Response to question 1
It is highly important and also very critical to understand the various amounts of stress and anxiety that is increasing in the public health scenario across the globe and also across the country of United Kingdom (Manser et al. 2016). Lack of the clinical supervision, lack of correct policy structures, lack the administrative policies and lack of proper risk management and risk prevention systems are the factors that are majorly responsible for the development of the clinical and the medication risks that has affected the health care system of United Kingdom and the quality of life of the patients along with the a poor prognosis in a major cardinal manner.
In this study, the supervision and the inspection conducted in the Coombe Women & Infants University Hospital, Dublin of Ireland, United Kingdom by the Health Information and Quality Authority also known widely as the HICA, will be discussed (Perelló et al. 2016). In this study, the effect and clinical supervision as well as the risk management process in the control and quality management of the hospital acquired infection by the clinicians and supportive staffs at the Coombe Women & Infants University Hospital is studied and explored very intricately so that the risk register and the risk matrix can be strategized (Card and Klein 2016). Infection control and prevention of the hospital acquired infections are the major areas of concern that requires ethical compliance with the evidence based or the best practice standards and during the unsuspected visit at the hospital in Dublin, various barriers and the risk factors were found out on investigation that lead to the increased patient readmission, increased time of the hospital stay ad increased rates of humans errors resulting in clinical complications arising from the increased rates of the hospital acquired infections and cross contaminations (Leonard-Roberts, Currey and Considine 2020).
Risk identification is the method of identifying the specific indicators that is indicative of the adverse clinical outcomes due to the lack of risk management or monitoring and chiefly due to the lack of clinical supervision. These can include various areas of issues ranging from social, resource, behavioural, management, collaborative, skill and communication gaps but all leading to risks to patient safety. Risk analysis on the other hand is the scrutiny of the major issues, the causes and the effect of the same, leading to a specific risk outcome. The analysis also points out whether it is preventable and which area needs to be changed. Risk prioritization is the process of triaging the issues and clinical risks posed and taking actions on the basis or rather the order of urgency. Risk Treatment refers to method of implementing the interventions to modify the presented risks only after, the same has been chosen. Optimization, avoidance, transferring or retaining of the problems are the majorly critical steps in risk treatment. Clinical surveillance is an important area of risk monitoring and reviewing and it is a vital part of the risk planning process and continuous improvement in the framework of organisational risk management. Risk matrix tool is used to depict risk levels by taking on at a time, probability of risk category and tallying it against consequence or outcome severity. Risk resister is used to develop a visual guide to compliance through identification of reference and owner, risk nature, risk mitigation measures.
| The main risks | Owner of risks | Reason/ cause | Effect | Level of risk | Impact score (0 – acceptable, 1- tolerable 2- intolerable 3 – could result in disasters | Existing control | New actions for risk mitigation | Key stakeholders involved in risk action | Dates | Residual risk |
| Cases of infectious disease | The clinicians | Due to lack of hand hygiene compliance in the hospitals | Hospital acquired infections | High | 3 | Electronic reminders | Developing compliance | Staffs and managers | 1month | -1.3 |
| Cases of colonization or infection with transmissible micro-organisms including multidrug resistant organisms | Clinicians | Lack of aseptic techniques, lack of personal protective equipment usage and lack of the hand hygiene compliance | Hospital acquired infections | high | 3 | Clinical supervision with the usage of personal protective equipment | Developing compliance | Staffs and managers | 1 month | -3.2 |
| Lack of Immunization uptake | Public health clinicians | Lack of education in the public scenario and lack of immunization policies at the local, state and the national health care framework of the country | Hospital acquired infections | low | 2 | Clinical supervision | Seminars and workshops | Staffs and managers, administrators | 1 month | -4.3 |
| Cases of mastitis | The gynecological specialists including the doctors, nurses and the allied health practitioners | Lack of compliance with the evidence based operative or best practice guidelines with respect to the peri-operative patient handling procedures | Hospital acquired infections | low | 3 | Clinical supervision | Surgical training and education, | Health administrators | 2 months | -4.5 |
| Positive blood cultures | Staffs | Cross contamination leads to the development of the blood borne diseases and it is in the blood bank, pathological and the serological testing departments, cross contamination of blood and improper test, wrong blood transfusions leads to the development of hospital acquires infections. | Hospital acquired infections | High | 2 | Clinical supervision | Electronic risk monitoring tools | Staffs and managers | 1 month | -2.3 |
| Episodes of bloodstream infection and cases of sepsis | The intensive care unit staffs especially the nurses | Sepsis and septicemia are other indicators of the hospital acquired infections and it is due to gaps presented in the health care service delivery by the nurse and due to the lack of clinical supervision, sepsis are developed in the patients, attributed by the hospital acquired infection hazards. | Hospital acquired infections | Low | 1 | Clinical supervision | Staff development session for elevating nursing skills | Staffs and managers | 1 month | -3.8 |
| Number of contaminated blood cultures · | The nurses and the other staffs as well | Contaminated blood cultures are another critical risk that cause the hospital acquired infections in the hospital | Hospital acquired infections | Low | 3 | Microbial risk tools | Clinical supervision | Staffs and managers | 3 months | -2.3 |
| Hospital activity levels | Staffs | The in-hospital activities without compliance with the environmental and safety guidelines leads to lack of proper sterilization that causes the increased rates of the hospital acquired infections | Hospital acquired infections | High | 2 | Risk Documentation | Develop multidisciplinary collaboration | Staffs and managers | 1 month | -4.7 |
| Ventilator-associated pneumonia episodes | The respiratory care staffs and the intensive care unit workers | Lack of biomedical safety and lack of the aseptic non -contact techniques is another huge risk that cause the increased rates of the hospital acquired infections | Hospital acquired infections | Medium | 3 | Anti-microbial resistance surveillance tool | Develop patient centered care policies | Staffs and managers | 3 months | -2.3 |
| Caesarean section surgical site infections | The surgeons, surgical nurses | Lack of wearing of the personal protective equipment, lack of following of the sterilization techniques and lack of compliance with the patient safety guidelines poses the hospital acquired infection risks | Hospital acquired infections | High | 3 | Evidence basedPractice compliance tool | Training and ongoing professional development | Staffs and managers | 3 months | -1.3 |
| Hand hygiene compliance by staff | New graduate nurses and the doctors | The nurses and the other clinicians are involved with the non-adherence to the hand washing and hand hygiene guidelines, thus increasing the risks for the hospital acquired infection risks | Hospital acquired infections | Medium | 2 | Hand hygiene compliance tool | Hand hygiene raining | Staffs and managers | 3 months | -1.7 |
| Lack of Uptake of hand hygiene education by relevant staff | New graduate nurses | Lack of the knowledge and the lack of skill sets needed for Hospital acquired infection prevention is another foremost reason for the presentation of the infection risks | Hospital acquired infections | Low | 1 | No | Staff training | Staffs and managers, trainers | 2 months | -3.4 |
| Antimicrobial consumption | Clinicians | Behavioral and clinical supervision issues are the risk factors that cause the increased rates of hospital acquired infections | Hospital acquired infections | Medium | 2 | No | Clinical audits | Trainers, managers, staffs, administrators | 1 month | –1.7 |
| Lack of Alcohol hand gel usage | Clinicians | Behavioral, comprehension and knowledge skills play a huge role in the development of issues | Hospital acquired infections | Medium | 2 | No | Clinical audits and behavioral training | Staffs and managers | 2 months | –2.6 |
| Environmental water and food sample results | Clinicians | Lack of quality checkup and the environmental risk management team hospital acquired infections. | Hospital acquired infections | High | 1 | No | Workplace health safety actions | Staffs and managers, risk and quality managers | 3 months | -1.9 |
| Likelihood Low | Medium | High | |
| Impact – low | Risk 3, 4 | 6, | |
| Medium | 7, 12 | 9, 11 | Risk 1 2 5 |
| High | 12, 13 | 8, 10 | 15 |
Response to question 2
Education and training play a huge role in the prevention of the hospitals acquired infections in the health care framework of the hospital and it is because there are gaps in the knowledge and skill set of the new graduate clinicians who lack the experience and practical understanding of the clinical situations – the errors and near misses, the lack of compliance with the evidence-based practice guidelines are the major reasons found in hospital (Brady et al. 2017). The lack of knowledge about the five moments of handwashing as given by the world health organization, lack of compliance with the wearing of the personal protective equipment and personal protective garments, usage of aseptic non-contact technique while handling the patients (Dunne et al. 2018). The skill enhancement and the staff development sessions are highly critical for the ongoing professional development of the clinicians at the chosen Hospital and the educational training programs should encompass he right documentation, risk prevention, risk reporting, behavioral ad knowledge development about hand hygiene, aseptic and sterilization techniques, personal protective equipment, ventilation care along with biomedical instrument handling – are highly crucial and also very critical to develop a safe patient care service in the hospitals, as recommended by the Health Information and Quality Authority.
Response to question 3
The efficacy achieved by the risk assessment plan given by the Health Information and Quality authority are multi-faceted in terms of its strengths and successes. Using the strategies such as clinical governance, policies, guidelines and safety procedures, evaluation and monitoring of the hazard related quality indicators for the identification of clinical risks pertaining to the hospital acquired infections in the Coombe Women & Infants University Hospital, the organization found various amount of the successes in terms of various parameters related to surveillance of the infection issues and the risk management. As for the statistical figures of the success of the Health Information and Quality Authority, seventy-nine per cent of the staffs of the hospital and of them, seventy eight percent of were from the nursing or midwifery background and healthcare assistant staff and ninety percent of the medical staffs were up to the date and it is critical to note that by the end of the health safety and quality change program delivery by the body, the hundred per cent medical non-consultant doctors were reported to be fully equipped with the knowledge about the hospital acquired infections prevention (Zhao and Zhang 2017). As mentioned in risk register, education, clinical monitoring, staff development session, audits, clinical supervision, electronic reminder and audit tools, documentation process are the critical risk management strategies. There has been increasing domains, departments and bundle care protocols and services in order to better provide a large coverage to the patient condition with various comorbidities and while, this in fact has increased the economic benefits of the clients from different sociocultural and socioeconomic backgrounds but on the other hand, it is to be noted very closely that this has also posed various amounts of stress and strain in the health care system (Aziz et al. 2016). Thus, the successes achieved by the Health Information and Quality Authority in Coombe Women & Infants University Hospital, can be translated at a larger scale with a larger population of United Kingdom in Ireland to prevent the issues.
Response to question 4
The compliance rates with the evidence-based practice protocol has been the major barrier along with many other barriers affecting the quality of care and the patient satisfaction and the health care framework of the United Kingdom (Andre-Vert et al. 2018). The robustness of the risk management and assessment plan is based on the fact that the it covered all the aspects of the issues starting from the knowledge gaps, behavioral, operational and clinical skills gaps to the structural, infrastructural, resource issues of the hospital or rather health care organization in relation to the risk management process of the hospital acquired infections and treatment delivery to the patient plus caring and supervision, the safety of the treatment, the safety of the patients – makes the risk assessment plan n more robust (Strametz, Tannheimer and Rall 2016). The recommendations to address the problems so as to prevent and manage the hospital acquired infections in the hospital are proper clinical governance mitigating the risk factors and the clinical supervision by the managers, health care administrator and the officers to maintain a safety culture in the hospital organization , having a system of auditing the performances related to the safety skill is vital. Improving knowledge and behavior of the clinicians, having the right policies in place regarding the handling of the clinical risks so as to mitigate the severity of the issues, staff training and education to aid them comply with the evidence based practice standards, having systems to monitor and prevent the transmission of resistant infections and having the right tools to prevent the surgical site infections is vital. Skill improvement in the employees will contribute to the continuous professional development and this will address the future challenges of attrition and increasingly complex patient care needs.
References
Andre-Vert, J., Ghadi, V., Lucet, B. and Grenier, C., 2018. ISQUA18-2617 Patients Engagement Strategy: 10 Years, Step by Step at French National Authority for Health. International Journal for Quality in Health Care, 30(suppl_2), pp.50-51.
Aziz, C., Grimes, T., Deasy, E. and Roche, C., 2016. Compliance with the health information and quality authority of Ireland national standard for patient discharge summary information: a retrospective study in secondary care. European Journal of Hospital Pharmacy, 23(5), pp.272-277.
Brady, M., Oza, A., Cunney, R., and Burns, K. 2017. Attributable mortality of hospital-acquired bloodstream infections in Ireland. Journal of Hospital Infection, 96(1), 35-41.
Card, A. J., and Klein, V. R. 2016. A new frontier in healthcare risk management: working to reduce avoidable patient suffering. Journal of Healthcare Risk Management, 35(3), 31-37
Dunne, C.P., Kingston, L., Slevin, B. and O’Connell, N.H., 2018. Hand hygiene and compliance behaviours are the under-appreciated human factors pivotal to reducing hospital-acquired infections. Journal of Hospital Infection, 98(4), pp.328-330.
Leonard-Roberts, V., Currey, J. and Considine, J., 2020. Emergency nurses’ perceptions of their role in responding to escalations of care for clinical deterioration. Australasian Emergency Care.
Manser, T., Frings, J., Heuser, G., and Mc Dermott, F. 2016. The German clinical risk management survey for hospitals: Implementation levels and areas for improvement in 2015. Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, 114, 28-38.
Perelló, R., Vergara, A., Camón, S., Saubi, N., Eto, Y., Quirós, C., Priu, I., Moreno, A., Martínez, E. and Marcos, M.A., 2016. Acute respiratory infection: first clinical manifestation of active infection with cytomegalovirus in HIV patients presenting to the emergency department. Signa Vitae, 12(1), pp.111-115
Strametz, R., Tannheimer, M., and Rall, M. 2016. What Surgeons Should Know about Risk Management. Zentralblatt fur Chirurgie, 142(1), 72-82.
Zhao, Y. and Zhang, J., 2017. Consumer health information seeking in social media: a literature review. Health Information & Libraries Journal, 34(4), pp.268-283.
