Chapter 1: Health Care Delivery for the 21st Century

(workplace redesign, restructuring, or re-engineering)

Why? Workplace redesign was necessary because reimbursement for services was less than it had been previously

What? Combining the services and departments

Fewer workers provide a broader spectrum of care

Workplace Reorganization

Nursing department’s responsibilities have been expandedNursing Assistance and unlicensed care providers are

taught to provide advanced technical skills

(Ex: cross-training)Nursing Assistants learn additional technical skills and

may be able to perform procedures and skills previously performed by other departments/nurses.(Ex: No longer a need for EKG tech or phlebotomist in the

hospital)

Effect of Workplace Redesign

The title of assistants has changed to reflect the changes in skill level

Past: Nursing Assistants

Present: Patient Care Technician

Future: ??????

Why to hospital hire more PCT’s and nursing homes hire CNA’s?

Effect of Workplace Redesign

(quality improvement, continuous quality improvement)

What? A department/program within a facility responsible for identifying problems or potential problems and finding solutions for improvement.

The QA department reviews and evaluates care provided and practices used in the facility and makes recommendations to improve care

Ex: restraint use, infections, pressure ulcers, infection control

Quality Assurance

What? An activity in which an organization establishes best practices by comparing what it is doing with what other, similar organizations are doing.

Why? So the facility can improve its processes and achieve excellence

Benchmarking does not involve copying what other facilities are doing

Benchmarking uses critical thinking (problem solving) to identify and correct problems. = better outcomes

Benchmarking

What? Decision making and research tools that are used for tracking changes, recognizing potential problems, and identifying areas that warrant further study and research

Quality Indicators are also a type of benchmark

Quality Indicators provide information about patient outcomes, access to care, cost…..

Quality Indicators

Adverse Event: incidents, accidents, events, and injuries associated with patient care and services. Ex- falls and med errors

Close Calls: “near miss” situations that could have resulted in an adverse event but did not

Catching the mistake at the last minute

Present opportunity for learning and further study

Are given as much attention as events that result in injury

Serious Events

Intentionally Unsafe Acts: criminal events, acts related to alcohol or drug abuse, intentional abuse/neglect

Sentinel Events: serious incidents that result in patient death or serious physical or psychological injury

Ex- medication error, wrong surgery

Serious Events

What? A process for identifying the cause or contributing factors associated with events. It is a review of unsafe acts, adverse events, close calls, or sentinel events.

RCA :asks what? and why?

identifies procedural changes to reduce future risks of events

Root Cause Analysis

ULP- unlicensed assistive personnel

Individuals who assist the licensed nurse in the role of providing direct nursing care to health care consumers as delegated by and under the supervision of the licensed nurse

Anyone providing direct patient care without a license

Unlicensed Assistive Personnel

See chart on pg 7-8:

Duties/Responsibilities

Education

Knowledge/Skills/Abilities

Physical Requirements

Reporting Responsibilities

Working Conditions

Ethics

Role and Responsibilities of the Patient Care Technician (PCT)

Must be taught to perform procedures/skills firstMust be under direct supervision of RNLaws regarding a ULP or PCT scope of practice may vary

from state to state

Scope of Practice: PCT

Are common health care practices based on laws, facility policies and procedures, information learned in class, job description, and published information

Applying standards of care means using the degree of care or skill that is expected in a particular circumstance or role

Standards are used to measure workers’ efficiencyNeglect: is failure to exercise the degree of care considered

reasonable in a situation Ex: forgetting to serve a confused patient’s meal tray

Malpractice: is the failure to act according to the acceptable course of conduct, resulting in harm to patient.

Standards of Care

Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires health care facilities to ensure that workers are competent in their responsibilities.

Facilities must evaluate skills regularlyHealth care workers are responsible for continuing

education and keeping up with changes related to their area of work

Most licensed health care providers are required to complete a minimal number of CEU’s per yr.

(continuing education units)

Continuing Your Education

Before delegating a task to a PCT, the nurse must decide if delegation is appropriate.

1.Right Task

2.Right Circumstances

3. Right Person

4. Right Direction

5. Right Supervision

Pg. 11

5 Rights of Delegation

When a PCT accepts responsibility for a delegated task, you are responsible for your own actions

Never perform a procedure if you have not been taught or allowed to do it according to state law or facility policy

Always ask if you do not understand somethingIf you feel it is unsafe, discuss those concerns with RNReport anything applicable observations about the patient

to the RNNotify RN immediately if the patient’s condition changes

Performing Delegated Activities

When? If not within scope of practice, have not been taught procedure, you feel it may harm the patient, you do not feel comfortable performing the procedure, you do not have proper supplies

Do Not Refuse- because the procedure is unpleasant

How? Notify the RN as soon as you know you are going to refuse the delegation and give reasons why

Refusing Delegation

Be courteous and politeState name of unit, name, and titleOnly a RN can take orders from a doctor over the phoneDo not give out personal information about patients over

the phoneThank the person for calling

Answering the Phone

Likes peopleTakes responsibility seriouslyBelieves in the importance of the positionTeamworkGood communication skillsTact(the ability to say and do things at the right time)CourtesyRespectPoliteThoughtful ………………….refer to work ethic traits

Desirable Qualities of the PCT

Reporting to work on time and using time wellKeeping absences to a minimal. Only when necessaryKeeping promises to patients and staff membersFollowing each patient care planCompleting assigned tasks quickly and accuratelyTreating patients with respect and dignityKeeping patient info confidential

Responsible Behavior

Examples of not respecting professional boundaries:

Discussing you personal problems w/ patient

Being flirtatious with a patient

Using offensive language

Spending an inappropriate amount of time with the patient including off duty visits

See pg 15-16

Professional Boundaries

Verbal: choose words carefully, positive attitude, do not interrupt, use proper tone

Non-Verbal: posture, body language, eye contact

Your words only represent 7% of your message

38% tone of voice

55% body language/facial expression

Communication

Sympathy: feeling sorry for someone and taking on their feelings as your own

Empathy: is understanding how the patient feels. It involves connecting with and supporting a patient when he/she works through difficult times

Sympathy vs. Empathy

Infant(birth to 1yr) learns to trust Toddler(1-3) learns to differentiate self from othersPreschool(3-5) develops initiative; self as part of familySchool Age(6-11) develops physical and mental abilityAdolescence(12-18) develops a sense of identity/sexualityYoung Adult(19-25) establishes intimate relationshipsMiddle Adult(26-50) marriage, family, careerLate Adult(51-65) helps adult child, chronic dz, Old Age(65+) reflective

Developmental Tasks

See pg 21-27

How might you communicate with a newborn?

How might you provide a toddler with safety and security?

What is the best approach to providing a preschooler with personal care and comfort? Vs. Old age?

Age Appropriate Care