Rabbi Scenario Analysis

Some of the indicators that are pertinent in the case of Mr. J. were listed by the American Montalvo (2007), and include Nursing Hours per Patient Day, Pressure Ulcer Rate and Restraints. Each of these indicators could be examined to provide Mr. J. with a higher standard of care. 

In the instance of Nursing Hours per Patient Day, it would be possible for the nursing to take note of inadequacies occurring on a given shift. Ensuring that patients are receiving the proper food is a matter of due diligence, and as such, enough nurses must be on the clock to make this happen. Paying attention to nurse staffing ratios and having an extra person on the floor during mealtime for even an hour helps to ensure that trays are being properly handed out.

Addressing the pressure ulcer rate within the facility would go a long way in ensuring that the one on Mr. J's back does not become a common occurrence. Having regular patient examinations would go a long way in detecting pressure ulcers before they become severe. Likewise, turning patients in their beds regularly will greatly aid in preventing the sores from forming in the first place. Having a regular schedule of when patients should be turned would aid greatly in both detecting pressure ulcers and treating them should they occur.

The role of restraints should be carefully examined in the case of Mr. J especially because there is potential for them limiting his movement to the point of contributing to the possibility of pressure ulcers in the future. While restraints could prove to be necessary considering Mr. J's dementia, they must be adjusted to facilitate the assisted moves in bed that are necessary. While the use of restraints can make the role of certain care personnel more difficult in terms of aiding them in bed, they need to be carefully utilized. Patients that would normally move, and as a result prevent pressure ulcers, are not able to do so when they are restrained.

In this instance, hospital data could have been utilized in a variety of different ways. For instance, the number of pressure ulcers occurring in each period is important, but so too is the severity of these ulcers. Considering what treatment regimen(s) the patient was on will aid greatly in coming up with the appropriate solution. For instance, knowing whether the pressure ulcers occurring in each care facility are arising with more frequency due to certain factors could help to discourage them from occurring. Looking at correlative factors will inevitably provide data that could be utilized to find solutions.

A thorough analysis of how hospital employee hours are being utilized regarding patient care would help elevate all types of care throughout the facility. The nursing hours per patient day indicator would yield data that provides insights into why some patients might receive superior care than others. Tracking these changes is vital in where care might be deficient, so that way the number of nursing hours can be re-allocated. Looking at how these hours could be best spent and on which patients will go a long way in discouraging various conditions from becoming worse or starting at all.

Examining the number of instances in which restraints were used, why they were used, the duration of time they were used and what accommodations were made to compensate for any complications that might arise from utilizing them. Determining the amount of time restraints were used in what scenarios will go a long way in identifying which situations they were used correctly in. Taking this information in conjunction with the efforts used to minimize the negative effects of restraints will show what methods might be effective. With this data available it is possible to maximize comfort for those patients who need to have restraints used in conjunction with their care.

One of the very first professionals that would need to be spoken to would be the supervisor in the dietary department because they need to take more responsibility for the food being served. Larsen (2012) noted that the need for Kosher diets in nursing homes had become so prevalent that in Florida the care being provided was specialized to suit the needs of Jewish patients. Logs and records of dietary restrictions need to be visible to everyone who is working in the kitchen, and more due diligence needs to be applied to every meal going out. These precautions being taken will go a long way in ensuring that every meal sent out meets with the needs of the patient it is being sent to.

In the case of pressure ulcers, retaining a dermatologist to aid other staff with addressing the instances of these conditions could be very helpful. According to data gathered by Mullaney (2014), nursing homes with higher rates of pressure sores also had frighteningly high rates of readmitting patients to hospitals. A dermatologist could help to prescribe the necessary creams and other medications that could aid in these sores being healing or being prevented altogether. This professional could also advise all staff on how often it would be advisable to turn patients in bed, different types of material to utilize as bedding and also some up-to-date techniques on cutting down on the moisture a patient is exposed to.

Having more nurse aids on the floor at any one time would greatly help to reduce the need for restraints. Patients who are supervised do not often need to be in restraints, and this is because restraints are typically used to prevent falls. Nientimp and Peterson (2012) noted that falls for patients typically result in a stay at a hospital lasting 12.3 days longer than it would have without a fall occurring. A greater amount of patient supervision would also allow patients to move about more freely, and with any luck provide them with more exercise. The only concern here would be the available budget to accommodate these work hours.

References

Larsen, D. (2012, July 5). Florida kosher certified assisted living communities. A Place for Mom. Retrieved April 12, 2014, from http://www.aplaceformom.com/blog/florida-kosher-certified-assisted-living-communities/

Montalvo, I. The national database of Nursing Quality Indicators (NDNQI). The Online Journal of Issues in Nursing, 12(3).

Mullaney, T. (2014, April 11). Hospitals worried about readmissions should focus on nearby nursing homes' pressure ulcer stats, study suggests. McKnight's Long-Term Care News and Assisted Living. Retrieved April 12, 2014, from http://www.mcknights.com/hospitals-worried-about-readmissions-should-focus-on-nearby-nursing-homes-pressure-ulcer-stats-study-suggests/article/342220/

Nientemp, D., & Peterson, E. (2012, May 29). hourly rounds & patient falls nursing interventions should be specifically directed at preventing patient falls. Advance Healthcare Network. Retrieved April 12, 2014, from http://nursing.advanceweb.com/Features/Articles/Hourly-Rounds-Patient-Falls.aspx