HLT 308 Week 4 Discussion Question One

HLT 308 Week 4 Discussion Question One

The Joint Commission introduced the National Patient Safety Goals to address patient safety issues within health care organizations. Determine three patient safety issues that are being addressed by your health care organization. Identify the actions the organization is taking or identify three issues that you think need to be addressed by health care organizations. Make suggestion for actions to be taken. Support your responses with two peer-reviewed references.

Patient safety issues were commonly described surrounding the following: lack of basic nursing care, in particular in relation to feeding, hydration and pressure area care; misdiagnosis, often due to diagnostic overshadowing and communication difficulties;

HLT 308 Week 4 Discussion Question One
HLT 308 Week 4 Discussion Question One

delayed investigations and treatment; non-treatment decisions and inappropriate DNAR orders, which may be due to assumptions about the patient’s quality of life; and misuse of the Mental Capacity Act, including a lack of staff knowledge and problems with capacity assessments. This is not an exhaustive list.

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There is a common thread of delays and omissions of care and treatment which could lead to preventable deterioration. As acts of omission are more difficult to recognise, capture and monitor than acts of commission, it may be difficult for organisations to monitor the safety of patients with learning disabilities. At present, incident reports are an insufficient way to assess the types and number of patient safety issues experienced by patients with learning disabilities in NHS acute hospitals.

The research team noted few formal complaints. Careers indicated a desire to put negative experiences behind them, and voiced concerns that the future health care of the person with learning disabilities might be affected by complaining.

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Patient safety issues
This chapter presents those results of the study that are concerned with the specific patient safety issues (those issues that may cause harm) faced by patients with learning disabilities in NHS acute hospitals. As described in Chapter 4 (see Researching patient safety), patient safety is concerned with any issue that could have or did cause harm to a patient as a result of the health care received. It is estimated that around half of all patient safety issues are preventable.75