Healthcare Policy And Nursing Practice: A Case Study

a. Healthcare policy has made a powerful impact on healthcare and nursing practice. When I first began my nursing career in 2000, I did not know much about policy and the hospital did not really have many areas of focus (that I can remember). I can recall getting CAUTIs, CLABSIs and pressure injuries and thinking that was par for the course. The theory when I began, was that when a patient entered the hospital, there were risks. I am very thankful that the Institute of Medicine recognized this theory as unacceptable in its IOM Report, To Err is Human, which originally dates to 1999. In this report, the IOM reviewed just how unsafe healthcare was, as it stated approximately 44,000 to 98,000 deaths each year were a result of medication errors.

Similarly, readmissions are also scrutinized. In addition, patient satisfaction has been added, as some believe if patients feel safe and involved, they will be more satisfied with the care they are receiving. Hospitals are held accountable through Medicare reimbursements, which was brilliant on the part of the government. Once reimbursement was affected, hospitals jumped on board and bought in to the need for a culture of safety. Researchers worked hard to develop the evidence for best practices, and multidisciplinary teams were created to ensure the best practices were delivered to the healthcare setting. Inpatient and outpatient settings collaborated in an effort to prevent readmissions. As a result of policy, I have transformed my practices. I am always asking myself “is this best for the patient?”, “will this cause harm?” I believe healthcare policy is quite powerful and has done a great deal of good for the community in which I serve. As I stated previously, when I first began my nursing journey, CAUTIs, CLABSIs and pressure injuries were commonplace. I did not like them, but I knew they happened. Now, my hospital sets limits to the number of event that can occur and those numbers are quite low: 1 CLABSI, 1 CAUTI, and 8 HAPIs for the year,

Now, that I have looked at the pro, there is always a con to every major change. As with any situation, not every scenario is cookie cutter, and one cannot predict all outcomes. On my unit, we recently had a HAPI, in which the staff did everything possible to make sure the patient was well taken care of; unfortunately, this patient was dying and refused to be turned. Despite premedication and education, the patient continued to refuse the interventions necessary to prevent skin breakdown. Regardless of our efforts, we own the HAPI. The same is true for readmissions. We have hard working nurses that dedicate a great deal of time educating their patients on the disease processes. We also have specialists that will round on the patients (heart failure, stroke, diabetes) to reinforce the nurses’ teachings. Case management is involved with getting the patients everything they need for a successful discharge. Outpatient rehab services are set up, in addition to home health, and yet, many of these patients return in less than 30 days. It is quite difficult to manage the patient after they leave the hospital, but hospitals remain responsible and the reimbursement is affected. I am a firm believer that when you present a