Initial Post
The issue I want to discuss is something that happened very recently in my current practice area. I am a registered nurse in a children’s emergency department. We were performing a routine ketamine sedation which we use frequently for fracture reductions, burn debridement, abscess drainage, etc. To give a brief background on the event, the ketamine that had been administered intravenously was starting to wear off when the patient suddenly dropped their oxygen saturations to around 44-45%. Immediate airway interventions were performed with no success, the patient entered respiratory arrest and then progressed into cardiac arrest. As nurses, we undergo a significant amount of training (ACLS, PALS, etc.). However, of the three nurses who were on this team, none of them were critical care trained and had no experience with arrest situations. There was a significant breakdown in communication, the scene was hectic, help was slow to arrive, and equipment to perform necessary life-saving measures were not stocked in the area. The patient was not stable so moving to a critical care room was not an option. The issue in this situation was at the microsystem level. “Clinical Microsystem: A healthcare clinical microsystem can be defined as a small group of professionals who work together on a regular basis, or as needed, to provide care to discrete populations of patients.” (Likosky, 2014, p. 33). A debrief occurred after the patient had been resuscitated, stabilized, and moved to the PICU. The debrief was essential to identify what the problems were, what went well, and what can happen in the future. The ED education team was also a part of the debrief. I personally would address the issue by implementing further education for the registered nurse roll, maintaining resuscitative equipment at multiple areas throughout the department. Some equipment which would have been helpful to have in a closer location were discussed in the debrief and some ideas were to have an intubation cart, pharmacy cart, and a “critical care” cart readily available in the area in which sedations will be taking place. In our readings we learned about organizational systems in health care at the micro, meso, and macro level. Each of these levels fundamentally build and rely upon one another to function at the highest level and produce the best outcomes. According to (Bergerum et al., 2019) “Microsystem interactions produce quality, safety and cost outcomes at the frontlines of health care. Macrosystem outcomes depend on the outcomes in the microsystems it harbors. Therefore, to improve and sustain quality in a health-care system, key leverage points exist at the clinical microsystem level.” Affecting change at the micro-system level will directly impact the meso and macro-system levels. Pertaining to our example, changes within the emergency department on protocols impacts the PICU, anesthesia team, nursing supervisor, pharmacy team, respiratory therapy team, and outcomes of the hospital. Interprofessional communication is also an essential aspect of this issue and how it can be resolved. Research has found that “Poor interprofessional collaboration (IPC) can adversely affect the delivery of health services and patient care. Interventions that address IPC problems have the potential to improve professional practice and healthcare outcomes.” (Reeves et al., 2017). Communication and collaboration between physicians, nurses, medics, respiratory therapy, pharmacy, patient care assistants, etc. all played a key role in this event. Improved
