Patient Safety And Quality Improvement Act Of 2005(psqia

By Author: Sherry Roberts
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Introduction:
The patient safety and quality improvement act is a legislation enacted on July 2005. Jim Jeffords introduced the Act in the Senate and the act went through the Senate and the House of Representatives with a common agreement. The legislation established a broad national patient safety database and a patient safety organization to encourage reporting and discussion of dangerous conditions, adverse events and near misses (Jcr, 2009). It also put in place privilege and confidentiality protections for Patient Safety Work Product. The patient safety work product includes data, records, data, memoranda and oral or written statements that can improve patient safety. However, it does not include patient’s discharge information and medical records. The patient safety work product is confidential and must not be disclosed unless in very specific circumstances and subject to restrictions (Levy, 2010). The law states that unless when there are other provisions of the federal, local law or state, the information concerning a patient should be confidential and health providers should not disclose it. The law aimed at ...
... responding to the increasing concern for the patient safety in the United States and the report by the Institute of Medicine's 1999 report, To Err is Human: Building a Safer Health System. The purpose of the Act is to improve patient safety by encouraging voluntary and confidential reporting of events that adversely affect patients (Radvanovsky, 2009). Finally, the Act calls for the establishment of a Network of Patient Safety Databases (NPSD) to avail an interactive, evidence-based management resource for health care providers and other entities. It will be used to analyze national and regional statistics, including trends and patterns of patient safety events. The NPSD will employ common formats and will promote interoperability among reporting systems. The Department of Health and Human Services provides technical assistance to PSOs. Hospital error is a major cause of deaths in the United States and an estimation of about 440,000 American citizens die each year from preventable hospital errors.
Improving patient safety involves creating an environment that is opaque and has commitment to change. The government's Patient Safety Initiative takes care of the patient safety improvement. Public Hospitals Act (PHA) regulatory amendment, enacted on July 28, 2008, calls for hospitals to provide public a report on patient safety indicators in relation to hospital-acquired infections and the actions taken to minimise such infections together with the mortality rates (Young, 2005). Under Regulation 965 of the PHA, hospitals should disclose the outcomes of each indicator via their website (Radvanovsky, 2009). These patient safety indicators include Clostridium difficile infection (CDI) rate, Hospital-Standardized Mortality Ratio (HSMR), Methicillin-resistant Staphylococcus aureus(MRSA) rate. Similarly, they include Vancomycin-resistant Enterococci (VRE) rate and Ventilator-Associated Pneumonia (VAP) rate. Other requirements include; Central Line-Associated Primary Blood Stream Infection (CLI) rate, Surgical Safety Checklist (SSC) compliance, Surgical Site Infection (SSI) and prevention rate in hip and knee joint replacement surgeries and Hand Hygiene Compliance. Health care facilities report these indicators either monthly, quarterly or annually. To abide by this regulation, several strategies have been put in place. These include;
Hand hygiene improvement:
Hand hygiene involves removing of microorganisms from hands after removing gloves or after contact with bodily fluids. Hospitals and other health care facilities have adopted to this initiative whereby nurses and other practitioners disinfect their hands using alcohol or soap and water before after seeing a patient. The hand washing initiatives includes both single and multilevel in interventions which include both staff and patient education and involvement. Advocates of hand-hygiene improvement interventions propose that multimodal interventions are necessary for inducing sustainable hand-hygiene practice improvements. These interventions should be based on theories of behavior change. Similarly, for individuals, the intervention should aim at providing education and motivation in relation to hand-hygiene practices. In addition, patients should be empowered to reinforce proper hand-hygiene practices. On the organization level, organizational structure and philosophy need to support proper practices. Several hospitals and healthcare facilities have embraced the idea of hand washing in relation to the patient safety and improvement act. CDC has developed hand hygiene compliance programs and is publicly available. These guidelines consist of suggestions for health care workers motivation and educational programs that states a rationale to provide information related to hand washing techniques and methods to maintain skin health (Holly, 2011). However, even though the hand washing before and after attending to a patient is important in ensuring patient safety, its compliance is quite low. The low compliance reduces the effectiveness of hand washing ensuring patient safety.
Surgical Safety Checklist (SSC) compliance:
The WHO requires all hospitals to have a surgical safety checklist. The checklist helps the staff and physicians to familiarize themselves with the medical history of the patient and any medical requirement needed for each individual case (Holly, 2011). Surgical safety checklist is useful as a part of the surgical procedure and it helps improve the teamwork and communication in the in the surgical room. The surgical checklists one of the tools used to ensure patients receive the best of the quality care. All hospitals and health facilities are mandated by the ministry of health to and long-term care to put their surgical safety checklist compliance results on their websites (Saturno, 2014). These surgical safety checklists contain all surgical procedures carried out at the hospital for a given period of time. The checklists are completed after every surgery and they inspire improved performance and enhance patient safety while strengthening of the public’s confidence in the hospital in question. The surgical safety checklist makes sure that every doctor or nurse has important medical information about the patient they require (Vincent, 2011). It also ensures that equipments are available and in working order and every nurse is ready to proceed. The surgical safety checklist has three parts that include briefing, time-out, and debriefing. Each of the section has information that that is relevant to the phase. For example, the briefing phase may contain verification with the patient’s names and the procedures to be done while the time-out phase may include the patient’s position and the debriefing may have surgeon reviews on important items.
Clostridium difficile infection (CDI) rate:
Hospital-based infections are becoming a common in hospitals in the United States. One of these infections is the Clostridium difficile infection. Clostridium difficle infection is becoming a major potential threat to health care and there are increasing numbers of outbreaks in hospitals in the United States. Some of these outbreaks have included cases of serious of death and diseases in America. The increasing cases of Clostridium difficle infections in American hospitals and other health care institutions have necessitated the government to initiate a CDI surveillance program. The program monitors and detects the rates of Clostridium difficle inspections in hospitals and the entire health system. The program identifies new emerging strains of Clostridium difficle as some of the Clostridium defficle infections caused by certain strains of the pathogen are severe cause of disease. The surveillance aims at reducing the Clostridium difficle infections rates that seem to be shooting up in American hospitals and other medical facilities. The increasing infection rates are as a result of the emergence of new strains of the bacteria that are more virulent and have increased toxic production. Recent data shows that the Clostridium difficle infection has replaced Staphylococcus aureus as the commonest cause of health care related infections. In the United States, diagnosis of the infections increased from 3.82 infections in 1000 discharges in 2012 to 8.75 infections in 1000 discharges in 2013 (Aldeyab, 2012). The cases were prominent in patients above 65 years. The increased Clostridium difficle has necessitated the need to have standardized definitions and surveillance techniques to detect outbreaks, facilitate the comparison of its rates across several healthcare institutions and assess diseases trends. The center for disease and control and prevention published the recommendations for surveillance and incorporated them in 2 CDC surveillance systems to help in monitoring the CDI rates.
Surgical site infection surveillance service (SSISS):
Due to the prevalence of the surgical site infection, the antimicrobial resistance department runs the surgical site infection surveillance service. Surgical site infections occur at the site in where the surgery took place and the infections may involve the skin, tissue under the skin or organs (Sturridge, 2011). Patients may have different risks for developing surgical site infections due to underlying medical conditions, age, duration of the surgery and other factors. Hospitals and other health care providers have subscribed to the site surgery infection surveillance to monitor and control the surgery site infections. Nurses, doctors, and other healthcare practitioners observe CDC infection guidelines that include washing hands and arms with an antiseptic agent before carrying out a surgery or before and after carrying out patient care. Similarly, they remove any patient’s hair using electric clippers immediately before surgery if the hair is around the same place where the procedure is to take place. They also wear special hair covers, gowns, masks and gloves during the procedure to keep the place to be operated clean (Health Networks, 2009). In addition, to reduce the chances of infections during the surgery, nurses give their patients antibiotics before commencing the surgery. The antibiotics are given twenty minutes before the surgery and are stopped twenty-four hours after the surgery.
Central Line-Associated Primary Blood Stream Infection:
About 30,000 central line and associated bloodstream infections occur in the American wards and the intensive care unit and acute health facilities each year (A handbook for nurses on patient safety and quality, 2008). These infections occur after surgery where the blood stream becomes infected, but these infections are preventable by applying proper insertion techniques during the surgery and management of the central line. Similarly, most hospitals have adopted the surveillance of the Central Line-Associated Primary Blood Stream Infection where data is obtained from the intensive care units, wards, shut down units and long-term care units. The surveillance helps theses hospitals to manage the Central Line-Associated Primary Blood Stream Infection rates (Ulrich, 2014). Similarly, hospitals have developed tools that they are using to reduce the cases of Central Line-Associated Primary Blood Stream Infection. Some of these tools include engaging its employees in sharing the experiences on Central Line-Associated Primary Blood Stream Infection. The sharing of these experiences makes the problem real as nurses and other health care practitioners share their experiences of patients they have met suffering from CLABS. In addition, hospitals reduce the cases of Central Line-Associated Primary Blood Stream Infection by making sure that its staff members have the understanding of how to reduce CLABSI prevalence. Similarly, they can reduce the Central Line-Associated Primary Blood Stream Infection rates by applying the evidence-graded guidelines developed by the center for disease control and prevention to prevent catheter-related infections.
Challenges:
Health care services are offered to patients in an environment with complex and numerous interactions such as the disease process itself, technology, clinicians, procedures, policies, and resources. When these factors act together harmful and unforeseen outcomes (e.g., errors) can occur (Arries, 2014). Human error is as a result of a failure of a planned action or a series of mental or physical actions that needs to be completed as intended. Similarly, error is the use of a wrong plan to achieve a result. Near misses, or “good catches, are defined as events, incidents or situations that could have caused dire consequences and harm to a patient, but did not. Factors involved in near misses have the ability to be root causes involved in errors if there are no changes made to disrupt or to limit their potentiality to producing errors. At times, it is difficult to eliminate these errors entirely no matter the extent of the efforts. These errors are inevitable in every health care setting making it impossible to eliminate the surgical site infections completely.
Another challenge encountered during the implementation of the Act Patient Safety and Quality Improvement of 2005 is insufficient of the necessary resources. In some hospitals, resources would be the limiting factor in improving the safety of patients. They may lack the necessary equipments such as disinfectants and the facilities could be in conditions that encourage. The lack or insufficient resources could present a bottleneck in improving the safety of patients.
Fixing the challenges:
The hospitals can identify and fix the flaws and errors in the improvement of the patient safety by using surveillance applications that are available in the market. These surveillance applications would help the hospital or the health service provider to identify the occurrence of these errors and develop a strategy to eliminate them (Saturno, 2014). One such surveillance service is provided by the center for disease control and prevention. After identifying the flaws, the hospital management in question should determine the possible cause of the error and the most appropriate solution to the problem. It should also educate its nurses on the importance of ensuring patient safety. The management should also avail the necessary resources and equipments to be used in improving the patient safety.
Conclusion:
The cases of surgical site infections are on the increase in most of the hospitals in the United States. These infections are as a result of contaminations during the surgical procedures and could have dire consequences for the patient. The American government enacted the Patient Safety and Quality Improvement Act of 2005(PSQIA) that aims at improving patient safety in hospitals. Both the government and hospitals have initiated surveillance programs that aim at controlling and improving the safety of patients. Health care providers are applying different techniques to bring about improvements in the patient safety.
References:
A handbook for nurses on patient safety and quality. (2008).Critical Care Nurse, 28(5), 10
Aldeyab, M. A., Kearney, M. P., Scott, M. G., Aldiab, M. A., Alahmadi, Y. M., Darwish Elhajji, F. W., & ... McElnay, J. C. (2012). An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings. Journal Of Antimicrobial Chemotherapy (JAC), 67(12), 2988-2996
Arries, E. J. (2014). Patient safety and quality in healthcare: Nursing ethics for ethics quality. Nursing Ethics. pp. 3-5. doi:10.1177/0969733013509042
Health networks (2009) how hospitals might reduce surgical-site infections. H&HN: Hospitals & Health Networks, 83(1), 45.
Holly, C. (2011). Interventions to improve hand hygiene compliance in patient care. International Journal Of Evidence-Based Healthcare (Wiley-Blackwell), 9(3), 276-277. doi:10.1111/j.1744-1609.2011.00231.x
Jcr (2009) Patient Safety: Essentials for Health Care; Joint Commission Resources, USA
Levy, F., Mareniss, D., Iacovelli, C., & Howard, J. (2010). The Patient Safety and Quality Improvement Act of 2005. Journal Of Legal Medicine, 31(4), 397-422. doi:10.1080/01947648.2010.535424
Radvanovsky (2009) Critical Infrastructure

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