A critical incident

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This assignment will analyse a critical incident relating to inter-professional delivery of healthcare, and will draw upon local, national and international perspectives whilst incorporating Political, Economical, Sociocultural, and technological (PEST) factors. A critical incident can be described as an event that creates an emotional impact (Ghaye and Lillyman 1999). Pseudonyms will be used to maintain anonymity and confidentiality in accordance with The Nursing and Midwifery Council (NMC, 2008) Code of Professional Conduct Guidance on confidentiality and permission has been given by the patient, staff and all participants’ involved to discuss the case.

1. Identify and incident The incident unfolds as follows. Mr Taylor was a 75 year old man who had experienced difficulty urinating for many years. Unbeknown to him it was a common problem for men his age, yet embarrassment and naivety prevented him from consulting a doctor immediately. Eventually, he consulted his GP and was referred to a hospital, where the Urologist gave him a full examination.

After being diagnosed with chronic urine retention he agreed to have an indwelling catheter implanted. A nurse was then summoned to his room to provide care until he was discharged. Shortly after his discharge Mr Taylor was feeling unwell and his experience soon became critical when he could not relieve himself without experiencing a burning sensation and pus and some bleeding was present. His wife was forced to call Sarah, the district nurse, who visited Mr Taylor to determine the nature and severity of his pain.

Mr Taylor’s examination revealed infection and so it was necessary to change his catheter. After doing so Sarah relayed her findings and decision to change his catheter to his GP who instructed treatment. Sarah informed the Taylor’s about the specific measures which would be taken to clear the infection. The measures used reflected those identified by Alexander et al (2006) who stressed that most catheter-associated urinary tract infections are treatable using antibiotics and removing or changing the catheter. Sarah documented all treatment given and ensured Mr Taylor’s medical records were up-to-date. This would enable any subsequent carers to access clear and concise medical records for future care. Good medical records prevent ambiguity, misdiagnosis and ill-treatment of patients.

Government and regulatory bodies have also enforced legal obligations such (Health Act 2006) as to provide best practice and evidenced based care./Additionally nurses have a professional responsibility to follow procedures which minimise the risks of urinary infections. Failure to properly execute such duties could be viewed as a failure to meet the standards set by the Nursing and Midwifery Council’s Code of Professional Conduct (NMC 2004). Due to their level of expertise Practitioners performing urinary catheterisation must provide a higher standard of care than nurses.

Political factors … strengthen the importance of early treatment for incontinence to prevent digression and in more extreme cases significantly reduce morbidity and mortality. Such findings have also led to increased government interventions and introduction of NHS policies. A policy is typically described as a deliberate plan of action to guide decision and achieve rational outcome(s). However, there is not definite term and it can denote what is actually done. A policy differs from rules or law, while law can compel or prohibit behaviours policy merely guides actions toward those that are most likely to achieve a desired outcome.

The development of a policy can be a complex process Bart and London distinguished between two types of policies; local policies and core policies, with the latter executing a high authorial approach where failure to comply with the mandatory requirements may warrant sanction. Arguably both core and local policies have been utilised by the DoH. In its aims to improve the health of people in Britain by improving the quality of care provided by the NHS and social services and moreover reduce ‘healthcare associated infections’ it has produced a number of guidance documents, which relate to specific and local areas within the NHS.

Getting Ahead of the Curve, Winning Ways: Working together to reduce Healthcare Associated Infection in England and Towards cleaner hospitals and lower rates of infection: Safe Care reducing infections and saving lives,: Reducing healthcare-associated infections, and the core policies incorporate the fundamental areas needed to ensure policies and legislation are complied with and objectives fulfilled. There is an increasing body of knowledge on the clinically effective treatments for most types of faecal and urinary incontinence (NICE 2006; SIGN 2004: NICE 2006a). Much work is in progress and the Continence Promotion Service will assist in keeping healthcare professionals up-to-date with this or use its national and international contacts to seek information as necessary.

Statistics show urinary catheterisation to be a leading cause of urinary tract infections (Emmerson1996). Hart 96…and therefore particular attention has been given to regulating the catheterisation process. The Health Act 2006, which obliges all NHS organisations to account for the quality of the services they provide sets out criteria to monitor, manage and reduce the risk of healthcare related infections. Local NHS policies on indwelling urinary catheter aim to identify potential sources and ports of entry of pathogenic organisms and the necessary precautions.

They also set standards that can be subject to clinical audit to improve the quality of patient care, and ensure indwelling urinary catheters are properly implanted or removed as soon as possible. Continence problems will ordinarily be observed and identified within primary and community care settings. However, some patients may be admitted for the first time and therefore have no incontinence medical history. In effect hospital nurses must be competent to perform a first level assessment and therefore appropriate funding should be attributed to specific training (Policy and continence care, Cornwall and Isle of Scilly NHS 2007).

Clinical directorates follow guidelines to standardise practices across the Trust by making sure that staff, are fully competent in catheter treatment and healthcare as well as monitoring and producing audit documentation (NHS 2008). (NICE 2003) developed infection control guidelines for primary and community care which addressed the prevention of infections during long term urinary catheterisation. However NICE has also been criticised for focusing primarily on improvements to the physical rather than the care giving aspects of healthcare development. And it is also seen to limit availability of treatment opposed to promoting quality care Carlisle, D (2006).

In addition to catheterisation problems it is also clear that poor medical care can indirectly lead to complications. For instance a failure to advice or perform regular checks on out-care patients or ill-kempt hospitals wards can lead to MRSA-type diseases. This is particular problematic to UTI sufferers, as they are commonly elderly and therefore more vulnerable and susceptible to infection through weakened immunity. It is important for policy creators to take these factors into account. and therefore legislation like Age discrimination Act and Disability act 2005 should be factored into UTI-related policies.

For elderly patients .. pre-existing illnesses like arthritis, Alzheimer or senile, might prevent them from understanding or following the medical advice or instructions given and therefore the type of training or assistance given should be decided on a case by case basis. Many current guideline draw upon the Aseptic technique(Pratt et al 2001, National Institute for Clinical Excellence (NICE) 2003)…which refers to and suggests clinical procedures should aim not only to promote the principles of asepsis but also give education, training and assessment in the aseptic technique.

Most nurses are aware of the importance of aseptic technique but may be unsure how to apply it during urinary catheterisation Mangnall J, Watterson L (2006). Bree-Williams and Waterman (1996) found that not all nurses followed the same actions while carrying out aseptic techniques and that the rationale for the practice of aseptic techniques was not always evidence-based. Therefore measures should be taken to ensure the technique is standardised specifically to UTI specialities.

The Department of Health policies on infection, ‘Winning Ways’ (2003) and the Care Quality Commission aim to ensure better health and care for everyone in all care settings. National service frameworks target groups include older people and diabetics amongst various others. Working together to reduce Healthcare Associated Infection in England was introduce to highlight the importance of controlling infection and also explained the growth in infections contracted by patients in hospitals worldwide.

The factors which have driven, and continue to drive healthcare associated infection are multiple and well known such as patients with. Some are therapeutic needs, including indwelling devices that breach normal defence mechanisms. The publication of ‘Winning Ways’ (DH 2003) identified actions necessary to improve infection control in all invasive devices, which were underpinned by Saving Lives (DH 2005).

For instance health professionals who undertake catheterisation should be, competent with insertion and manipulation of the urinary catheter’s system (DH 2003), also points out that staff should have the knowledge of the anatomy and physiology of the urinary system. Funding should be attributed to better training in areas such as aseptic techniques. World Health Organization (WHO 2009) also points out the importance of Aseptic technique whilst carrying out this procedure and the use of innovative training initiatives designed to ensure skills are maintained helping to improved patient outcomes (Ribby 2006)

Johns (2004) suggests that the methods for managing quality in care need to be devolved to the point of delivery and is an essential aspect of everyday practice. This approach has been adopted through the implementation of clinical legislation such as (Health Act 2006). Prevention and control of HCAIs policy is an extremely important part of the NHS. Independent and voluntary sectors are equally important to healthcare providers.

Such groups work with LAs to tackle social exclusion in deprived areas, using the NA process. It is particularly important to have a high awareness of the possibility of HCAIs in both patients and healthcare workers to ensure early and rapid diagnosis. This should result in effective treatment and containment of the infection. The Department of Health policies on infection, ‘Winning Ways’ (2003) and the Care Quality Commission aim to ensure better health and care for everyone in all care settings. National service frameworks target groups include older people and diabetics amongst various others.

Working together to reduce Healthcare Associated Infection in England, was introduce to highlight the importance of controlling infection and also explained the growth in infections contracted by patients in hospitals worldwide. Some are therapeutic needs, including indwelling devices that breach normal defence mechanisms… The publication of ‘Winning Ways’ (DH 2003) identified actions necessary to improve infection control in all invasive devices, which were underpinned by Saving Lives (DH 2005). World Health Organization (WHO 2009) also points out the importance of Aseptic technique whilst carrying out this procedure, and the use of innovative training initiatives designed to ensure skills are maintained helping to improved patient outcomes (Ribby 2006)

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