Letter to editor
Letter to the Editor and copy to Legislative Representative
Health Care delivery measures require the imparting of high quality medical and paramedical care in primary, secondary and territory care. With the rapid advancement in the fields of medicine, surgery post-operative convalescence and long term geriatric or tertiary cure there have emerged more areas for making mistakes.
With this emergence of new techniques and methodologies of health care delivery there have become possible several levels of care. Along with the provision of such care came the greater responsibility of ensuring the best possible quality of care.
There are currently some issues that need to be focused upon in this care giving world. There have been rising instances of the fatal loss of life due to some avoidable mistakes. Also, the onus of responsibility of making a mistake was usually fixed upon the grassroots level workers like the paramedical staff. Many of the nurses are currently protesting about the sharing of such responsibility.
Therefore, the current topic of ‘Care Coordinator Quality Measurement’ needs to be carefully studied and a panel is formed so that the exact circumstances surrounding the care given in any particular case. For this it is essential that
- All steps of quality care should be meticulously noted at all levels of the care giving exercise.
- All forms of drugs, their dosage and their usage along with precise timings, quality and reaction if any be astutely discussed with the care giver directly.
- Close monitoring should the done to ensure that all instructions are being followed.
- Responsibility fixing should be done at all levels to ensure that all levels of care givers are alert and attuned to the needs of the patient. (Many a times, especially for patients in long term care programe there creeps in an element of ‘routine’ which can prove detrimental to any care giving programme)
- Doctors monitoring and in-charge of such cases should take special care in such cases.
Doctors have the added responsibility of studying, analyzing and carefully monitoring the impact of the medicines, care and overall therapy. Even while the entire team is working on the patient, the major responsibility lies with the care giving institution. The quality of care is the responsibility of the entire team.
There have been several reports of junior level staff being penalized for mistakes that could not have been performed without the explicit instructions of the seniors. Some such cases were:
- Dosage of medicine was not adjusted as per requirements of the patients and over dosing occurred.
- Patients who had been lying prone for a long time tend to go into tachycardia if made to sit up. But instructions are not given, and relapses occur.
- Close monitoring of fluids intake and outputs tend to become routine after sometimes, and slight aberrations can prove fatal.
- Sudden break or increase of pace in breathing or heart beat or any change in any of the vital functions must be reported immediately lest there be any fatal breakdown.
(In such instances the care-giver in charge may be alert in reporting but the higher authority that takes time in responding. When such fatalities occur there is often the exercise of blame mongering from lower to higher and vice versa levels of responsibility.
It is our plea, Sir, that it be widely understood and acknowledged that the entire process of treatment, care to go and health care delivery is a process of joint responsibility or at the best collective responsibility.
Thus, as the subject suggests we the nurses are of the opinion that every patient is a systematized responsibility. There should be instituted a ‘Care Coordinator Quality Measurement’ panel be set up for each patient to ensure that the total care given is of a high quality from beginning to end. This panel should be formed for every patient and share joint responsibility for the entire duration of care.
Reference:
Russo, Allison C and Jiang, H Joanna. “Hospital Stays Among Patients with Diabetes, 2004” Healthcare Cost and Utilization Project, AHRQ, November 2006.
