Patient Safety: Who Guards the Patient?
in response to topic Patient Safety: Who Guards the Patient? (September 30, 2003)
I write in response to the topic of Patient Safety. I have worked in long term as a Charge Nurse, the Director of Nurses, and the Staff Development Director, the latter being my present title.
My concern is the public's unrealistic view of what can be accomplished in a Long Term Care (LTC) facility considering the limited reimbursement for LTC, even in the best of facilities. Often the daily rate of reimbursement would not cover the daily rate of a moderately priced hotel, much less staff to care for our patients. The Alzheimer unit at my current facility, a 50-bed unit, is normally staffed with two charge nurses, one nurse manager, and eight certified nursing assistants (CNAs). We responded to the push to decrease the restraint use by innovative care plans, interdisciplinary staff meetings, bed alarms, personal alarms, chair alarms, and movement detectors. We have informative sessions with the families to decide if the potential of falling is a greater danger than the negative effects of immobility and restraint. Unfortunately, residents still fall. The only other way we could prevent most falls would be to have a CNA for nearly every resident; yet who would pay for this?
I believe legislators and other standard setters need to take off their rose colored glasses and realize that what they are asking for in terms of patient safety is just not possible given the current reimbursement in LTC. As the old saying says, these standard setters need to walk a mile in our shoes to see just how monumental this task of keeping the residents safe really is. Our facility does a great job at safety, but staff is far too limited. My solution is: let's look at the root cause of the problem of patient falls, namely, too few staff and too little reimbursement.