This paper seeks to evaluate Joint Commission Standards in the Intensive Care Unit. A problem facing the quality of health care in ICU will be identified, and intervention using Joint Commission Standards derived. Information from a case and past literature will be used in the analysis. Nurses in the ICU are involved in the provision of quality care to the ICU patients. Also referred to as the critical care nurses, they avail direct care to patents encountering life-threatening condition within the ICU. The Joint Commission is a non-profit organization that works to accredit programs for hospitals and other healthcare enterprises. The operations of this commission entail the development of performance standards that address important elements of practice which include medication safety and patient care among others (The Joint Commission 2016). This paper analyzes the issue of delirium in the ICU and proposes solutions to its prevention. It has been noted that patients in the intensive care unit have instances of acute changes in consciousness and cognition that shows delirium. Delirium episodes have been known to have serious prognostic ramifications such as independent risk factor for death, longer hospital stay, and worse long-term brain functioning. The problem is being experienced the ICU of WX hospital.
Develop a written proposal by doing the following:
Identify a problem or issue related to practice, policy, population, or education that aligns with the organizational priorities you seek to solve.
Delirium is an issue that is characterized by consciousness disturbance accompanied by a cognition change. Delirium episodes have been known to have serious prognostic ramifications such as independent risk factor for death, longer hospital stay, and worse long-term brain functioning. This has been an issue in the ICU of WX hospital.
Explain the problem or issue, including why it is applicable to the area of practice you chose and the healthcare environment.
Delirium is usually manifested as a combination of symptoms showing an acute onset and course fluctuation. This issue is often encountered in the ICU mostly among the patients who are mechanically ventilated. In the nursing practice, there are accuracy issues when diagnosed by the nurses. Delirium can be mistaken for dementia only that its impacts in the attention span of the patient, levels of consciousness and the cognitive abilities. It, therefore, means improving quality of care does deal with delirium which is an opportunity for enhancing nursing care thereby developing the nursing profession (Miller & Barreiro, 2015). The prevalence of this condition is increasing in the hospital settings and especially in the intensive care unit. It, therefore, means that a multi-component intervention is needed for effective delirium management. This means using inter-professional teams in addition to the use of evidence-based intervention strategies.
Discuss your investigation of the problem or issue.
a. Include evidence to substantiate the problem or issue (e.g., organizational assessment, national source documents, evidence from a stakeholder).
Delirium which is also referred to as the acute confusion state and entails an acute reduction in the attention and cognition. This issue has been a problem for the patients on long-term care and older hospitalized patients. It has been estimated that the rates of occurrence in the hospital setting are between 14% and 56% (Miller & Barreiro, 2015). This variance is dependent on why the patient was hospitalized. For instance intensive care, urgent surgery or medical admission and the extent risk that the patient is exposed. This issue brings an increased risk for patients' death, longer hospital stay, and postoperative complications and intensive care unit admissions. On the healthcare organization, delirium has implications on the short-term and long-term healthcare costs.
It has been detailed that delirium is an independent risk for mortality in ICU patients and mostly those that are ventilated. The mortality rate of delirium patients exceeds that of non-delirious patients. For the diagnosis of delirium, acute changes in mental status and inattention must be present. This disorganized thinking or altered consciousness can vary from the patient being alert, stupor or in a comma (Miller & Barreiro, 2015). It has been documented that delirium can also be present in patients having a reduced degree of consciousness. Nurses can suspect and diagnose delirium when a patient is agitated and violent. However, it has been reported that delirium can be missed in mentally obtunded patients. According to research conducted involving approximately 600 intensive care unit patients, the most common was mixed-type delirium characterized by instances of hypoactivity and withdrawal (Miller & Barreiro, 2015). The patients were also found to be restless. The occurrence of pure hyperactive delirium was not common and was only found in 2% of the patients and only in those below the age of 65years.
Analyze the state of the situation using current data.
a. Analyze areas that might be contributing to the problem or issue.
Patients can either have hyperactive delirium or hypoactive delirium or a combination of both. It has been determined that delirium affects approximately 80% of the patients in the intensive care unit. Estimation has shown that the United States spends approximately four to sixteen billion dollars on cases of delirium in the ICU. Currently, the implications of delirium include increased the length of stay in the intensive care unit, mortality, prolonged neuropsychological deficits, and duration taken in the reception of mechanical ventilation. Doctors and nurses can fail to detect delirium in the absence of validated tools. Currently, delirium is a significant issue in critical care resulting in an increased mortality and morbidity. Some of the risk factors associated with delirium include preexisting dementia, admission severity illness, alcoholism, and hypertension. The risks for delirium in the intensive care unit can be categorized into predisposing factors and precipitating factors. Examples of predisposing factors include age, smoking or hypertension among others. Precipitating factors, on the other hand, are those that occur during the patient's stay in the ICU. These factors include severity of illness, surgery, acute infection and ICU medication.
Propose a solution or innovation for the problem or issue.
a. Justify your proposed solution or innovation based on the results of your investigation and analysis
The proposed intervention to prevent or manage delirium in the ICU complement the standards of Joint Commission. The commission works to continually enhance healthcare for the public while working with the stakeholders. The Joint Commission does this through the assessment of healthcare organizations and motivation to provide high-quality care to patients (The Joint Commission 2016).
The proposed solution for preventing delirium in the ICU is to educate nurses on the use of non-pharmacologic and pharmacologic interventions. WX hospital patients in the ICU have been experiencing delirium, and therefore the nurses need to be educated on the prevention methods. The proposed solution entails the use of a multicomponent invention strategy aimed at reducing the risk factors. This strategy aimed to modify delirium risk factors and to improve quality in the ICU such as reduction of noise, light, and disturbance during sleep. In the promotion of components of this strategy, there was nurses' education and training. These education and training sessions will focus on providing background information concerning delirium and how the intervention should be implemented.
ICU observation charts will be used in monitoring incidences of delirium. There will be the incorporation of routine Confusion Assessment Method in taking ICU measurements. The prevention strategy incorporated both medical treatments and non-medical nursing intervention (Patel et al., 2014). The non-medical nursing interventions involved regulation of sleep hours, monitoring sound and light and taking a routine confusion assessment. The medical interventions involved regulation of medication noted to cause delirium such as sedation.
Recommend resources to implement your proposed solution or innovation.
a. Include a cost-benefit analysis of your proposed solution or innovation.
To ensure sustainability, there is need to train and educate ICU nurses and implement a multicomponent invention strategy to assess delirium and evaluate preventive measures. By having a routine Confusion Assessment Method, it was possible to stress the essence of learning and growth in the intensive care unit and thereby promoting the better working environment.
Once the nurses were trained, they were allowed to implement the core measures and then a weekly assessment was done. This effort was critical in documenting that the education and training efforts were worth the time and cost investment. It was also important in showing that wide implications of training of staff in the delivery of quality services in the healthcare settings. The training helped the nurses in understanding the protocols, capabilities, limitations, and procedures of the ICU units.
A cost-benefit analysis can be described as a systematic approach utilized in the estimation of strengths and weaknesses of an alternative. The intensive care unit has been overly criticized for demanding much resources which is a major part of the healthcare organization budget (Lee & Kim, 2014). The application of cost-benefit was essential in pointing whether the intervention. The cost-benefit analysis usually entails treatment of categories of patients or diseases and not a single patient. To avoid cost-ineffectiveness, it is essential to avoid patients getting to the end-stage of the disease. This means that the proposed solution must focus on preventive measures.
I spent approximately 90days working on this project at around 5hours a week which resulted in an approximate cost of $1,124.00. The nurse in-charge spent approximately 15 hours helping in the project which was costed $350.00. The cost of training the intensive care unit nursing staff is part of the cost-benefit analysis. A total of 20 nurses were trained with a total cost of $20,000.
The potential benefits for the training ICU nurses was an improved efficiency and effectiveness. The ICU nurses' skills improved and therefore they could help in the prevention of patients with delirium. They would be able to offer for standardized and quality care to patients in the ICU.
Include a timeline for implementation based on your proposal.
The timeframe for this project is 90 day period from September 30th, 2017 through December 29th, 2017. In this period, actions that are precise, timely and measurable will be taken that supports the improvement of the quality of care in the ICU leading to the reduction of delirium. The function of this project is to accomplish a multicomponent invention strategy aimed at reducing the risk factors for delirium in the ICU. This will be conducted through thorough nurse staff education. The project, therefore, will focus on educating the nurses in the ICU on prevention of delirium.
Identify key stakeholders and/or appropriate partners that are important for the implementation of your solution or innovation.
Discuss why each key stakeholder and/or appropriate partner is important for the implementation of the solution or innovation.
The most important stakeholders concerning the prevention of delirium in the ICU patients. The key groups of shareholders include the administrative staff of the hospital and the ICU nursing staff....
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