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The Gibbs (1988) Reflective Method, is used for the reflection of clinical incident happened in the operation theatre (OT).
A female patient around 40 years of age got admitted to the ENT department for a routine operation. She was anaesthetized and taken to OT, after 6- 8 mins she underwent respiratory depression. Her oxygen saturation level reduced to less than 40%. The ENT surgeon was attempting to reoxygenate the patient. The patient's oxygenation levels were still low. The emergency code was raised and three registered nurses from the adjacent room came to help the patient. The medical emergency can't incubate and can't ventilate arise, the patient was turning blue within 10 mins post admission to OT. After 15 mins the patient oxygenation levels were brought up to 85%. The surgical team made the decision to not operate the patient and made her shift to the ward where she can wake up naturally from anaesthesia. The patient during the recovery was seen that she was not responsive and was ultimately declared dead.
I felt helpless as the whole team was not able to achieve the oxygenation level of the patient. When we were asked to respond to the emergency code, I had sensed the tension in the situation. My other colleagues were also feeling the same. The surgeon was not able to figure out the reason for the low oxygenation levels.
The nurses knew the situation that was going in the operation theatre. I had arranged for bed in ICU and the tracheotomy equipment which should have been used to provide oxygen directly to the lungs artificially. The ENT surgeon was confused about the condition of the patient as in what step should be taken next. I tried to communicate with the doctor but restrained ourselves from breaking the professional boundaries of decision making. I later criticized myself that I should have laid more emphasis on my perspective and should have conveyed it to the team (Kourkouta, & Papathanasiou, 2014).
The whole team lacked the awareness and interprofessional communication, which was important for the benefit of the patient’s condition (Bramhall, 2014). The ENT surgeon and the anaesthetist did not communicate and discussed the medical condition of the patient. The communication improves the patient experience, prevents medication errors, and delivers better patient outcomes (Foronda, MacWilliams & McArthur, 2016). The situation required the shared decision-making approach wherein the healthcare team and the patient collectively take decisions (Babiker et al., 2014).
The team should have displayed an interdisciplinary approach in handling the situation would have led to a positive outcome. The team members must communicate and put their perspective regarding the health of the patient. The nurses should have conveyed the solutions which they had analyzed and should have escalated the issue.
I would be more conscious of my patient needs, and my approach will be to communicate the same with my team. I will also discuss the patient conditions with my senior colleagues and doctor and would escalate the issue if required.
The NSQHS Standards are primarily aimed at protecting the public from harm and improving the quality of healthcare provision. The eight NSQHS Standards make a comprehensive and holistic statement on the quality of treatment patients should expect from healthcare services (ACSQHC, 2019). In the above clinical situation, the NSQHS standard which was not followed was “Communicating for safety standard”. The whole team lacked knowledge of the seriousness of the situation. The team also lacked inter-professional communication, which was vital to the patient's health. The ENT surgeon and anaesthetist did not interact and addressed the patient's medical condition which deteriorated continuously in the OT. The three nurses though had sensed the fall in condition of the patient as they had arranged all the required equipment and arrangements for the patient. But the nurses did not share the concern with the doctors and restrained themselves from breaking the professional boundaries of decision making. The lack of interprofessional communication it cost the life of the patient and led to demise of the patient.
The Communicating for Safety Standard is structured to ensure purpose-driven, timely, and effective communication and documentation ensuring coordinated, reliable, and safe care for patients. The standard recognizes the need for effective communication in medical care, and identifies times of high risk when it is important. This defines the systems and procedures that enhance direct understanding at all patient encounters: when critical information occurs or changes; make sure that the patient's procedure is accurately recognized and aligned, and make sure that crucial data is captured in the patient's medical record (ACSQHC, 2019).
The quality of patient care is increased as healthcare team member work together to express their opinions on the health conditions of the patient (Keller et al., 2013). Each member of the interdisciplinary team has a common set of expertise, experience, and professional backgrounds to enhance the care of the patient, but there are several gaps between practitioners and at the level of the hierarchy that may impede a team-based structure. These challenges include a lack of interprofessional cultural competence, perceived differences of authority, and occupational-based role models. It is necessary to incorporate the Interprofessional Collaborative Practice in response to these challenges in an attempt to build trust, respect, mutual responsibility, and decision-making and successful collaboration to improve patient care (Watters et al., 2015). It has been well established that the introduction of interprofessional collaborative activities fosters greater patient satisfaction, improved performance, and enhanced work performance among health care providers.
Certain recommendations could be implemented within the hospital setting so that the interprofessional communication barriers can be removed. Barriers to communication in hospitals can affect patient experiences and satisfaction, leading to unfavorable feedback and potentially fewer referrals. Medical knowledge will help remove any barriers to communication in healthcare, improve compliance and improve patient satisfaction and recall (Eddy et al., 2016). The perceived differentials in authority can be tackled by giving authority to all team members in decision making. The nurses should be given a concrete and robust way where they can immediately escalate the issues if they are not able to approach the doctor.
Australian Commission on Safety and Quality in Healthcare (ACSQHC). (2019). Communicating for Safety Standard. Retrieved from: https://www.safetyandquality.gov.au/standards/nsqhs-standards/communicating-safety-standard
Babiker, A., El Husseini, M., Al Nemri, A., Al Frayh, A., Al Juryyan, N., Faki, M. O., Assiri, A., Al Saadi, M., Shaikh, F., & Al Zamil, F. (2014). Health care professional development: Working as a team to improve patient care. Sudanese Journal of Paediatrics, 14(2), 9–16.
Bramhall, E. (2014). Effective communication skills in nursing practice. Nursing Standard. 29(14), 53-59. https://doi.org/10.7748/ns.29.14.53.e9355.
Eddy, K., Jordan, Z., & Stephenson, M. (2016). Health professionals' experience of teamwork education in acute hospital settings: A systematic review of qualitative literature. JBI Database of Systematic Reviews and Implementation Reports, 14(4), 96–137. https://doi.org/10.11124/JBISRIR-2016-1843
Foronda, C., MacWilliams, B., & McArthur, E. (2016). Interprofessional communication in healthcare: An integrative review. Nurse Education in Practice, 19, 36–40. https://doi.org/10.1016/j.nepr.2016.04.005
Husebø, S. E., O'Regan, S. & Nestel, D. (2015). Reflective Practice and its role in simulation. Clinical Simulation in Nursing, 11(8), 368-375.
Keller, K. B., Eggenberger, T. L., Belkowitz, J., Sarsekeyeva, M., & Zito, A. R. (2013). Implementing successful interprofessional communication opportunities in health care education: A qualitative analysis. International Journal of Medical Education, 4, 253–259. https://doi.org/10.5116/ijme.5290.bca6
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia Socio-medica, 26(1), 65.
Watters, C., Reedy, G., Ross, A., Morgan, N. J., Handslip, R., & Jaye, P. (2015). Does interprofessional simulation increase self-efficacy: A comparative study. BMJ Open, 5(1), e005472. https://doi.org/10.1136/bmjopen-2014-005472
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