Myocardial infarction (MI), also called heart attack, occurs when a part of the myocardium does not receive enough blood. The Centers for Disease Control and Prevention (n.d.) indicate that the condition affects approximately 735,000 Americans annually. In particular, 525,000 cases are new conditions and 210,000 cases are recurrences in people who have already had the heart attack (Centers for Disease Control and Prevention, n.d.). Steg et al. (2012) argue that if patients delay seeking prompt treatment, they risk having a damaged heart muscle that can be challenging to treat. Some patients with this condition require surgery called a coronary artery bypass graft (CABG) to open their blood vessels, thus enhancing blood flow. This process necessitates hospitalization because healthcare providers need to monitor the recovery process and alleviate MI symptoms such as chest pain. During the admission period, the hospital environment predisposes patients to various risks that can be detrimental to their health. Accordingly, it is imperative for the hospital administration to ensure that it protects patients from such hazards. This paper examines the risks that MI patients who have undergone CABG are likely to encounter in the hospital environment, describes the risk management program for these patients, identifies infection control risks and the way the hospital administration can mitigate them, and analyzes the implementation of the international safety patient goals.
Potential Risks for Heart Attack Patients Who Have Done CABG
Medical Negligence and Medication Errors
Postoperatively, patients may encounter medical negligence such as medication and diagnostic errors. According to Gershlick (2012), heart attack patients who have undergone CABG experience various health problems such as bleeding, arrhythmias, blood clots, and even death. Because of such dangerous risks, they require healthcare providers who are knowledgeable about the surgery and its outcomes. Consequently, hospitals need enough experienced staff members who can address such critical patients. However, despite the increasing number of people with MI and individuals undergoing CABG, healthcare providers, particularly nurses specialized in the field, are few. According to Juraschek, Zhang, Ranganathan, and Lin (2012), the patient-nurse ratio keeps increasing, thus affecting the quality of care given to patients. In this case, patients can find themselves under the care of clinicians who are inexperienced in handling heart attack cases, hence leading to negligence and medication errors. Huang, Sun, and Lien (2015) contend that negligence does not only involve ignoring the provision of the necessary care but also the lack of knowledge regarding the delivery of the required therapy. Patients under the care of such clinicians can receive substandard care, thus affecting their health outcomes negatively.
Patients can also contract nosocomial infections. After surgery, the subsequent management can result in the infection of the surgical incision if healthcare providers do not practice the aseptic techniques. Additionally, if the hospital does not provide the necessary materials required to perform sterile procedures such as wound dressing, nurses can improvise, which can predispose patients to infections. According to Naidu et al. (2014), patients with wound areas after surgery have a high risk of contracting hospital-acquired infections that consequently affect the bloodstream and lead to sepsis, which can cause increased mortality in CABG patients. Furthermore, Mehta et al. (2014) argue that poor hygiene in the hospital and an untidy hospital environment can lead to increased rates of nosocomial infections among surgical patients. Moreover, inadequate promotion of hygiene observance by patients can cause hospital-acquired infections.
Breach of Privacy
Healthcare providers can risk sharing patient medical information with the public. When relatives of patients visit the healthcare environment to know their health status, healthcare practitioners on duty may be tempted to reveal the information that clients might be uncomfortable to expose. Additionally, social media can be a platform where healthcare providers can risk sharing patient information against their will. The U.S. Department of Health and Human Services (n.d.) ascertains that patients have rights over their medical information and thus healthcare practitioners should not share it. However, some healthcare providers usually fail to be cognizant of their professional obligations. According to Spector and Kappel (2012), some healthcare practitioners breach patient privacy intentionally or unintentionally. As a result, they erode their relationships with patients and harm the reputation of the hospital. Further, a weak relationship between healthcare providers and patients may result in substandard care, which eventually affects the health outcome of patients negatively (Kelley et al., 2014). Therefore, sharing medical information affects not only the care of CABG patients but also the hospital management.
Another risk is hospital falls due to disorientation. According to Alexander and Smith (2016), bleeding is inevitable for patients who have undergone CABG. The intraoperative procedures lead to the loss of blood. Additionally, the patient can lose more blood postoperatively. Consequently, the lack of enough red blood cells can result in anemia (Giuffrida et al., 2013). Giuffrida et al. (2013) further argue that patients who have undergone such surgeries can have mental confusion because of anemia. As a result, they can be at risk of hospital falls and neglect to comply with the therapy.
Risk Management Program
Increasing the Number of Competent Staff
The risk management program for CABG patients can involve addressing the factors that contribute to the problems that they are likely to face. First, the administrator can consider solving the staffing issue in the hospital. Healthcare providers whom the manager can hire should be conversant with managing cardiovascular diseases to avoid misdiagnosis of the heart attack related symptoms. Such practitioners can also be instrumental in teaching other inexperienced healthcare providers on the proper management of Heart Attack patients who have undergone CABG. For instance, Moore and Prentice (2013) contend that a healthy collaborative relationship between nurse practitioners and other registered nurses enhances the quality of nursing care delivery and leads to an improved patient outcome.
Additionally, a reduced nurse-patient ratio decreases burnout syndrome among nurses and promotes collaboration, thus ensuring the delivery of quality nursing care services (Stimpfel, Sloane, & Aiken, 2012). Therefore, hiring sufficient and competent healthcare staff can guarantee the improved delivery of care to patients who have undergone CABG. It can also prevent them from problems such as neglect and medication errors. Most importantly, the administrator should ensure that healthcare providers communicate with patients accurately and do a follow-up on their diagnostic results to ensure adequate management.
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Equipping the Public Health Units in Hospitals
Public health officers are instrumental in the hospital environment because they assist in coordinating health activities that can help the hospital to prevent nosocomial infections. For instance, they ensure proper collection and disposal of wastes, thus avoiding an increased incidence of nosocomial infections (Ogbonna, Chindah, & Ubani, 2012). Lack of equipping the units and poor remuneration of the public health officers can reduce their motivation to work, thereby hampering the efforts of mitigating the risks of hospital-acquired infections.
Thus, the administrator should ensure that officers are fully equipped and motivated to provide a sterile environment in acute settings where patients who have undergone CABG are admitted. Moreover, the administrator should encourage public health officers to create posters that promote a sterile environment in such units to prevent incidences of nosocomial infections.
Strengthening Hospital Policies regarding Patient Privacy
Most healthcare providers are aware of their professional ethics that requires them to maintain confidentiality over patient information. However, they expose themselves to situations that might force them to contravene these requirements. For this reason, the administrator can revise hospital policies regarding patient privacy to include factors such as social media, which can predispose healthcare providers to instances that tempt them to share the patient information.
Then, the administrators should put the posters in units where healthcare providers can see them while managing CABG patients. Harman, Flite, and Bond (2012) agree that such hospital policies have proven effective in protecting patient information and enhancing their dignity, hence improving the relationship between them and health care providers. Most importantly, the administrator should make sure that the policy addresses the consequences of not adhering to it.
Hospital managers can ensure that they manage the risk of hospital falls by making minor modifications in the wards. For instance, critical patients, particularly seniors who have undergone the CABG surgery, should have rails on their beds. Such rails can help to prevent them from falling. Additionally, administrators can ensure that bathtubs used by patients have grab bars to assist them in moving when they experience body weakness. Furthermore, managers should make sure that the floors are not slippery since they can lead to an increased incidence of hospital falls and delay patient recovery.
Evaluation, Follow-Up and Record Keeping
The administrator can implement other measures that can address the hospital risks for CABG patients and facilitate patient recovery. For instance, encouraging evaluation of patient symptoms after treatment and doing a follow-up are efficient ways of dealing with the exposure of patients to diagnostic errors. Marks, Loehrer, and McCarthy (2013) state that patient follow-up promotes accountability, thus preventing substandard care in the subsequent management of patient symptoms. Furthermore, proper record keeping in the hospital can help healthcare providers to monitor the progress of the patient toward recovery. For this reason, the administrator should facilitate proper documentation by healthcare providers to ensure credible records.
Infection Control Risks
Heart attack patients who have undergone CABG can experience different risks while carrying out infection control measures. For instance, they might take the initiative of preventing infection by cleaning the site of infection. As a result, patients may make mistakes due to inadequate knowledge and worsen their symptoms, thus delaying recovery. Additionally, the gloves used by healthcare providers may have tears that might further contribute to the transfer of microorganism and, consequently, the spread of infections. The hospital management can mitigate these two risks by first advising patients to leave hospital procedures for qualified health care providers. Then, the manager can facilitate the provision of materials of verified quality such as latex gloves, which healthcare practitioners can use in their aseptic technique.
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Implementation of the International Safety Patient Goals
According to the Joint Commission International (n.d.), the six international patient safety goals focus on improving healthcare delivery to patients to enhance their health outcomes. The six goals include proper identification of the patient, effective communication, safe medication use, ensuring correct-procedure, correct-site, correct-patient, reduction of risks of nosocomial infections, and reduction of risks associated with falling.
All the six patient goals apply to patients who have undergone CABG. The health administration can implement the first goal by encouraging healthcare providers to identify their patients correctly and by name. According to Ulrich and Kear (2014), proper identification of patients can minimize medication errors, which is a potential risk for such patients. Similarly, the fourth goal that requires healthcare practitioners to prevent wrong-procedure, wrong-site, and wrong-patient events can help healthcare providers to verify the names of their patients before any procedure to minimize the risks associated with irrational interventions. In this case, administrators can come up with patient identifiers and encourage healthcare providers to innovate theirs to avoid performing wrong procedures.
Furthermore, the manager can ensure the effective implementation of the second goal by promoting healthy communication through the free interaction among healthcare providers and patients who have undergone CABG. Similarly, the manager can create a healthy environment for healthcare practitioners to communicate well among themselves regarding the management of such patients.
Additionally, the subsequent care of patients who have done CABG involves taking vital signs to monitor any deviations from normal. Communicating and interpreting the findings adequately can help other care providers to provide appropriate care. Ulrich and Kear (2014) contend that reporting diagnostic findings on a timely basis and handing over correct information is an efficient way of implementing this goal, thus promoting patient recovery.
The administrator can ensure the observance of the third goal by encouraging an appropriate labeling of high-alert drugs to reduce the likelihood of harming patients. For instance, Gershlick (2012) asserts that patients who have undergone CABG experience bleeding. Consequently, administering anticoagulants in a wrong way can lead to increased bleeding and eventually cause death. Thus, healthcare providers should improve medication safety by labeling drugs appropriately. Finally, the manager can ensure the observance of the fifth and the sixth goals by equipping the public health unit of the hospital to improve sterilization and creating an environment where patients can stay without harm such as putting rails on beds.
CABG is an efficient method of treating a heart attack. The surgeon takes a blood vessel from another part of the body to connect it to other vessels in the heart to ensure adequate blood flow. However, patients who undergo this procedure experience problems such as bleeding. They are also susceptible to medication errors, nosocomial infections, hospital falls, and lack of privacy. In spite of these risks, an efficient management of the healthcare facility using a comprehensive risk management program can help to prevent them. The risk management program can include equipping the public health units in hospitals, increasing the number of competent staff, strengthening policies regarding patient privacy, taking measures to prevent hospital falls, and ensuring proper evaluation, follow-up, and record keeping. Finally, the implementation of the international safety patient goals can ensure appropriate treatment of patients who have undergone such a surgery.