ER Requirements
Content
St. Mary’s College, Inc.
TAGUM CITY
BACHELOR OF SCIENCE IN NURSING
RELATED LEARNING EXPERIENCE
Reading Article:
“Majority of Unintended Incidents in the Emergency Room Are Caused By Human Error, Study Finds”
Concept: Nursing Management
Submitted by: ALFIE G. CABUNOC, SN BSN 4A1
Submitted to: MELJUN F. PEREZ, RT, RN
Clinical Instructor
Web address: http://www.sciencedaily.com/releases/2009/ 09/ 090917191603.htm
Majority of Unintended Incidents in the Emergency Room Are Caused By Human Error, Study Finds
ScienceDaily (Sep. 20, 2009) — Sixty percent of the causes of unintended incidents in the emergency department that could have compromised patient safety are related to human failures, according to a study published in the open access journal BMC Emergency Medicine. Hospitals and emergency departments are challenging settings with regard to patient safety -- a considerable number of patients suffer from unintended harm caused by healthcare management. Little is known about the causes of unintended events and, thus, these results from Marleen Smits and colleagues from Netherlands Institute for Health Services Research and EMGO Institute for Health and Care Research, may help to target research and interventions to increase patient safety. The Dutch team studied emergency departments at 10 hospitals in the Netherlands for 8-14 weeks, during which staff were asked to report unintended events, defined as all unintended incidents that could have harmed or did harm a patient. A total of 522 unintended events were reported, of which more than half of the events had consequences for the patient. A quarter of the reported events related to cooperation between the emergency department and other hospital departments. The team found that most root causes were human (60%), followed by organizational (25%) and technical (11%). Nearly half of the causes were attributable to departments outside the emergency department, such as the laboratory. Event reports are internationally relevant for healthcare providers and policy makers in the area of emergency medicine. Smits said, "Patient safety in the emergency setting should be improved, especially the collaboration with other hospital departments". All general hospitals in the Netherlands participate in the safety program "Prevent harm, work safely". They are setting up safety management systems that include incident reporting systems. Moreover, hospitals follow action plans on 10 themes with a high potential for reduction of unintended harm, for example, early detection of a decline in a patient's vital signs, medication verification and prevention of substitutions of patients.
Journal Reference: Marleen Smits, Peter P Groenewegen, Danielle RM Timmermans, Gerrit van der Wal and Cordula Wagner. The nature and causes of unintended events reported at ten emergency departments. BMC Emergency Medicine, 2009; (in press)
Online Source: BioMed Central (2009, September 20). Majority Of Unintended Incidents In The Emergency Room Are Caused By Human Error, Study Finds. ScienceDaily. Retrieved January 28, 2010, from http://www.sciencedaily.com /releases/2009/09/090917191603.htm
Summary:
____________________________________________
The article cites about the unintended incidents in the emergency department that could have compromised patient safety must have been caused human failures. Hospitals and emergency departments are challenging settings with regard to patient safety -- a considerable number of patients suffer from unintended harm caused by healthcare management. Little is known about the causes of unintended events and, thus, these results from Marleen Smits and colleagues from Netherlands Institute for Health Services Research and EMGO Institute for Health and Care Research may help to target research and interventions to increase patient safety. The Dutch team studied emergency departments at 10 hospitals in the Netherlands for 8-14 weeks, during which staff were asked to report unintended events, defined as all unintended incidents that could have harmed or did harm a patient. A quarter of the reported events related to cooperation between the emergency department and other hospital departments. Smits said, "Patient safety in the emergency setting should be improved, especially the collaboration with other hospital departments".
____________________________________________
Reaction:
____________________________________________ In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end patient safety has become the focus of a world-wide endeavor aimed at reducing the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments. We are indeed human that errors nay possibly come our way. Even the “experts” in their field are also prone to commitment of even grave errors that had caused a detriment to their clients’ safety. It is not as always ideal if we are to examine the hospital setting. As far as I can remember during my encounter with the PAASCU accreditors, “there is no place wherein we can find an ideal hospital setting…” she simply pointed out that there is always a room for error. And this is somehow alarming if the incidence of negligence will seemingly increasing.
As student as I am, I have always been reminded and motivated by my superiors and clinical instructors, same as true with the others students, that I have to practice in a resemblance of an ”ivory tower”, and that competence must always be aimed in doing single procedure in order to achieve optimum safe and quality nursing care. This has been long held philosophy, and that I am always trying my very best to achieve such expectation. However, since the article already presented a legitimate fact that human error paves its way to cause harm to patients, it is quite a call for a challenge for us neophytes to make a change in order to abate this issue. It further means that we have to triple our efforts to promote more the safety and security of every individual who seeks for a healthcare. And of course, it is quite burdening!
Yes, we are neophytes, coined to be “young” in the field of healthcare. However, this must be the very reason why we should have to strive more to achieve excellence in whatever actions that we are to be doing. i accept the challenging demand personally. I am always looking forward for a best training ground to hone up my skills. With this “human factor” in
causing errors to clients’ safety, I am indeed very much willing to abolish this notion, in order to achieve maximum health for the people for the next years to come, as being lived by the creed of dead and living nursing theorists.
____________________________________________
St. Mary’s College, Inc.
TAGUM CITY
BACHELOR OF SCIENCE IN NURSING
RELATED LEARNING EXPERIENCE
Progress Notes
Concept: Nursing Management
Submitted by: ALFIE G. CABUNOC, SN BSN 4A1
Submitted to: MELJUN F. PEREZ, RT, RN Clinical Instructor
Date: Concept: Area: Clinical Instructor:
January 25-26, 2010 Nursing Management Davao Regional Hospital Meljun F. Perez, RT, RN - Emergency Department
Summary:
We had already been exposed to the ED of DRH these past two days for the concept of Nursing Management. That duty seems analogous to those other RLE days, but there is actually something special for this week since we are to be evaluated by the PAASCU Accreditors there exactly on our actual hands-on at the ER. The afternoon shifters started the day through a circle which was observed by one of the PAASCU representative. However, we haven’t been able to attend with the circle as we had already been signaled to go due to the time constraint (considering that DRH does the endorsement earlier; example, 30 minutes before the starting time of the shift). Thus, at around 2:15 pm, we departed the school for DRH. Upon arrival, we had usually cites first the Nurses’ Prayer. Right after, we prepared, then attended the Afternoon Endorsement. Soon after the endorsement, we did the nursing rounds to every area of the Emergency Department, starting from the Pedia down to the Surgery area. As we are through, we had been gathered and given specific areas of assignment per pair. As for me and with my partner, we had been assigned on the first day at the Triage. It has been further instructed that after the second table, the rotation of area must be done. After some sorts of instructions and clarifications with regards to our duty, we are immediately distributed to our assignments and started doing our functions. The length of my Triage experience has been evident with numerous admissions. Not until the clock strikes 6:00 pm, I had taken my meal together with the other assignees for the second table. As being instructed, we had done the rotation of areas sooner as we came back form our 30-minute break, and proceeded to the Pediatric area. On the second day, the first area of assignment that I had been assigned was on the Medicine area, and rotated after the break at the OB-GYN.
We spent every remaining hour in doing procedures and attending to patients’ needs. Some instances were also prevalent with our assistance to the residents-on-duty for patients who requires immediate attention. As it was about 10:30 pm, we started doing the aftercare of our areas of concern. Since there were procedures that were still pending, we just endorse them to the staffs for the continuity of care. We attend the outgoing endorsement as the night shift is receiving it. Soon after, we had been gathered for the last minute instructions for tomorrow’s updates. As we are all settled, we ended the day and departed the institution at beyond 11:00 pm.
____________________________________________
Reflection:
____________________________________________
I had been excited yet thrilled for the exposure. Prior to duty, there were queries in mind that tucks me in. as what I had been heard by some of the SN’s who had already been exposed there, Ma’am Coral, the Chief Nurse of the Hospital, is fond of doing her rounds there at the Emergency Department. That rumor was indeed to be true as I had personally seen Ma’am Coral on the first day of our duty having her rounds exactly at the ED! I had felt the anxiety. I even asked to my self, “Makatubag kaha ko kung pangutan-on ko nya karon?” It sounds fool, but it was actually a big deal. And yet, I laughed to my self in the end. At the middle of my duty hours, I motivated myself to be really efficient and competent to every action that I must be doing. Apart from it is to be prepared whenever Ma’am Coral would have her visit (hehehehe). I can say that I performed well during my duty. I had done through my efforts to perform effectively the provision of my nursing care to my patients, even just through the little ways I can. And indeed, it turned out to be successful. I was also thankful to my Clinical Instructor who was considerate. I admit that there are times that I was so fond of asking questions, and yet, those were answered by him. And that was a great factor why a student can perform well in the area. I appreciated also the positivity of my patients towards me. Though I can assess their agonizing condition brought about by their illness state, they still have the chance to show to me their warm welcome and positive reaction to my presence in caring for them even just for shorter time. They had been participative to my instructions. However, there is one of my patients who has been limited with her motions. I understand, though, that it is due to her
debilitation condition. And for that, I felt pity for her. And that was a motivation for me to really work harder to care for those who are needy. I had learned lots of lessons throughout my exposure. Aside from the instance wherein one of the resident physician who had attended to his patient has been so generous in explaining to me the pathophysiology of the patient’s condition (patient who has Idiopathic Thrombocytopenic Purpura). It expounded more my knowledge about the disease. I had also been oriented with the new and unordinary procedures and true challenging hospital setting. Though Ma’am Coral wasn’t able to ask me (she had just stared at me while taking the vital signs of one of the patients), at least I was motivated to double my efforts. In the end, my anxiety felt at the beginning caused me to perform effectively for my duty. Thus, the end was justified by the means…
____________________________________________
St. Mary’s College, Inc.
TAGUM CITY
BACHELOR OF SCIENCE IN NURSING
RELATED LEARNING EXPERIENCE
Nursing Care Plan
Concept: Nursing Management
Submitted by: ALFIE G. CABUNOC, SN BSN 4A1
Submitted to: MELJUN F. PEREZ, RT, RN Clinical Instructor
TAGUM CITY
BACHELOR OF SCIENCE IN NURSING
RELATED LEARNING EXPERIENCE
Reading Article:
“Majority of Unintended Incidents in the Emergency Room Are Caused By Human Error, Study Finds”
Concept: Nursing Management
Submitted by: ALFIE G. CABUNOC, SN BSN 4A1
Submitted to: MELJUN F. PEREZ, RT, RN
Clinical Instructor
Web address: http://www.sciencedaily.com/releases/2009/ 09/ 090917191603.htm
Majority of Unintended Incidents in the Emergency Room Are Caused By Human Error, Study Finds
ScienceDaily (Sep. 20, 2009) — Sixty percent of the causes of unintended incidents in the emergency department that could have compromised patient safety are related to human failures, according to a study published in the open access journal BMC Emergency Medicine. Hospitals and emergency departments are challenging settings with regard to patient safety -- a considerable number of patients suffer from unintended harm caused by healthcare management. Little is known about the causes of unintended events and, thus, these results from Marleen Smits and colleagues from Netherlands Institute for Health Services Research and EMGO Institute for Health and Care Research, may help to target research and interventions to increase patient safety. The Dutch team studied emergency departments at 10 hospitals in the Netherlands for 8-14 weeks, during which staff were asked to report unintended events, defined as all unintended incidents that could have harmed or did harm a patient. A total of 522 unintended events were reported, of which more than half of the events had consequences for the patient. A quarter of the reported events related to cooperation between the emergency department and other hospital departments. The team found that most root causes were human (60%), followed by organizational (25%) and technical (11%). Nearly half of the causes were attributable to departments outside the emergency department, such as the laboratory. Event reports are internationally relevant for healthcare providers and policy makers in the area of emergency medicine. Smits said, "Patient safety in the emergency setting should be improved, especially the collaboration with other hospital departments". All general hospitals in the Netherlands participate in the safety program "Prevent harm, work safely". They are setting up safety management systems that include incident reporting systems. Moreover, hospitals follow action plans on 10 themes with a high potential for reduction of unintended harm, for example, early detection of a decline in a patient's vital signs, medication verification and prevention of substitutions of patients.
Journal Reference: Marleen Smits, Peter P Groenewegen, Danielle RM Timmermans, Gerrit van der Wal and Cordula Wagner. The nature and causes of unintended events reported at ten emergency departments. BMC Emergency Medicine, 2009; (in press)
Online Source: BioMed Central (2009, September 20). Majority Of Unintended Incidents In The Emergency Room Are Caused By Human Error, Study Finds. ScienceDaily. Retrieved January 28, 2010, from http://www.sciencedaily.com /releases/2009/09/090917191603.htm
Summary:
____________________________________________
The article cites about the unintended incidents in the emergency department that could have compromised patient safety must have been caused human failures. Hospitals and emergency departments are challenging settings with regard to patient safety -- a considerable number of patients suffer from unintended harm caused by healthcare management. Little is known about the causes of unintended events and, thus, these results from Marleen Smits and colleagues from Netherlands Institute for Health Services Research and EMGO Institute for Health and Care Research may help to target research and interventions to increase patient safety. The Dutch team studied emergency departments at 10 hospitals in the Netherlands for 8-14 weeks, during which staff were asked to report unintended events, defined as all unintended incidents that could have harmed or did harm a patient. A quarter of the reported events related to cooperation between the emergency department and other hospital departments. Smits said, "Patient safety in the emergency setting should be improved, especially the collaboration with other hospital departments".
____________________________________________
Reaction:
____________________________________________ In recent years there has been increasing recognition internationally that health care is not as safe as it ought to be and that patient safety outcomes need to be improved. To this end patient safety has become the focus of a world-wide endeavor aimed at reducing the incidence and impact of preventable human errors and related adverse events in health care domains. The emergency department has been identified as a significant site of preventable human errors and adverse events in the health care system, raising important questions about the nature of human error management and patient safety ethics in rapidly changing environments. We are indeed human that errors nay possibly come our way. Even the “experts” in their field are also prone to commitment of even grave errors that had caused a detriment to their clients’ safety. It is not as always ideal if we are to examine the hospital setting. As far as I can remember during my encounter with the PAASCU accreditors, “there is no place wherein we can find an ideal hospital setting…” she simply pointed out that there is always a room for error. And this is somehow alarming if the incidence of negligence will seemingly increasing.
As student as I am, I have always been reminded and motivated by my superiors and clinical instructors, same as true with the others students, that I have to practice in a resemblance of an ”ivory tower”, and that competence must always be aimed in doing single procedure in order to achieve optimum safe and quality nursing care. This has been long held philosophy, and that I am always trying my very best to achieve such expectation. However, since the article already presented a legitimate fact that human error paves its way to cause harm to patients, it is quite a call for a challenge for us neophytes to make a change in order to abate this issue. It further means that we have to triple our efforts to promote more the safety and security of every individual who seeks for a healthcare. And of course, it is quite burdening!
Yes, we are neophytes, coined to be “young” in the field of healthcare. However, this must be the very reason why we should have to strive more to achieve excellence in whatever actions that we are to be doing. i accept the challenging demand personally. I am always looking forward for a best training ground to hone up my skills. With this “human factor” in
causing errors to clients’ safety, I am indeed very much willing to abolish this notion, in order to achieve maximum health for the people for the next years to come, as being lived by the creed of dead and living nursing theorists.
____________________________________________
St. Mary’s College, Inc.
TAGUM CITY
BACHELOR OF SCIENCE IN NURSING
RELATED LEARNING EXPERIENCE
Progress Notes
Concept: Nursing Management
Submitted by: ALFIE G. CABUNOC, SN BSN 4A1
Submitted to: MELJUN F. PEREZ, RT, RN Clinical Instructor
Date: Concept: Area: Clinical Instructor:
January 25-26, 2010 Nursing Management Davao Regional Hospital Meljun F. Perez, RT, RN - Emergency Department
Summary:
We had already been exposed to the ED of DRH these past two days for the concept of Nursing Management. That duty seems analogous to those other RLE days, but there is actually something special for this week since we are to be evaluated by the PAASCU Accreditors there exactly on our actual hands-on at the ER. The afternoon shifters started the day through a circle which was observed by one of the PAASCU representative. However, we haven’t been able to attend with the circle as we had already been signaled to go due to the time constraint (considering that DRH does the endorsement earlier; example, 30 minutes before the starting time of the shift). Thus, at around 2:15 pm, we departed the school for DRH. Upon arrival, we had usually cites first the Nurses’ Prayer. Right after, we prepared, then attended the Afternoon Endorsement. Soon after the endorsement, we did the nursing rounds to every area of the Emergency Department, starting from the Pedia down to the Surgery area. As we are through, we had been gathered and given specific areas of assignment per pair. As for me and with my partner, we had been assigned on the first day at the Triage. It has been further instructed that after the second table, the rotation of area must be done. After some sorts of instructions and clarifications with regards to our duty, we are immediately distributed to our assignments and started doing our functions. The length of my Triage experience has been evident with numerous admissions. Not until the clock strikes 6:00 pm, I had taken my meal together with the other assignees for the second table. As being instructed, we had done the rotation of areas sooner as we came back form our 30-minute break, and proceeded to the Pediatric area. On the second day, the first area of assignment that I had been assigned was on the Medicine area, and rotated after the break at the OB-GYN.
We spent every remaining hour in doing procedures and attending to patients’ needs. Some instances were also prevalent with our assistance to the residents-on-duty for patients who requires immediate attention. As it was about 10:30 pm, we started doing the aftercare of our areas of concern. Since there were procedures that were still pending, we just endorse them to the staffs for the continuity of care. We attend the outgoing endorsement as the night shift is receiving it. Soon after, we had been gathered for the last minute instructions for tomorrow’s updates. As we are all settled, we ended the day and departed the institution at beyond 11:00 pm.
____________________________________________
Reflection:
____________________________________________
I had been excited yet thrilled for the exposure. Prior to duty, there were queries in mind that tucks me in. as what I had been heard by some of the SN’s who had already been exposed there, Ma’am Coral, the Chief Nurse of the Hospital, is fond of doing her rounds there at the Emergency Department. That rumor was indeed to be true as I had personally seen Ma’am Coral on the first day of our duty having her rounds exactly at the ED! I had felt the anxiety. I even asked to my self, “Makatubag kaha ko kung pangutan-on ko nya karon?” It sounds fool, but it was actually a big deal. And yet, I laughed to my self in the end. At the middle of my duty hours, I motivated myself to be really efficient and competent to every action that I must be doing. Apart from it is to be prepared whenever Ma’am Coral would have her visit (hehehehe). I can say that I performed well during my duty. I had done through my efforts to perform effectively the provision of my nursing care to my patients, even just through the little ways I can. And indeed, it turned out to be successful. I was also thankful to my Clinical Instructor who was considerate. I admit that there are times that I was so fond of asking questions, and yet, those were answered by him. And that was a great factor why a student can perform well in the area. I appreciated also the positivity of my patients towards me. Though I can assess their agonizing condition brought about by their illness state, they still have the chance to show to me their warm welcome and positive reaction to my presence in caring for them even just for shorter time. They had been participative to my instructions. However, there is one of my patients who has been limited with her motions. I understand, though, that it is due to her
debilitation condition. And for that, I felt pity for her. And that was a motivation for me to really work harder to care for those who are needy. I had learned lots of lessons throughout my exposure. Aside from the instance wherein one of the resident physician who had attended to his patient has been so generous in explaining to me the pathophysiology of the patient’s condition (patient who has Idiopathic Thrombocytopenic Purpura). It expounded more my knowledge about the disease. I had also been oriented with the new and unordinary procedures and true challenging hospital setting. Though Ma’am Coral wasn’t able to ask me (she had just stared at me while taking the vital signs of one of the patients), at least I was motivated to double my efforts. In the end, my anxiety felt at the beginning caused me to perform effectively for my duty. Thus, the end was justified by the means…
____________________________________________
St. Mary’s College, Inc.
TAGUM CITY
BACHELOR OF SCIENCE IN NURSING
RELATED LEARNING EXPERIENCE
Nursing Care Plan
Concept: Nursing Management
Submitted by: ALFIE G. CABUNOC, SN BSN 4A1
Submitted to: MELJUN F. PEREZ, RT, RN Clinical Instructor
