Situation
The patient in the psychiatric unit complained of fatigue, headache, chest pain, and difficulty breathing. In addition, the patient noted the presence of persistent fatigue, nausea, and diarrhea. After assessing the patient’s condition, high fever, sweating, and shaking chills were detected. The patient was diagnosed with non-ventilator hospital-acquired pneumonia. A patient developed an infectious disease during inpatient treatment in a psychiatric ward.
Background
There are several possible causes of hospital-acquired pneumonia in a patient. The first reason is many patients are hospitalized with unrecognized infectious diseases. During the initial assessment of a patient entering the department, some symptoms of an infectious disease may be overlooked, resulting in its spread to other patients. Secondly, drug treatment of patients with psychiatric disorders can cause a decrease in immunity and, as a result, makes them more vulnerable to the influence of infections. Finally, the reason may be the failure of patients to adhere to the rules of hand hygiene and the lack of proper supervision by the staff.
These factors correlate with the National Patient Safety Goals set by The Joint Commission (2022). First, NPSG.01.01.01 requires an improvement in “the accuracy of the identification of individuals served” (The Joint Commission, 2022, p. 1). In addition, NPSG.03.06.01 implies a more careful selection of medicines, considering their compatibility, to ensure patient safety. Finally, NPSG.07.01.01 establishes the need to “reduce the risk of health care-associated infections” (The Joint Commission, 2022, p. 3). Compliance with these standards is essential to reduce the risk of healthcare-associated infections (HAIs) among patients.
Assessment
Infection of one of the patients of the psychiatric department with pneumonia poses a threat to all patients who are in inpatient treatment. According to the statistics, “one in every 100 hospitalized patients will be affected by non-ventilator hospital-acquired pneumonia (NVHAP)” (The Joint Commission, Division of Healthcare Improvement, 2021, p.1). However, this disease is contagious and easily transmitted by airborne droplets. Therefore, in case of untimely adoption of preventive measures to block its spread and treat patients, there are risks to the safety of all patients and the likelihood of multiple infections.
Recommendation
It is necessary to raise the level of examination of people during hospitalization in a psychiatric department. It is recommended to introduce the practice of assessing the human condition not only for psychiatric disorders but also for the presence of other diseases and infections that may threaten other patients. In addition, it will help identify risk groups that will be most susceptible to infection in the first place. A patient with pneumonia must be isolated from others, and his treatment should be selected individually, depending on compatibility with other drugs taken. Moreover, standard precautions, including hand hygiene for patients and caregivers, disinfection of the environment, use of personal protective equipment, and minimizing the exposure of the infected to other patients, must be taken (Centres of Disease Control and Prevention, n.d.).
The incidence of HAIs aligns with a high-reliability organization’s principles. High-reliability indicators of a medical institution are the quality and safety of the services provided there. One of the tasks of the medical staff is to ensure the safety of patients undergoing inpatient treatment. It also implies taking preventive measures to reduce the risks of HAI occurrence and spread (The joint Commission, 2022). Thus, the fewer patients who have HAI and the more quickly the infection is treated, the more highly reliable the institution is.
Barriers to implementing these recommendations may be the lack of sufficient awareness of the medical staff about the prevention and reduction of HAI. In addition, a barrier may be the lack of awareness among patients about the precautions they should take. These barriers can be removed by educating and informing all parties about preventive measures for HAI. All department medical staff should receive the necessary training to eliminate these shortcomings and prevent the further spread of infection among patients. Moreover, informing patients and their families about the precautions and prevention of HAI is necessary. Patients in psychiatric wards may have difficulty absorbing information, so it is important to make sure that they understand it and will apply it in practice. It may include stickers and posters reminding patients to adhere to hand hygiene standards.
To eliminate the problem, the joint work of all stakeholders is necessary. The management of the medical institution should allocate the necessary “human and material resources for infection prevention to ensure consistent and prompt action to remove or mitigate infection risks and stop transmission of infections” (Centres of Disease Control and Prevention, n.d., para.7). This group should include healthcare professionals qualified in the prevention and treatment of infectious diseases. Moreover, qualified professionals can coordinate with other healthcare workers to eliminate the infection and prevent its spread.
The main indicator of the effectiveness of the measures taken will be a decrease in the number of patients in the department infected with pneumonia. An increase in the number of recovered patients and a decrease in cases of infection in other patients can measure this indicator. Moreover, an important indicator will be the increase in the high-reliability organization, as measured by the overall reduction in the number of HAIs and the compliance of the services provided with medical standards.
Currently, in healthcare settings, a team care delivery model is used. It represents a coordinated work of all key stakeholders to identify non-compliance with the standards that led to the infection of pneumonia patients and correct them. This model guarantees efficient communication between all parties, which is necessary to comply with NPSG.01.01.01, NPSG.03.06.01, and NPSG.07.01.01. Achieving these goals is an important step towards increasing the credibility of the healthcare provider by improving patient safety and the quality of services provided.
References
Centres of Disease Control and Prevention. (n.d.). CDC’s Core Infection Prevention and Control Practices for Safe Healthcare Delivery in All Settings. Web.
The Joint Commission. (2022). National Patient Safety Goals. Effective January 2023 for the Behavioral Health Care and Human Services Program. Web.
The Joint Commission, Division of Healthcare Improvement. (2021). Preventing non-ventilator hospital-acquired pneumonia. Quick safety, 60, 1-2. Web.