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Patient Safety CultureAnalysisAHRQ (2016) defines safety culture as the organization’s values, attitude, perceptions, competencies and patterns of behaviors that determines its commitment to proficient health and safety management. AHRQ with QuIC implemented the Hospital Survey on Patient Safety and Culture which was designed for employees to input their opinions on patient safety within their organizations. This hospital survey plays many roles that benefit staff knowledge and training along with assessing, identifying, examining, evaluation and conducting trends/comparisons so new initiatives and interventions can be put in place. Every role within a hospital from housekeeping to physician plays a role within patient safety therefore, this guide is essential withidentifying quality of care. The survey identifies 12 steps that can be used to gather data on near misses, incident reporting, effective communication, and teamwork to name a few. At Union
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Hospital Emergency Department, they lacked awareness, poor handoff and transition, effective communication, and overall perceptions of patient safety. Personnel failed with many task that ranged from performing a sentinel event, obtaining informed consent and reassessing its patient throughout care. OutcomeOrganizations with strong patient safety culture would be considered high quality health care organizations and due to the event at Union Hospital Emergency Department care was below standard. IHI (n.d) has 2 great strategies that should be in place in order for the facility to improve its patient safety and that is doing walk-rounds and involve patients in safety initiatives. The Walk-rounds help open a line of communication between upper management and staff to discuss cases where incidents have occurred and how to manage them. The walk-round system would have identified the patient’s mishap by having supervisors or physicians available to conduct valuable rounds. With involving patients in safety initiatives this gives a chance to the patient and families to be involved with monitoring for compliance with safe practices therefore, by creating an additional defense layer against an adverse event (IHI, n.d).RecommendationSBAR was implemented to improve collaboration and communication regarding patient safety (AHRQ, n.d) which breaks down to Situation, Background, Assessment and Recommendation which works for healthcare professionals with critical-skill conversations. SBAR assists with identifying vital information and provides awareness with staff when doing patient hand offs so that communication does not fall through. Another similar tool is STEP which breaks down to Status of the Patient, Team Members, Environment and Progress Toward Goal. STEP is used to monitor a situation when delivering healthcare.
CommunicationStrategyYearly if not twice a year the hospital survey designed by AHRQ should be performed in each department. Once data has been gathered and examined it can be reviewed with all clinical
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Hospital accreditation, Patient safety, Patient Safety and Quality Improvement Act
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