Absconding is a Major Patient Safety Issue
For a long time, the organization has tried to ensure the safety of mentally ill patients in the forensic unit. Still, it faces various challenges to ensure that the psychiatric patient is adequately safe. According to the hospital administrator, the mentally ill patient and the forensic unit face significant patient safety issues that need evidence-based and best practices to help resolve the matter. Previous strategies to help solve the various problems have proved to be inadequate and ineffective with more waste of organizational resources. This negatively impacts patient and organizational outcomes. The consistent patient safety issue has consumed most of the organizational resources. The administrator identifies absconding as the significant patient safety issue experienced in the Forensic unit.
According to the administrator that mentally ill patients face various safety issues when getting healthcare services. The organization’s staff and other stakeholders have significantly less awareness of mental illness safety in the unit. The mentally ill patient safety issue that is mainly faced in the unit is absconding. Absconding among sick mentally patients poses significant health risks to the nurses, family, and the patient. This is a significant safety issue that was also identified by the administrator. Absconding is a significant patient health issue because of the increased risk of the patient harm to self and others, mainly when they depart from the care environment, as in Voss & Bartlett (2019).
Absconding is generally referred to as the mentally ill patent that cannot be located or obtained within the unit of treatment, and the whereabouts are unknown. This means that the patient misses the treatments. The patient’s intent, legal, and clinical status must be taken into account to effectively classify a patient as an absconded. The intent involves the patient showing the healthcare team that he or she wants to leave ad is not interested in care (Browne & Braden, 2020). Legal status refers to whether it came to the unit as a voluntary admission or involuntary admission. Voluntary admission means that the patient decided under his or her volition to be there in the unit. Involuntary refers to the forceful admission of the patient into the unit. The clinical status refers to the risk that the person can do to self and the risk the patient poses to others. The following factors are always being taken into consideration when terming a patient to have absconded from the forensic unit (Slemon, Jenkins & Bungay, 2017).
How the Organization Addresses Patient Safety Issues
The organization to effectively address various patient issues there has been the identification of factors that can contribute to the safety concerns. For example, the factors that promote absconding among the mentally ill patients are boredom, lack of privacy, fearing other patients, patients feeling as if they are confined, lack of proper recreational and leisure activities, and the isolation, as in Browne & Braden (2020).
The organization has helped to put in place policies and regulations that ensure that patient safety is maintained. There are rules and guidelines towards social media use, ensuring the privacy and confidentiality of the patients, and training the staff on how to improve and address patient safety. The rules that guide on social media use are meant to avoid the breaching of the privacy rules that have been to unnecessary expose patient information that can expose him to unnecessary risks. Consistent training and creation of awareness are always done in a periodical manner to sensitize the nurses and other healthcare providers on the various concepts that relate to absconding and other safety issues.
The culture and organizational objectives contribute directly to the maintenance of safety issues. An organization with poor attitudes and inadequate resources to handle the issue will foresee an exacerbation and significant decline in patient safety. For example, an organization must collect comprehensive demographic details that can help locate or assess the whereabouts of an absconded patient. Identification, assessing, implementing, and evaluating quality improvement projects and initiatives. The need for quality and efforts for safety improvements is essential in the healthcare setting (Dewa et al., 2018). The organization can be involved in benchmarking practices to help identify how the best organization deal with specific patient health issues. Measures should also be put in place to ensure that the quality improvement projects bring a change towards the desired direction, need additional resources, or lead to the production of unwanted results. Measuring quality improvement projects ensures that good quality practice is reflected in the excellent performance, and comparing performance among different organizations will lead to better performance (Bishop & Macdonald, 2017).
Legal and Ethical Consequences of Not Addressing the Issue
Failure to address the issue of absconding among mentally ill patients can have critical legal and ethical consequences. It the duty of an organization to ensure the safety of all its patients and a time when it cannot account for even one for the patients, then its heled responsible for the harm or consequences the absconding has on the patient or the public. When a person with mental illness absconds from a closed area or unit, there is a burden of legal implications that are put on the hospital staff. The person that absconded may not be able to effectively take care of him or herself, property, and others. It has been noted that about 10% of those that abscond commit suicide (Voss & Bartlett, 2019). Most of the patients with high absconding behaviors have schizophrenia, and those with drug-induced psychosis with less insight into the severity of the mental illness. Mentally ill patients that have been given involuntary admission in the forensic unit do not have caregivers; hence the responsibility is ion the hospital staff. Legal investigations are always done to see at what scenarios and situation did the patient abscond, the management of the hospital can be taken to court for not taking necessary precautions to prevent the absconding patients, or for having laxity in addressing the issue, as in Bishop & Macdonald (2017).
Ethically a patient has the right to be autonomous and refuse medications or any treatment provided. At the same time, nurses must uphold the ethical principles of beneficence and non-maleficence. The act of a patient eloping from the hospital, and they are under the care of the hospital means that the staff exposes the patient to harm and they are not benefitting the patient by exposing them to various risks (Browne & Braden, 2020). In any healthcare setting, failure to protect the patient from himself and others can lead to ethical violations, which translates to legal tussles, which negatively affects the organization’s reputations and revenue supposes compensation is needed by the family and the patient (Dewa et al., 2018). Any implication that contributes to loss of organizational finance should be reduced and acted upon immediately. This is why the organization at all times should come up with evidenced-based strategies to handle the issue of absconding among mentally ill patients. The legal and ethical implications stated harm the revenues, adherence to the various regulations which cumulatively affect the delivery of services (Slemon et al., 2017).
Evidence-based Interventions to Address the Patient Safety Issue
Browne & Braden (2020) states that for an organization to manage the issue of absconding in mentally ill patients effectively, the following strategies can be employed to protect the patient and the organization. There should be consistent counting and reporting of the patient numbers in various phases in a day. Improving the mental health team and incident response at any time that a report has been identified as a vital strategy to help locate and protect the patient. Engaging the police, community services, family, and friends together in with the mental team is essential for searching for the missing patient.
According to Dewa et al. (2018), the hospital should also ensure strategies to develop and maintain strong therapeutic relationships with the patients. These strong relationships create a trusting relationship where the patient feels loved and values the relationship; hence rarely can they abscond. This is a process that should start at the time of the admission, where the rapport and the sustaining relationship are initiated. The strategy should be utilized by all persons in the unit, not only a specific person.
Another practice is protecting the mentally ill from other patients. It has been reported that various patient discriminates and instigate violence towards others. This makes others live in fear and escape from the hospital to avoid bullying and harassment from other patients. The organization should ensure that aggressive patients are separated from calm and not over packed in a unit or a cube (Slemon et al., 2017).
The adoption of a patient-centered care approach is also essential in preventing and dealing with absconding. Coordination of care with a team, including the family members and significant others, ensures that it doesn’t feel isolated. In the approach, power and control are shared equally with the patient. The clinicians or nurses don’t exert their influence and control on the patient, especially for involuntary admissions of traumatic history, as in Bishop & Macdonald (2017).
Minimizing restrictions or restrictive procedures can also be an effective preventing strategy. The restrictive procedure can be used to prevent absconding at the same time can be the same reason for absconding. Restrictive procedures always lead agitation, feeling of worthlessness, isolation, dehumanization, which are some of the causative factors of absconding, as in Slemon et al. (2017).
In a nutshell, the organization should increase the supervision of patients, especially during transitions in care, at night, weekends, and holidays when there is laxity. Educate the staff on a patient-centered approach, identifying patients with a high risk of absconding and conducting debriefings and more than enough social contacts for those who have a high risk of absconding (Voss & Bartlett, 2019).
How Technology Can Be Used to Improve the Issue
Technologies that can be used to monitor and record the times of signing in and out for the patients can be useful in tracking the movements of the patients in and out of the unit. At the same time, there have been ethical issues with the usage of technology to monitor patients, as it doesn’t respect their confidentiality and privacy. Alternatively, the organization can use technologies that improve a patient-centered approach, which is a strategy used to avoid absconding (Browne & Braden, 2020). The use of technology to promote patient safety has been a topic of discussion lately. Technologies can help in facilitating communication among the health care team hence minimizing delayed care, medication errors. Ineffective communication has led to various mistakes in care that exposes a patient to unsafe interventions (Slemon et al., 2017). Hussain et al. (2018) state that Electronic prescriptions can also be used as a technology to minimize prescription errors. The use of electronic health records also ensures the safe storage of patient protected health information hence ensures privacy, confidentiality, and security. Technologies also improve patient-centered care. Technologies foster communication in various ways between the client and the various providers in different online portals, messages, emails, and this enhances satisfaction and experiences (Cameron & Green, 2019).
Organizational Barriers to Change
The main barriers to change is the budget restrictions. The organization doesn’t have enough finance to implement the various strategies that can be used to ensure patient safety. New technology cannot be employed, which will increase the need for expanded staffing and roles while there are restrictions financially. Lack of the necessary technology also acts as a barrier to change. There are change initiatives that can be facilitated by technology; lack of this leads to unsatisfactory progress and a barrier. Ineffective communication and involvement of the organization staff in change and change management is a challenging hat that has also contributed to a poor attitude towards change among the hospital staff (Cameron & Green, 2019).
To overcome these barriers, there is a need for sensitization of the staff on the importance of change and its effect on patient outcomes and revenues. Creation and awareness on the issue may help to develop and improve the attitudes of the staff. There is a need to engage the various stakeholders in the organization to address them on extra financial assistance so that the changes concerning patient safety can be implemented (Hussain et al., 2018)
Practical training and development of the management and other staff should be done to make them develop insight on how to correctly implement and manage change through the application of best practices so that all the initiatives brought on board are successful (Cameron & Green, 2019).
Hussain et al. (2018) posit that the identification of organizational barriers to change is essential in ensuring the success of future change initiatives. The can be the implementation of change models e.g., Kurt Lewin Change theory, that promotes the identification of restraining factors and driving factors to implement the change effectively. Restraining factors in an organization divert the staff away from the desired change direction. Driving factors move the organization towards the change direction. At all times, there should be the minimization of the restraining factors and increasing the driving factors.
Conclusion
The primary patient safety issue addressed is absconding, especially among metallic ill patients in a Forensic unit. Absconding means that the patient cannot be located in the organizations, and his whereabouts are unknown. At sometimes, it’s termed as a missing patient.
The leading causes of absconding that have been identified in the organization are boredom, fear of other patients, and restrictions. The organization can employ supervision, a patient-centered approach, identification of high-risk patients, and separation of patients to help manage the issue. If the issue is not addressed, legal and ethical implications will affect the revenue and finance of the whole organization. Various technologies can be used to monitor the movement of patients and increase patient-centered approach. Organizational barriers like ineffective communication, budget barriers, among others, have been identified with how they can be managed e.g., engaging stakeholders to allocate more funds.
References
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