Issue link: https://beckershealthcare.uberflip.com/i/1169964
82 CMO / CARE DELIVERY Nurse viewpoint: 'Workarounds' reveal the dysfunction of American hospitals By Anne-Marie Kommers W orkarounds, in which provid- ers bypass burdensome rules to ensure their patients receive the care they need, are common throughout the American healthcare system and reveal its dysfunction, eresa Brown, PhD, RN, a clinical faculty member at the University of Pittsburgh School of Nursing, wrote in an op- ed for e New York Times. Staff use workarounds because they save time, Dr. Brown wrote. Hospital nurses are already stretched to the limit on their shis, and inefficiencies in the system force them to find creative ways to deliver required care. Some nurses have resorted to hiding drugs, for example, because the hospital pharmacy is too slow and they don't want to keep patients waiting. Dr. Brown had her own experience with work- arounds when her hospital started requiring nurses to use bar code scanners for medica- tions that did not work with EMRs. Checking off the drugs in both systems took up valuable time, and many nurses started ignoring the rules to provide better care. One can argue the entire American healthcare system is built on workarounds, wrote Dr. Brown, and medical scribes are one example. Physicians are increasingly using medical scribes to keep up with paperwork, and in that sense medical scribes are workarounds for the design flaws of EMRs. Dr. Brown also wrote that the ACA, which she supports, is a workaround. e ACA was not intended to ensure all Americans had affordable care, but rather to work around the nation's failure to provide healthcare to all citizens. In sum, workarounds demonstrate how dys- functional the American healthcare system has become, Dr. Brown wrote. Workarounds represent a "trade-off of values," in which pro- viders are forced to choose between onerous rules and patient safety. n Mississippi VA hospital cited over patient's death By Mackenzie Bean H ealth officials cited Gulf Coast Veterans Health Care System for the 2017 death of a patient whom staff members failed to perform timely resuscita- tion on, according to a federal report cited by WLOX News. The Department of Veterans Affairs Office of Inspector Gen- eral released its report on the incident Aug. 6. The patient died in late 2017, less than 24 hours after being admitted to the Biloxi, Miss.-based health system's behavioral health unit. The report found staff members failed to conduct regular 15-minute checks on the patient, as ordered by a physician. When employees found the patient unresponsive, they "did not quickly assess the patient, act with a sense of urgency, alert the care team, immediately initiate basic life support, locate the nearest automated external defibrillator, nor acti- vate the community 9-911 emergency response system, all of which were required by policy," the report said. The OIG could not determine whether appropriate resus- citation efforts would've saved the patient. "We recognize opportunities for improvements in our practice and corrective actions are being implemented to address the recommendations," Bryan Matthews, director of Gulf Coast Veterans Health Care System, said in written comments included in OIG's report. The health system has since retrained employees on how to respond to medical emergencies, among other cor- rective actions. n Nurse research prompts care improvements at Providence St. Joseph Health By Anne-Marie Kommers S everal nurses have conducted research focused on bedside care to improve patient satisfaction at Prov- idence St. Joseph Health hospitals in California's Los Angeles and Orange counties, according to a press re- lease published by KHTS. Many of the nurses were featured in the health system's an- nual Research and Evidence-based Practice Day on Sept. 3. The nurses include Melissa Reilly, RN, a critical care nurse at Fullerton, Calif.-based St. Jude Medical Center, who devel- oped a board with pictures, signs and words at which pa- tients on ventilators can point to better communicate. The boards significantly improved patient satisfaction. In another example, nurses at Providence Little Company of Mary Torrance (Calif.) coached each other on communi- cation skills to keep patients better informed about their care. The percentage of patients saying they were kept in- formed subsequently increased, from 66.2 percent to over 71 percent in eight months. "Nursing research is focused more at improving patient outcomes," said Marysol Cacciata, a nurse who leads the research council at St. Jude. "It overlaps with research by doctors and scientists who are looking at the disease. Nurses are looking at how to impact patients' lives." n