slight improvement in condition as a success and the patient can still remain disappointed because of higher expectations for anticipated results. Patient safety in a health care facility should be preserved, protected, and improved and viewing the patient as a guest or customer makes that individual the most significant determinate as to whether an unfavorable incident has occurred.

References:

Impact of Quality on the Patient: Patient Safety and Medical Errors. (2012). [Powerpoint Slides]. Retrieved from https://webcourses.ucf.edu/webct/urw/tp14717307490131.lc14158134517121/displayContentPage.dowebct?pageID=14837728424111&resetBreadcrumb=false&displayBCInsideFrame=true

Food for Thought...

I always wonder if the doctor who uses billboards on I-4 to advertise for vasectomys really gets a good return on investment? How many guys driving on the highway have the desire to get a vasectomy after seeing that advertisement?

Nursing Shortages and the Impact on Quality Health Care

 A persisting quality concern in the majority of health care settings involves shortages in skilled employees, especially nurses. As the baby boomer generation grows older, the need for registered nurses (RN’s) and certified nursing assistants (CNA’s) has been increasing yearly. The shortage of nurses is anticipated to near a deficit of almost a million nurses in the next few years which presents a threat with the potential to negatively impact national health care quality (May, 2006). Complicating the shortage and quality concerns is the inability for schools and universities to increase nursing enrollment levels. According to Patrician, many unfavorable patient outcomes are preventable in health care facilities and are affected by inadequate RN and CNA staffing levels or overutilization of staff (2011).

Another contributing factor for deficiency of quality nursing levels is the lack of reimbursement and funding received by some health care facilities. Organizations that have the ability to hire more nurses fail to do so at times based on financial inefficiencies (Harrington, 2012). Instead of costing a health care facility more money by hiring another qualified nurse, preexisting nursing staff may be expected to work longer hours or more days consecutively. The largest concern with this practice is that the quality of care decreases directly as the amount of consecutive hours of (nurse) work increases (May, 2006). Patient quality care decreases through inability to properly transport patients, through medication errors, infection oversight, increased ulcers, and cross-contamination. According to Harrington, the larger hospitals have quality issues surrounding RN and CNA shortages but nursing homes experience more shortages and are more likely to overwork nursing staff which has more probability to lead to unintentional staff actions “that cause harm or jeopardy” to nursing home patients (2012).

As colleges and universities attempt to expand enrollment and keep up with the growing demand for RN’s and CNA’s, the U.S. job market that is willing to accept qualified nursing staff is growing at the same or faster rate. Quality standards for each health care facility are currently measured and compared to industry standards in the nation, state, and county. When the nursing shortage continues into the future, there will have to be some substantial organizational overhauls made by administrators and executives to keep quality standards at a historically acceptable level. Industry quality standards will undoubtedly decrease in time (if/when these trends continue) and future standards may receive better quality indicators and benchmarks by looking into the past instead of comparing with the rest of the understaffed health care industry.

 References:

Harrington, C., Olney, B., Carrillo, H., & Kang, T. (2012). Nurse staffing and deficiencies in the largest for-profit nursing home chains and chains owned by private equity companies. Health Services Research, 47(1 Pt 1), 106-128. doi:10.1111/j.1475-6773.2011.01311.x 

May, J., Bazzoli, G., & Gerland, A. (2006). Hospitals' responses to nurse staffing shortages. Health Affairs (Project Hope), 25(4), W316-W323. 

Patrician, P., Loan, L., McCarthy, M., Fridman, M., Donaldson, N., Bingham, M., & Brosch, L. (2011). The association of shift-level nurse staffing with adverse patient events. The Journal Of Nursing

What Does Quality Mean to Me?

The presence of quality exists in many realms pertaining to health care. Individuals seeking medical treatment and services have a predetermined level of quality, or satisfaction, that they have come to expect and desire in the United States health care complex. The real perplexing dynamic facing health care organizations’ is that there is quality on so many levels from when an individual enters a facility, to when they exit. Quality factors of waiting (room) times, competence of doctors and staff, in/outpatient rooms, supplies, cleanliness, service or treatment, discharge, and more all contribute to an individual perceived level of quality.

                The health care quality definition is multidimensional and has a different meaning to every individual. A native New Yorker may be unsatisfied with the quality of health care received in California at the same time a Texan appreciates the very same level of quality. The entire health care quality experience is subjective. This being said, health care quality is the perceived level of overall satisfaction based on a combination of an individual’s entire experience of interactions, comforts, inconveniences, treatments, and progress of a medical situation from start to finish at any health care organization.

                The cost of health care in the United States is expensive and the medical capabilities available for a number of disorders are vast. There should be high levels of quality because of the cost many Americans pay for health insurance, or (worst case scenario) out-of-pocket. The health care organization administrator has a large responsibility to oversee the multiple staff departments that are contributors to quality, while at the same time maintaining the costs as close to (or below) the budget as possible. The quality “balancing act” in the United States pits overcharged patients versus underfunded health care organizations and at times, either entity may lose out in one way, shape, or form.

                Nationwide or regional industry health care quality standards are the closest technique to gauge or evaluate a particular health care organization’s customer, or patient, quality satisfaction. The most effective method to provide adequate and superior quality in the health care realm is to go above and beyond patient expectations while staying inside budget parameters.