Health Policy Brief Part 1 Essay.

Posted: December 30th, 2022

Health Policy Brief Part 1 Essay.

Preventable adverse events are not uncommon in virtually all interactions between patients and the health care system. To be more precise, the concept of adverse events in health care has existed for as long as health care, typically discussed in iatrogenesis while receiving much attention from health stakeholders. In fact, they are noted for having an impact on care quality and safety of the patient in the USA (Schwendimann et al., 2018). The present health policy brief is intended to inform discussions on health care quality and patients’ safety with regards to preventable (ameliorable) adverse events. It seeks to offer specific options that allow stakeholders to transparently and systematically consider strategies for improving patient safety and improving quality of care. Health Policy Brief Part 1 Essay.

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Identify and describe the specific and relevant healthcare issue

Patients visit medical facilities with the expectation that their health will improve. Unfortunately, that is not always the case with some patients experiencing worsening health rather than improving health. In some cases, the patients are harmed as a result of adverse events. In these cases, adverse events are described as any injury resultant from health interactions that either result in disability at the time of the patient being discharged, or prolongs hospital stay, or both. Another definition is that it is an unintended injuries that are contributes to or results from medical intervention (or absence of medical intervention) that causes the patient to require additional hospitalization, treatment and monitoring, and that could result in death (Huff, Kline & Peterson, 2015). Office of Inspector General, US Department of Health and Human Services (2019) offers a more comprehensive definition of adverse events as any occurrence that causes harm to the patient as a result of health care to include never events (such as surgery on the wrong patient) and temporary harm events (such as hypoglycemia and allergic reaction). Preventable adverse events are occurrences that can be avoided using the currently available strategies and technologies, thus implying that thereare any health care events that falls below the standard expected (Billings & Halstead, 2016).Health Policy Brief Part 1 Essay.

The issue of adverse events in the health care system is of particular concern in the USA, accounting for at least 1.1% of patient fatalities in interactions with health care facilities, a significant population at more than 400,000 mortalities. A more in-depth analysis of the figures reveals that 10% of patients are affected by at least one adverse event in their interactions with the health care system, with 7.3% of the adverse events being fatal. Additional reviews reveal that it is the third leading iatrogenic cause of mortality among patients with the most common types of adverse events being health care associated infections, fluid/drug or medication related infection, and surgical/operative related infections. Other than the shocking numbers, the problem is of significance since it costs as much as $17.1 billion in associated management costs. Perhaps the most alarming aspect of adverse events is that approximately 57% of them are preventable, thus implying that the associated fatalities could have been prevented and resultant costs avoided (Schwendimann et al., 2018).Health Policy Brief Part 1 Essay.

A review of the sources of preventable adverse events reveal that they are caused by a range of factors. A leading cause of adverse events are seen in common medical services where cost-containment measures are noted to compromise the care quality and safety of patients. In this case, care delivery problems that results from conditions at the level of the task, or individual medical personnel and patient. Besides that, the problems could be rooted in the overall environment. This is a causal pathway that requires the implementation of safeguards. Also, poorly performing medical personnel could cause adverse events through their action or lack of action, such as negligence. Yet another cause of adverse events is that the national registries are typically ignored. For instance, the US FDA manages a voluntary reporting system for serious drug and medical device related adverse events. The implication of these different causes indicate that the incidence of adverse events vary, thus pointing to contextual and methodological variations (Tollefson et al., 2019).Health Policy Brief Part 1 Essay.

Identify the potential stakeholders and constituents

Six groups of stakeholders have been identified to ensure that preventable adverse do not occur. They include: patients, medical personnel, educators, administrators and researchers, governments, professional associationsand accrediting agencies. The first group are patients who passively receive medical care and have limited knowledge of health care concepts thereby placing them at the ‘mercy’ of medical personnel who determine their care approaches. Patients are becoming increasingly involved in their care through improving their knowledge levels and questioning the care approaches and credentials of medical personnel.Health Policy Brief Part 1 Essay. The second group is medical personnel who include nurses and physicians. Their profession is based on knowledge, allowing them to provide collaborative medical care based on scientific practice. They are held accountable for the care approaches and outcomes through standards, rules and laws that are intended to enhance health care quality and patients’ safety. They have an obligation to provide competent care that is instrumental in avoiding preventable adverse events through identifying and describing risks as well as promoting safe care (Ballard, 2003). The third group is educators, administrators and researchers who occupy a leadership position and have the responsibility of promoting health care quality and patients’ safety through their teaching content, procedures and policies, and research studies. The fourth group is the government that includes regulators and legislative bodies. They are responsible for establishing medical practice regulations, rules and acts concerning health care that authorizes medical personnel and protects the public from harm while strengthening safe care.Health Policy Brief Part 1 Essay. The fifth group is professional organizations such as Agency of Healthcare Research and Quality, Institute of Safe Medical Practice, National Patient Safety Foundation, National Committee for Quality Assurance, American Nurses Association, and International Council of Nurses. They are responsible for promoting patients’ safety and health care quality through system-wide approaches that identify and address the root causes of adverse events. In addition, they promote public awareness and demonstrate improvements. The final group of stakeholders accrediting agencies (such as the Joint Commission on Accreditation of Healthcare Organizations) that occupy an influential position that can monitor health care delivery and approaches to ensure that the patient safety and health care quality objectives are achieved with regards to the occurrence of preventable adverse events (Ballard, 2003).Health Policy Brief Part 1 Essay.

Pending legislation

There are two pending legislations concerning preventable adverse events. The first legislation is the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2019 (H.R.2581). Sponsored by Representative Janice Schakowsky and introduced into the 116^th Congress on 8^thMay 2019, the bill seeks to amend the Public Health Service Act by establishing the nurse staffing standards that would ensure patient safety and quality of care in medical facilities. In fact, it seeks to determine the minimum nurse-to-patient rations that should be observed for every health care purpose, and how this requirement would be enforced. Currently, the bill is before the Energy and Commerce, and Ways and Means Congress Committees where discussions are ongoing on the issues relevant to the two committees (Library of Congress, 2019). The second legislation is the Registered Nurse Safe Staffing Act (H.R. 1821 and S. 2353), a federal legislation that is applicable to Medicare-participating medical facilities that requires these facilities to establish a committee that would create appropriate staffing plans based on staff experience, patient acuity and other relevant factors. At least 55% of the committee must be comprised of registered nurses (Working Nurse, 2019).Health Policy Brief Part 1 Essay.

Draft plan for the health policy brief

Two policy options are available for addressing the issue of preventable adverse events. The first option is staffing models for medical facilities with a focus on optimizing the number of medical personnel and professions to reduce the opportunities for errors. The staffing model intervention includes changes to the use of agency staff and overtime, shift patterns, staff allocation models, education preparation of medical personnel, skill mix (proportions of experiences, expertise, qualification levels and grades) , and staffing levels. To be more precise, medical personnel should be considered as a resource and allocated to meet the existing needs while being quantified in terms of staff per patient ratio. The second option is to empower patients and other stakeholders to allow them be involved in the development of clinical practice guidelines, patient information material, and health care research and policy. Empowering health stakeholders promotes their rights and reduces adverse events through involving them in health care planning and implementation (Stanhope & Lancaster, 2014).Health Policy Brief Part 1 Essay.

The two policy options will be implementation through a combination of strategies. The first strategy is adequate remuneration, non-material and material incentives targeted at motivating medical personnel to provide high quality care. The second strategy is continuing professional education, feedback and audit to motivate medical personnel in adopting evidence-based practice. The third strategy is public mobilization and sensitization that improves the attitudes, skills, knowledge and motivation of health stakeholders (Stanhope & Lancaster, 2014).

Conclusion

One must accept that preventable adverse events are an issue of concern owing to their common occurrence, especially in the USA where they result in more than 400,000 fatalities that cost approximately $17.1 billion every year. In addition, one must acknowledge that preventable adverse events are caused by a range of factors that include cost-containment measures, overall environment, poorly performing medical personnel, and ignoring national registries.Health Policy Brief Part 1 Essay. The issue is of concern to six groups of stakeholders who include patients, medical personnel, educators, administrators, and researchers, governments, professional associations, and accrediting agencies. Two legislation are currently being discussed that would have an impact on reducing the incidence of preventable adverse events. These legislation are: the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act; and Registered Nurse Safe Staffing Act. Two policy options are available to address the issue of preventable adverse events: staffing models for medical facilities; and empowering health stakeholders. The two policy options can be implemented through three strategies: adequate remuneration and incentives; continuing professional education, feedback and audit; and public mobilization and sensitization.Health Policy Brief Part 1 Essay.

Introduction
Health care practitioners have always made the same promise as they take their professional oaths: do no harm. Despite observing this maxim within the professional domain, medical personnel are still prone to the same errors as other humans unintentionally cause harm on some occasions. This is particularly true for nurses who despite being held to a higher standard as they provide primary health care that could have grave implications for the wellness and health of their patients, they still make mistakes. In this case, the unintentional harm caused by the nurse is defined as an adverse event since it is harm that is caused by the nursing care rather than the underlying health care issue. Three subcategories of adverse events can be identified.Health Policy Brief Part 1 Essay. The first subcategory is adverse events caused by negligence whereby the nursing care falls short of the expected standards. The second subcategory is ameliorable adverse events that are not preventable but the harm can be reduced through deliberate approaches. The third category is preventable adverse events that occur owing to failure or error in applying accepted prevention strategies (Huff, Kline & Peterson, 2015).
Adverse events are a serious concern for the health care industry because more than 140,000 patients die from their occurrence annually. The concern has subtle links with nurse-to-patient ratios whereby it is noted that low nurse populations are associated with higher incidences of adverse events. The implication is that increasing the number of nurses can reduce the occurrence of adverse events. The industry can use all the help that it can get to reduce preventable adverse events from occurring, including policy reforms that establish legislative mandates for nurse staffing standards that optimize nurse-to-patient ratios to ensure patient safety and quality of care in nurse-patient interactions. This cultural shift coupled with reducing pathogen bioburden, facilitating patient communication, and helping track medicine management can work to reduce adverse events in nursing care (Huff, Kline & Peterson, 2015; Office of Inspector General, US Department of Health and Human Services, 2019). This paper will discuss nurse staffing legislation as a patient-safety intervention and the legislative interventionnecessary to support efforts to reduce adverse events in nursing care.Health Policy Brief Part 1 Essay.
Discussion
Adverse events are an acknowledged source of concern in health care since they are resultant from health care process across a range of procedures and conditions. In fact, approximately 10% of all patients report at least one adverse event, with 51% of adverse events being preventable thus justifying intervention efforts (Schwendimann et al., 2018). In addition to the significant impact on patient mortality and morbidity, adverse events increase the cost of health care from longer stays in medical facilities (Rafter et al., 2015). In this case, medical facilities have identified this concern and implemented strategies they deem appropriate to address these issues. For that matter, patient safety improvement interventions have been applied through actions, behavior, procedures, structures, strategies, and practices to mitigate or prevent unintended harm to patients (Tollefson et al., 2019). Black (2016) comprehensively discusses some of the health campaigns implemented as interventions.Health Policy Brief Part 1 Essay. First, it notes that medical facilities apply screening and early identification strategies to identify the factors that place patients at risk. Secondly, conducting comprehensive interdisciplinary assessments when risks are identified, particularly among geriatric patients. Finally, effectively communicating with stakeholders and ensuring that there is collaboration between medical personnel in nursing care provision. This is based on the understanding that all stakeholders have a shared role in preventing the occurrence of adverse events (Black, 2016).Health Policy Brief Part 1 Essay.
In addition to interventions by medical facilities, the legislature recognizes the magnitude of the issue and had proposed safe staffing as a legislative intervention. Introduced as The Safe Staffing for Nurse and Patient Safety Act of 2018 in the US Congress (H.R. 5052) and Senate (S. 2446), the legislation seeks to have Medicare-participating medical facilities to form committees to determine optimal nurse-to-patient ratios for each unit. At least 55% of the committee members must be direct care nurses working at the facility. The legislation seeks to amend title XVIII of the Social Security Act with the intention of protecting patients by establishing safe nurse staffing levels that would benefit the medical facilities, nurses and patients through reducing costly readmissions, nurse turnover and adverse health events. Sponsored by Rep. Dave Joyce (R-OH) and Sen. Jeff Merkley (D-OR), and co-sponsored by Rep. Suzanne Bonamici (D-OR-1), Rep. Tulsi Gabbard (D-HI-2) and Rep. Suzan K. DelBene (D-WA-1), the legislation passed the Senate and House owing to its clinical and economic merits. However, the legislation was not enacted at the end of the 115th Congress, resulting in it being cleared from the legislative agenda (American Nurses Association, 2018; GovTrack, 2019).Health Policy Brief Part 1 Essay.
There are two pending legislations concerning preventable adverse events. The first legislation is the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2019 (H.R.2581). Sponsored by Representative Janice Schakowsky and introduced into the 116th Congress on 8th May 2019, the bill seeks to amend the Public Health Service Act by establishing the nurse staffing standards that would ensure patient safety and quality of care in medical facilities. In fact, it seeks to determine the minimum nurse-to-patient rations that should be observed for every health care purpose, and how this requirement would be enforced. Currently, the bill is before the Energy and Commerce, and Ways and Means Congress Committees where discussions are ongoing on the issues relevant to the two committees (Library of Congress, 2019). The second legislation is the Registered Nurse Safe Staffing Act (H.R. 1821 and S. 2353), a federal legislation that is applicable to Medicare-participating medical facilities that requires these facilities to establish a committee that would create appropriate staffing plans based on staff experience, patient acuity and other relevant factors. At least 55% of the committee must be comprised of registered nurses (Working Nurse, 2019).Health Policy Brief Part 1 Essay.
The proposed plan for addressing adverse events in nursing care is to develop new legislation that would be discussed and enacted. The new legislation would present federal guidelines mandating nurse-to-patient ratios based on the medical facility’s capacity. The legislation is based on the awareness that nurse staffing has an effect on the quality of care and patient safety with appropriate staffing protecting patients from adverse events and lowering the risk of mortality. Unlike The Safe Staffing for Nurse and Patient Safety Act of 2018 that empowers nursing personnel to determine the variable and unique needs of their patients to ensure quality and safe nursing care outcomes, the proposed legislation would set up, empower and fund an independent federal agency to present and regularly update staffing models that present minimum nurse-to-patient ratios for all medical facility units and health care scenarios. The federal agency would focus on optimizing the number of medical personnel and professions (including nurses) to reduce the opportunities for errors. Some of the federal agency’s responsibilities would include changes to the use of nursing agency staff and overtime, shift patterns, staff allocation models, education preparation of medical personnel, skill mix (proportions of experiences, expertise, qualification levels and grades), and staffing levels (American Nurses Association, 2018; Stanhope & Lancaster, 2014).Health Policy Brief Part 1 Essay.
Mandating minimum nurse-to-patient ratios has implications for adverse events. This has been seen in the State of California where safe staffing legislation has results in improved care outcomes and reduction in procedural mistakes so that fewer patient get sick in medical facilities, more patients recover and fewer patients suffer from complications that required them to be re-hospitalized (National Nurses United, 2019). There is a need to acknowledge that this legislation presents some cost concerns. The legislation would impose steep fiscal costs on medical facilities by minimizing their involvement in staffing decisions. To be more precise, the legislation would require medical facilities to spend more on hiring more personnel and increasing benefits and salaries to attract enough personnel. Still, the high initial cost could be considered an investment since it would be associated with cost savings from addressing adverse events (Cherry & Jacob, 2013).
Getting support from legislators for the proposed legislation will require lobbying and advocacy efforts. Lobbying involves asking the legislators to introduce the legislation for discussion in the Congress and Senate, and support it. Advocacy involves informing legislators how the proposed legislation affect the constituents. In this case, five approaches have been identified as appropriate for influencing legislators. The first approach is to hold individual briefings and meetings with strategically positioned legislators. In planning for the meetings and briefings, it is necessary to identify an appropriate time and location, and information that would interest the legislator. The second approach is to use telephone calls and letters that clearly state the legislative objective, reasons for supporting it, and potential concerns. The third approach is public hearings that involve substantive formal deliberations between key stakeholders who include legislators. The fourth approach is public discussions that involve informal public debates. The final approach is public forms that involves the stakeholders who support and oppose the legislation to a neutral location where they can raise discussions on their points (Marquis & Huston, 2017). Any legislative opposition would be addressed by presenting comprehensive information on the merits of the legislation, and how it positively affects their constituents. In addition, any concerns that the legislators have will be identified and substantively addressed through providing the required information or amending the proposed legislation to incorporate the concerns (Marquis & Huston, 2017).Health Policy Brief Part 1 Essay.
Conclusion
One must accept that despite the best efforts and being held to a higher standard, it is not uncommon for nurses to be unintentionally involved in adverse events. In addition, one must acknowledge that adverse events are a source of concern since approximately 10% of all patients report at least one adverse event resulting in more than 140,000 patients dying annually. Legislative efforts to address the issue of adverse events through presenting The Safe Staffing for Nurse and Patient Safety Act of 2018 were derailed when the legislation was not enacted on time. Still, Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act of 2019 and Registered Nurse Safe Staffing Act are currently being discussed as legislative interventions. To support these legislations, the proposal is presented that an independent federal agency be set up with legislative support to determine minimum nurse-to-patient ratios that reduce the opportunities for adverse events. Advocacy and lobbying would then be used to garner support from legislators for the proposed legislation.Health Policy Brief Part 1 Essay.