Unit 7 Assignment - Healthcare Operations

QUALITY AND SAFETY

Tatiana Santos

Kaplan University

HA540 – Healthcare Operations and Quality Assessment

Jeffersonville Health & Rehab Center

Long-term care includes a broad range of health, personal care, and supportive measures that meets the need of frail patients, especially geriatric patients whose ability to self-care is limited due to a chronic illness, injury, cognitive, or mental disability. The services included at Jeffersonville are bathing, dressing, grooming, toileting, feeding, medication management, physical therapy, speech therapy, occupational therapy, and recreation (Harris-Kojetin, Sengupta, Parker-Lee, & Valverde, 2013). In order qualify for these services, quality care is provided. However, quality service requires a team of doctors, nurses, pharmacists, administrative office, social services, physical therapy, maintenance department, housekeeping and laundry services. Jeffersonville Nursing & Rehabilitation Center (hereinafter referred to as “Jeffersonville”) lacks the characteristics sufficient to meet the need of each resident in order to provide quality care.

Jeffersonville is located at 113 Spring Valley Drive in Jeffersonville, GA. The facility is owned by Great Beginnings Care, LLC and is a for-profit long term care facility with 131 beds. Jeffersonville accepts Medicare and Medicaid. Their facility is not located in a retirement community. An automatic sprinkler system is installed in the required areas. Jeffersonville also provides a council program for resident and family (Jeffersonville Health & Rehab, 2017).

Jeffersonville received a two star rating in quality for the care provided. The facility received nine deficiencies in the most recent health inspection. The first deficiency is F0225. The facility failed to fully investigate and report an injury of unknown origin on behalf of a resident. The resident was said to be on the floor crying and stating that another resident pushed and hit her with their chair. The victimized resident complained of pain in their shoulder, hip, and leg. On 08/10/2014, the resident was sent to Emergency Room with a chief complaint of chest, left arm and left leg pain. This resident returned back to the facility with an order. As a result of Jeffersonville’s negligence, the resident sustained a leg fracture from being shoved by the other resident. All facilities are required to report and investigate any signs or accounts of abuse, neglect or mistreatment of residents (Jeffersonville Health & Rehab, 2017).

Jeffersonville’s second deficiency is F0282. The facility did not follow a plan of care associated to the fluid restriction diet for a resident. Upon investigation, the resident was observed drinking a cup of water as an empty soda can was found on the bedside table. The resident stated that he drank as much he wanted. The CNA on staff stated that she did not have any residents who were strictly on fluid restrictions. The CNA did not believe he was on a fluid restriction diet. An order for the fluid restricted diet was found and verified. This deficiency crossed with F0309, a third deficiency. The facility failed to provide the required care and services in order to maintain their residents in good health. The facility also failed to follow an order (Jeffersonville Health & Rehab, 2017).

The fourth deficiency Jeffersonville obtained is F0314. A resident who sustained pressure ulcers or sores must be treated routinely in order to promote healing, prevent infections and prevent new pressure ulcers from forming. Jeffersonville failed to note the pressure ulcer and assure that it was dry and intact. The facility also failed physician orders for vitamin and protein supplement. The resident investigated had a stage IV sacral pressure ulcer, right medial thigh pressure ulcer, and left medial thigh pressure ulcer. According to the plan of action, the resident was ordered to receive skin care and to be turned and repositioned every two hours. Staff members did not pay adequate attention to the wounds f the resident in question. Consequently, the wounds worsen over time due to lack of treatment (Jeffersonville Health & Rehab, 2017).

The fifth deficiency the facility received is F0323. The facility must ensure that the resident is in an environment free from any hazards with supervision in order to prevent accidents. The facility failed to observe their residents in the dining room area. A resident pushed another resident in a wheelchair, and her leg got trapped under the chair in the dining room causing this resident to sustain a broken hip. At the time of the accident, no staff member was present in the dining room area. Another resident notified the staff of the incident and that the victim was crying out in pain (Jeffersonville Health & Rehab, 2017).

Jeffersonville has left several doors unlocked to hazardous and dangerous equipment. One room in specific contained the facilities’ heating and air unit. The Fire Marshal stated that the room should stay locked at all times due to the fact that this room contains “mechanical equipment that could be a potential hazard related to accessibility to fuel-fired equipment” (Jeffersonville Health & Rehab, 2017). The janitor’s closet on C-hall was also left unlocked, which contained a jug of Lavender Multi-surface Cleaner. The warning on the jug disclaims the cleanser causes eye irritation. A further review of the Material Safety Data Sheet (MSDS) sheet for Lavender Multi-Surface Cleaner disclosed that hazards do include serious eye damage/eye irritation. In addition, the therapy room was left open with no staff inside. The therapy room contains a Hydrocollator unit. The lid to the unit was open and the water was steaming. When the temperature of the water was taken with the surveyor's thermometer read 167.1 degrees Fahrenheit (Jeffersonville Health & Rehab, 2017).

Fire safety experts assess whether a nursing home meets standards such as Life Safety Code (LSC) set by the National Fire Protection Agency (NFPA). The inspection includes fire protection including construction, protection, and operational facets structured to be safe from fire, smoke, and panic (Fire Safety Inspections, 2017). Upon inspection, Jeffersonville received ten fire safety deficiencies. The building is not equipped with a corridor and hallway doors that can block smoke from passing through and resist fire for at least one hour, or construction that can resist fire for one hour in addition to an approved fire extinguishing system. The building was not fire proof. Residents could possibly die from smoke inhalation should the building be on fire. More specifically, the building could not resist a fire for at least one hour. The fire extinguishing system is not an approved system. It is possible that it could have been outdated. Therefore, the extinguisher may not work to serve it’s purpose in putting out a fire. The building did not have properly installed hallway dispensers for hand sanitizers. The hallway dispenser helps to protect the residents and staff members from an infection. The building did not have a written emergency evacuation plan displayed. How will staff members know how to evacuate their residents in case of an emergency? This is a must due to the facility not having the necessary protection from a fire. When further looked into, the building did not have record of quarterly fire drills for each shift under varying conditions (Jeffersonville Health & Rehab, 2017).

The average number of fire safety deficiencies in the state of Georgia is 3.7. Jeffersonville tripled the average number. Jeffersonville also tripled the average number in fire safety deficiencies in the nation. Each deficiency was corrected by June 18, 2017 (Jeffersonville Health & Rehab, 2017).

The utmost quality care in a nursing home is paramount. Every individual should think about how they would want their love ones treated. It is not easy to work in a long term care facility. Therefore, by keeping a positive attitude and knowledge that someone’s life is going to better because of you takes precedent. Quality care starts first and foremost with the head of the facility. In-service exams and evaluations must be conducted for this facility. Through the education of staff members on the deficiencies of the facility and how it must be corrected can prevent deficiencies in the future. The facility will focus on issues as opposed to pointing fingers. All staff members will be in-serviced on the techniques necessary to provide quality care to their residents. These employees will be checked off on their skills. The changes in resident’s orders or care will be carefully communicated to staff by their supervisors. All nurses and CNA’s will make routine walk thru rounds at the end of their shift. Delivering optimal care is also ensuring there is enough staff on floor. There must be sufficient staff in order to meet the demand of each resident. However, out of all the techniques mentioned, the one that is most important is to make the staff feel appreciated. High morale in the workplace will reap positive results.

Safety within a nursing home is just as important as the quality of care they deliver. Families place their love ones in facilities believing and trusting that the resident will be safe and cared for. It is the facilities’ ultimate goal to provide a safe environment to their residents. The first step in improving safety in Jeffersonville’s building is to add corridor doors and buy new and approved fire extinguishers. Install hallway dispensers for alcohol-based hand rub and encouraged staff members and visitors to use them. An evacuation plan will be written out and discussed with staff periodically. The facility will host a monthly fire drill and elopement drills. Each drill will be logged into a notebook and stored in a safe cabinet.

Jeffersonville received several deficiencies that will take time and effort to get the facility back on track. It is not the impossible. However, it will require a team of dedicated professionals who have the necessary managerial skills and knowledge to get Jeffersonville from a three star to a five star rating.

References

Fire safety inspections. (n.d.). Retrieved February 19, 2017, from https://www.medicare.gov/NursingHomeCompare/About/Fire-Safety-Inspections.html

Harris-Kojetin, L., Sengupta, M., Parker-Lee, E., & Valverde, R. (2013). Long-term care services in the United States: 2013 overview. National Center for Health Statistics. Vital Health Statistics 3(37), 1-93.

Medicare.gov Nursing Home Compare. (n.d.). Retrieved February 19, 2017, from https://www.medicare.gov/NursingHomeCompare/compare.html