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Abuse and neglect in nursing homes

Medical malpractice in nursing. Nothing to hide!

It is assumed that medical malpractice occurs when a doctor, nurse or other health professional in the exercise of professional activities did not make do diligence or has exceeded its powers, the consequence is the loss of the patient's health or life.

It recently observed to be replaced by the concept of a medical error term opposed event, which is broader in meaning, since the share of external factors such as work organization and equipment of, in this case is important. Both the medicinal error and adverse event are not concepts of the code - laws do not define them.

Error executive

Error associated with the activities of nurses in the sense of law is the most common category of error of the Executive, involving the improper performance of diagnostic and therapeutic orders. Such errors usually charged to a nurse who is involved in the complex process of diagnosis and treatment of the patient. A number of step's nurses can be the cause of the risk of the Executive, because each medical act is fraught with the risk of error, and thus harm the patient the more complicated the procedure, including a risk.
The nurse throughout study and training acquires the right to perform medical acts more or less complex, alone or on behalf of doctors. It is responsible for the correctness of the operations performed on their own and commissioned to do by others, as well as to enforce the clear and bright notes in the order, correct and understandable they are made. If this is not done and will do wrong, take responsibility for this.

Sometimes, the doctor will nurse for an action (operation) that goes beyond its competence. In this case, if an error or irregularity shall bear responsibility, and physician and nurse.

The nurses' work based on the safety of their activities in addition to due diligence, accuracy and thoroughness of the knowledge of their profession: the scope of the duties, powers and responsibilities. Furthermore, important are psychosocial characteristics of nurses. Refusal to comply with an order wrong or incorrectly worded is not easy. Nurse occupying this position must be convinced of the correctness of its decision, defending it skillfully; it cannot create conflicts.

Categories of nursing errors
Causes of medical errors associated with the performance of professional activities or nurse on staff share - assignable to the nurse, and organizational - attributable to the company.

Personal Reasons

A common mistake is to provide nurses, medical orders undocumented entry in the medical card orders. This is an obligation, among others the Ministry of Health of 21 December 2006 on the nature and extent of medical records in health care and how it is processing (OJ 2006, No. 9, item 45), which establishes rules for prescribing and treatments: * basis for the implementation of medical orders by the nurse is an entry in the medical records, so. Medical card orders, * nurse performs medical treatment according to the order, which includes drug name, dose, dosage form, frequency of administration, route of administration, authorize a physician confirming the order on a given day. If the order is not of the entries, the nurse has the right to refuse the request, informing the doctor requesting. Exceptions are emergency situations, interventions and resuscitation (defined by separate regulations).

The personal medical order is the only document on which the nurse may perform medical treatment (medical). A common practice in hospitals is a rewriting of orders entered in the medical records of the various types of "helpers": notebooks, notebooks and sticky notes, etc. These entries are the basis for performing varied operations and procedures: the collection of blood for diagnostic testing, commissioning consultation, blood transfusion, performance of intravenous or intramuscular injection. However, transcription of orders is a simple way to confusion. In practice, awfully documented, illegible medical orders are quite frequent, often accepted by the nurses who perform the treatments ordered by telephone, orders issued orally, poorly or improperly stored.

Nurse in accordance with applicable state law is also entitled to perform certain medical acts solely, without a medicinal order, according to Minister of Health, 7 July 2007 on the nature and extent of diagnostic, therapeutic and rehabilitation provided by a nurse or midwife only without order's doctor (OJ ........). Some of them, however, require special training of nurses. It is common in hospitals by nurses is to perform an ECG, which often is not included in the medical card orders.

review abuse and neglect in nursing homes statistics
If not entered, and the nurse does it, in accordance with applicable law, should be trained, allowing them to perform this action. Nurses on the question of why exercise ECG without a proven treatment order, do not have permission to correspond to the most that they do it for a sick or do not want to expose yourself to unnecessary comments, favoring the formation of bad air, or that the study must be done quickly and there is no time the formalities.

Nurses often face a dilemma: if they can perform some task without special training, despite the doctor's orders? Most do it because I did not know the rules and regulations of their profession, are also unclear responsibilities, powers and responsibilities. Such steps can include: performance of vaccination, the establishment of tuberculin sensitization test reading, connection of blood or blood products, carrying out biological tests, intubated patients, handling of dialyses.

The greatest risk of nursing practice, the error is burdened administration of drugs. According to a study on this subject by the U.S. agency dedicated to quality shows that 30% of all applications of drugs are at risk of medical error. Drugs in hospitals are mainly nurses; therefore, it is this professional group should be assigned to the statistics. There are no data on this subject, because it does not lead to such observations.
Hospitals are not registered error - the staff does not report them. Numerous factors attributable to the nurse contribute to their formation: inappropriate reading of the order, an omission of the order, the calculation of the dose incorrect, in error route of administration, the administration of the drug expired, too fast a drug, administration of another drug (usually a syringe lying next to) the application substitute other, non-aseptic conditions, confusing hours of administration, wrong administration technique. Nurses are aware of the risks, as evidenced by the results of surveys conducted on this topic by the centers dealing with issues of quality.

Causes of Organizational
Studies conducted by the Centre for Monitoring Quality in Health Care in Krakow that the adverse events recorded in only a few percent errors guilty of a particular person. In most cases this is due to inappropriate work organization. If the hospital adopted a habit of prescribing physician orders for "helpers," accepted by the organizers and managers, we are dealing with poor work organization, which promotes the occurrence of medical errors.

Nurse accompanies many circumstances that pose a risk of mistakes, and even professional misconduct. Especially if you complete complicated tasks overworked staff, with a low level of motivation for its implementation. Large number of patients per one nurse, the lack of proven standards for the retaining staff from the departments, divided into individual sections of work and roster changes, is another example of a situation conducive to errors.

Identify the need for nursing care, especially in hospitals, it is still a current problem. You cannot create a single, universal document giving precise numbers, because each hospital is unusual, even the branches of the same specialties are different. Employment standards, extremely important for the proper and safe employment arrangements in the hospital, must be due to specific units, taking into account their individual characteristics and working conditions.

An extremely important element, often overlooked, is the adoption by hospitals for alternative forms of work in case of sickness absence and absence of nurses. Lack of adequate regulation means that errors begin to appear in organizational decision making, which can lead to medical errors. Such decisions should be included to make the rotation of staff between departments or leaving the inexperienced nurses on call.

Another example of an organizational situation, which favors the errors, is accepted by the duplication of management changes due to additional employment nurses, e.g. combining with a night on call daily. The next problem is the loading of nursing tasks from reduced jobs, mostly support.

In addition to organizational errors predisposes unsystematic distribution of duty, irregular selection of the teams, faulty information flow in the therapeutic team, illegible medical records kept, no doctor on call, as well as excessive bureaucratization, too extensive documentation of nursing, issuing orders by phone, improper equipment of work and poor labeling of drugs and similar containers.

It happens that the branches in the habit of practicing the exercise of medical treatment by nurses from other units, because the ward where the patient resides, none of the nurses did not have the required permissions in the specified range (e.g., vaccination, blood transfusion). Such actions are wrong and should not formally take place in hospitals.

No retraining program is another factor predisposing to errors. Young, inexperienced nurses are left to self-duty hours, are not uncommon in hospitals faced with staffing shortages.

Proven method of quality
The primary task of every hospital is risk management by maintaining proper security policy. The realization of this goal should be to develop and adopt standards, particularly directly related to patient safety, in addition to develop a method to be systematic assess the risk of errors and adverse event's responsibility for health and life of the patient lies on all hospital employees, especially the medical and nursing staff. A manifestation of this responsibility is to take preventive action to protect the patient against the risk of injury or life.

There are no complete solutions, just as there are no perfect hospitals. Medical errors and adverse events were and were. We are inscribed in the nature of the work of these units. The problem is that they do not hide to open talk about them. It is a proven method of quality. By taking corrective action, we are able to effective monitor and eliminate them.

Professor Theodor Billroth was one of those who turned in the nineteenth century, surgery of primitive craft, practiced by barbers, the art of close and documented.

He was the first dared to publish the reports of the operation. Their reading was difficult, because at that time performed significantly more unsuccessful than successful treatments. Billroth, however, did not yield: "The failure must be given to the general public without covering up mistakes. It is much more important to know everything about the failed one treatment than just a few successful operations. "

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