Franklin University Week 5 Prelude to a Medical Error case Discussion Overview Quality improvement continues to be a major focus in the healthcare industr

Franklin University Week 5 Prelude to a Medical Error case Discussion Overview

Quality improvement continues to be a major focus in the healthcare industry. Fundamental to quality improvement is the connection between employee performance and patient satisfaction. Healthcare professionals struggle to balance a variety of competing forces driving the quality of care, mainly in the area of employee performance, care delivery, and patient satisfaction.

Action Items
Complete Chapter 7: Ouality Improvement Basics and review the previous weeks’ reading in your textbook.
Reread the case “Prelude to a Medical Error.”
Using APA guidelines, develop an employee performance evaluation for this organization that connects patient satisfaction with employee performance.
Incorporate the concepts of continuous quality improvement into your performance evaluation model.
Based on your reading, create your employee performance evaluation system to link employee performance with continuous quality improvement strategies. The proposal should include the following:
An explanation of each component and how it connects to quality improvement theories, tools, and concepts.
A flow chart (or diagram) demonstrating the connections between employee performance and patient satisfaction APPLICATION EXERCISE 1: PRELUDE TO A MEDICAL ERROR
Mrs. Bee was lying in her bed after her morning physical therapy with Mr.
Traction and felt like she couldn’t breathe. “Is something bothering you, Mrs. Bee?”
asked Nurse Karing. “I know you had a disagreement with your husband regarding
rehabilitation last night,” she said. Nurse Karing knew that Mrs. Bee had suffered a bad
fall and that therapy was going to be difficult for her to handle. She had discussed the
support issues that were important during stressful hospitalizations. With Mrs. Bee’s
husband and he had appeared supportive. She felt that a disagreement wasn’t the
source of Mrs. Bee’s discomfort.
Nurse Karing thought back to her previous night’s visit with Mrs. Bee. Mrs. Bee
had complained of terrible spasms within her left calf. Nurse Karing had proceeded to
order a STAT venous Doppler ultrasound to rule out thrombosis. She had also page Dr.
Cural to notify him that Mrs. Bee was having symptoms of thrombosis. Dr. Cural, upset
that he was being bothered after a long day of work, had shouted into the phone, “I
evaluated that patient this morning and nothing was wrong with her. I don’t need
incompetent nurses calling me at night to tell me that my patient is having leg cramps.
Don’t bother me again! And by the way, you had no right to order that test! Cancel it!
(click).” The phone call had upset Nurse Karing, leaving her feeling humiliated and
distracted. She had canceled the venous Doppler test, as directed by Dr. Cural, thinking
that he must have been right. Mrs. Bee was probably just having leg cramps from being
sedentary during the day. And besides, she had thought, Dr. Cural always claimed to
know his patients inside and out! Still, Nurse Karing had gone home that night feeling
bothered by the incident and the lack of respect and communication displayed by her
coworkers lately.
But today, Mrs. Bee was short of breath, pale, and had elevated blood pressure,
and was losing consciousness. Nurse Karing ordered at STAT VQ scan to rule out a
pulmonary embolus. Nurse Karing called for help. The nursing team and Dr. Krisis (from
the ER) race to the room to help stabilize Mrs. Bee. “Looks like we have another
problem from one of the nursing floors,” observed Dr. Krisis. “Someone must have not
had time again to call the doctor yesterday to see if a venous Doppler was necessary.
Now she’s really critical!” Nurse Karing ignored Dr. Krisis’s comment and notified Dr.
Cural. “Why didn’t anybody call me to tell me that my patient was having problems? I
am the physician! Can’t you nurses do anything right? Don’t you know that you need to
focus on what symptoms Mrs. Bee is having? Get Mrs. Specimen up here to draw some
blood. I want STAT ABG’s now! Get ICU on the phone!”
At the same time, Mr. Friendly, the social worker, happened to be walking by. He
stopped to speak to Dr. Cural and Nurse Karing. “Mrs. Bee’s paperwork is all ready. Her
insurance will allow her to go to a rehabilitation facility for one week of physical therapy.
The MediCar will be here in 1 hour to pick her up.” Nurse Karing was furious. She
thought to herself, “It’s time for administration to hear this one.”
References
McGinnis, S. (2012). Prelude to a Medical Error, In S. Buchbinder & N. Shanks (Eds.),
Introduction to Health Care Management (pp, 416-417). Burlington, MA: Jones &
Bartlett Learning.

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