No organization can survive for long without measuring its performance. Our health network seems to be mired in mediocrity by not evaluating its practices. And if, indeed, the workforce was sufficient in a context where the practice would be of quality?
Posted at 10:00 a.m.
After more than 30 years of analyzing the supply needs in our health network, I could only see the difficulty of establishing an organizational culture focused on measuring the efficiency of medical practices and their overall costs.
How much does non-quality cost in business? Several studies demonstrate this and are revealing in terms of possible labor savings, simply by adopting best practices from the start of the production or care chain.
Far from wanting to blame the nurses, they are placed in a context of overload and where the training time is insufficient. It then becomes difficult for them to question their practices. In fact, nurses get bogged down in non-quality, unwittingly contributing to their own burden.
Here are some convincing examples of non-quality in the care provided in our health network:
Urinary tract infections
Non-quality indicators include too many medication errors that can lead to prolonged hospitalizations.
One of these other indicators is that related to urinary tract infections following the insertion of a urinary catheter. Some 3% of hospitalized patients will develop an infection as a result of poor practices or, sometimes, the use of inadequate or poor quality supplies. Thus, for a single hospital center with 10,000 admissions per year, this can easily translate into 900 additional days of hospitalization, with what this requires in terms of nursing time.
Infections and wound care
Another common and most costly indicator of non-quality is that related to wound care. This is probably one of the areas of care where quality in practice would allow the network to recover thousands of hours of nursing time, while improving the quality of the care provided to the patient.
Remember that the primary consideration in the care of complex wounds is the risk of infection. Infection prevention should therefore be a priority objective for all healthcare professionals. Here are some examples of poorly treated wounds and their consequences:
Partial thickness burns:
- the hospital-acquired infection rate reaches up to 10% of admitted patients;
- consequences: prolonged stay (on average 10.2 days longer).
Venous ulcers:
- 70% of ulcers are of venous origin, therefore treatable;
- two-thirds of people over 65 will suffer from ulcers with the current practice;
- half of the affected population has had ulcers for 5 to 10 years.
Diabetic Foot Ulcers (DPUs):
- more than 50% of PDUs become infected with current techniques;
- 85% of lower limb amputations in a diabetic are preceded by a foot ulcer.
Handling of catheters
Let’s also talk about mishandling intravenous catheters causing a need for extra care from nursing staff. They are largely caused by complications that could have been avoided, if only we took the time to adopt good practices.
The failure rate of catheter installations is 30%. The causes are multiple. Here are some of them: poor choice of insertion site, inadequate dressing/stabilization, blood or liquid under the dressing, redness at the site, exposure to blood, presence of blood at the connection point, etc.
The consequences of these failures are significant: infection, phlebitis, occlusion, dislodgement, extravasation.
Practice assessment
In fact, there are many other examples where quality is not measured in our healthcare network, despite the Accreditation Canada standards that are supposedly met.
In the context of the COVID-19 pandemic, the labor shortage and the “refoundation” promised by Minister Dubé, the recovery of nursing time associated with the adoption of best practices in care is would prove to be a gold mine for the management of the health network. It is imperative to take the time to integrate clinical expertise based on best practices to improve care and thus reduce costs and nursing time. Unfortunately, during this time, some bandages are placed upside down…