Patient safety has become a significant concern in patient care ever since the Institute of Medicine published the report, The Err Is Human, in 1999. Patients who are elderly tend to be vulnerable to medical errors which must be addressed. Improvement in quality health care delivery and patient safety in elderly patients has been witnessed in recent years, thanks to the six aims for improvement elucidated by the Institute of Medicine (IOM) in 2001. In their report, crossing the Quality Chasm, IOM highlighted the existing gap between the current and ideal state of the healthcare industry concerning the quality of patient care (Aragon et al., 2016). Six aims were defined to aid in the provision of care to patients, and they include, patient care should be, safe, effective, efficient, timely, patient-centered, and equitable. Recommendations that entails implementation of systemic approaches that aids in, detecting and reporting geriatrics syndromes, identifying system failures when geriatric symptoms occur, establishing dedicated geriatrics units, improving the continuity of care, reducing adverse drug effects, and improving geriatric training programs are critical (Connors et al., 2015). This essay examines how these six aims have been implemented in and examples of how each is being achieved in improving the safety of geriatric care.
Safe. This aim stipulated that the care provided to patients in healthcare facilities be as safe as in their homes. The measurement for this was the overall rates of mortality or the percentage of patients under self-care. Practices aimed at ensuring the safety of patients has been defined as those that lower the risk of adverse effects from medical exposure over a range of conditions or diagnoses. Safety as an aim of IOM is being achieved in the following ways. Prophylaxis has been properly in patients at risk of venous thromboembolism to thwart it. Perioperative beta blockers have been used to prevent perioperative morbidity and mortality in appropriate patients. Complications have been prevented through appropriate provision of nutrition with emphasis placed on enteral nutrition in patients who are either critically ill or are undergoing surgery. Detection and reporting of medical errors have been a vital safety practice in geriatrics as it helps in instigating immediate treatment plan (Sherwood & Barnsteiner, 2017). This practice assists geriatricians in investigating the underlying systemic failures that result in new-onset geriatric syndromes.
Effective. This aim provided for the use of standard and application of science and evidence behind health care in the delivery care. Services are to be provided by scientific knowledge to those who can benefit while those unlikely to benefit are not provided with the services. The measurement for this aim is by determining how well practitioners follow evidence-based practices. It is necessary to pinpoint the fundamental failures in a system that cause geriatric syndromes upon detection and report of the symptoms by geriatricians. An example of this approach for geriatricians involves identifying new onset geriatric syndromes and outlining, retrospectively, the sequential chain of clinical events that lead resulting in their happening. The onset geriatric factors here may include delirium, pressure ulcers and underfeeding. The sequential chain of events may entail human factors such what made physicians fail in recognizing the occurrence of geriatrics syndromes and why the orders laid down by physicians were not carried out in time by non-physician staff to ward of geriatrics symptoms.
Efficient. This aim provides for cost-effective care and services and waste removal from the system. Such wastes may include waste of equipment, supplies, ideas, and energy. To measure this aim, costs of care by patients, provider, organization, and community should be analyzed. Outcomes of elderly patients, according to studies are better in environments that have been designed to their unique needs (Parkinson & Zeller, 2017). Reduction in functional decline and geriatric symptoms has been witnessed in these environments.
Timely. This aim outlined that patients should be accorded timely care or service without waits or delays. This is to be measured by delays or waits in care or service. According to many studies, improving continuity of care among health care providers helps in improving patient care. Improvement in the transfer of information between inpatient and outpatient pharmacies is an important safety practice that helps in reducing adverse effects.
Patient-centered. Under this aim, the system of care should center on the patient, respecting patient preferences and putting the patient in control. This can be measured by the extent of satisfaction of the patient and family. Implementation of computerized physician order entry (CPOE) and computerized alert monitors has helped in reducing adverse drug events in elderly patients.
Equitable. This aim provided for the eradication of disparities in care and equal treatment of all patients irrespective of race, income, or gender. The measurement for this entails disparities in quality measurements based on race, gender, income or any other factors that are population-based or socioeconomic. No matter how clinically skilled a physician may be, if the system is not structured properly, they will not be able to provide optimal geriatrics care. Integrating new recommendations and the existing geriatric skills has the impact of enhancing the implementation of safety practices and averting geriatric syndromes.
In conclusion, the IOM's six aims have been implemented in geriatrics care in the following ways: Detecting and reporting geriatrics syndromes, identifying system failures when geriatric symptoms occur, establishing dedicated geriatrics units, continuity of care improvement, reducing adverse drug effects, and improving geriatric training programs. All these have helped in achieving patient safety.
Aragon, L., & Dand, A. (2016). The relationship between the six aims of quality in trauma care.
Connors, J. M., Cravero, J. P., Kost, S., LaViolette, D., Lowrie, L., & Scherrer, P. D. (2015). Pediatric Sedation: Outcomes of a Multidisciplinary Consensus Conference.
Hoffman, K. (2015). Evaluation of Patient Satisfaction in Men Receiving External Beam Radiation Therapy for a Diagnosis of Prostate Cancer.
Jolley, R. J., Lorenzetti, D. L., Manalili, K., Lu, M., Quan, H., & Santana, M. J. (2017). Protocol for a scoping review study to identify and classify patient-centred quality indicators. BMJ open, 7(1), e013632.
Lee, Y., Shin, S. Y., Kim, J. Y., Kim, J. H., Seo, D. W., Joo, S., ... & Bates, D. W. (2015). Evaluation of mobile health applications developed by a tertiary hospital as a tool for quality improvement breakthrough. Healthcare informatics research, 21(4), 299-306.
Parkinson, J. W., & Zeller, G. G. (2017). Clinical Performance Measures and Quality Improvement System Considerations for Dental Education. Journal of Dental Education, 81(3), 347-356.
Sherwood, G., & Barnsteiner, J. (Eds.). (2017). Quality and safety in nursing: A competency approach to improving outcomes. John Wiley & Sons.
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