Evaluation of Service Report - Medical Science Assignment Help

Assignment Task

Introduction
The purpose of this report is to reflect on the experiences of working with service users during my practice placement. I will critically evaluate the evidence-based coordinated service while analysing the interprofessional team involved. Furthermore, this report will explore how online media/digital technology could be used to improve patient’s engagement and experience. In addition, the effectiveness and efficiency of number of integrated service delivery model will be evaluated. Based on the evaluation, collaborative improvement will be recommended. This assignment will start with learning outcome 1,2,3 then 4.

Background information and context
Tissue viability service will be evaluated, this evaluation report aims to improve assessment for the patients with pressure ulcers on the general surgical ward. this is a complex health and social care need because some of the patients on this ward has, pressure sore and have diverse tasks involved in the delivery of their care which poses challenge for healthcare professionals involved. This was identified through my clinical placement on this ward. According to the Nursing & Midwifery Council (2018), which states the importance of our role in identifying the needs of patients and meeting their needs.
During my last placement on general surgical ward, I identified that patients needing tissue viability assessment for patients are not being assessed face to face on this ward due Covid-19 but are being assessed using medical imaging taken by medical photographer, this process involves staff nurses filling a paper form and doctors countersigning and faxing it, this process takes time and this current tissue viability assessment service is inefficient because this is having negative impact on the patients due to delay in their assessment and care.
For tissue viability service to change and be more person-centred, tissue viability service should support more patients on the ward by involving the other professionals, educating more health care professionals, increasing the use of telemedicine and the use of tele-triage to prioritise who needs to be seen early. National Institute for Health and Clinical Excellence guideline (2014) suggested training the healthcare professionals who have contact with any patients that have pressure ulcer or are at high risk of developing a pressure ulcer.
Ebi et al, 2019 has highlighted the negative impact of lack of training. Ebi et al, 2019 found that health professionals on the wards have been incorrectly assessing the risk of pressure ulcer formation which has led to incorrect grading of pressure ulcers and not delivering the appropriate interventions to maintain their patients’ skin integrity. Patient ‘s pressure ulcer assessment by Tissue Viability Nurses (TVN) is important because the assessment of pressure ulcer in nursing practice is a mandated and policy driven activity (NICE, 2014). A study undertaken by NHS England estimated that receiving effective care early reduces pressure ulcer healing times from two years to a few months, minimises treatment costs and improves patient outcomes and experience (NHS Right Care, 2017). Also, successful pressure ulcer requires a holistic assessment of the patient which TVN gives. Furthermore, research done by Stausberg et al. (2007), suggests that the ability to classify pressure ulcers accurately is directly related to the level of knowledge and experience of the nurse possess. Furthermore, Stausberg et al. (2007), posit that this knowledge and experience varies significantly depending on who undertakes the assessment, thus TVNs comes to assess patients.
For this service to be successful, other professionals are going to be involved and it is going to be co-ordinated because in the past two decades tissue viability has been integrated into a nurse-led and mainly community-based with aim on the delivery of best care (White, R. 2008). Therefore, this service evaluation is going to be more inter-professionals specific with the involvement of various health professionals ranging from doctors, various types of nurses like diabetic nurses, TVN, ward-based nurses, health-care assistants, dieticians, podiatrists, occupational and physiotherapists (White, R. 2008). According to Green & Johnson (2015) collaborative working will be beneficial for service user because healthcare professionals from diverse sectors will be working together to identify their needs, solve their health issues and provide a planned integrated care for their benefits. Department of Health (DH) (2015) also points out the benefits of Interprofessional working which produces effective care for the service user. This concept was further endorsed with the publication on (NHS Plan,2019, P82) and World Health Organisation explains the benefit of collaborative working in the diagram on Appendix 1 which shows that it improves patient outcome.
Many scholars (Laming,2003; Francis,2013) have highlighted the what the lack of Interprofessional working can cause harm to service users. For example, Laming, (2003) pointed that failure to collaborate and failure of communication between different healthcare professionals contributed to the death of Victoria Climbie, which lead to the initiation of the policy Every Child Matters. Francis, (2013) also pointed out the case about Mid Staffordshire report where patient was not attended to because of poor communication and collaboration among interprofessional team. This highlights how Interprofessional working is essential and massively influences service users’ experience.
According to Wood (2018) Adult Nurses' roles involve direct interaction with patients suffering from different health issues (Newell & Jordan, 2015). Adult nurses will be collaborating with other professionals and patients in this surgical setting to enhance patient-cantered care, and influence patients' behaviour and satisfaction. (Newell & Jordan, 2015). For collaboration with other inter-professional to be successful, adult nurse need to exhibit characteristics, diversity in skills like communication, active listening, decision making and leadership skills, all these enhances the quality of care for the patients (Zapatka et al. 2014). NMC code of conduct, (2010), which states that all nurses must use excellent communication and interpersonal skills.  Thus, Adult nurses requires excellent communication skills since part of nurse’s roles is constant interaction with other health professionals to provide excellent care for patients e.g., working with dieticians, doctors, TVN, physiotherapy on this surgical ward etc. With effective communication, patients are safeguarded and protected against potential harm they may be exposed to by reducing the number of errors that may occur. For example, a TVN might have prescribed the wrong wound dressing that is not effective for the patient wound, the nurse is able to pick up on this and get in contact with the TVN to change this. For the to happen, nurses must have adequate knowledge of wound care, dressings and must know if the patient is allergic to any dressings. Castledine, (2002) suggests that nurses should possess some knowledge of a medical conditions.
Another crucial skill is Active listening with both patient and other staffs, it is essential in patient-nurse exchange since some patients might not understand some medical terminologies and diagnosis of symptoms; thus, adult nurses need to carefully listen to patients to decipher most to actively listen to other team members. Adams et al. (2017) emphases that these qualities calm family members, restore trust, control impatience, and reassure upset patients of safety in the healthcare environment. However, Searl et al. (2014) highlighted how ageist prejudice can hinder active listening which leads to discrimination and misunderstanding, therefore nurses also require confidence to speak during multi-disciplinary team meeting for example, nurses need to be able to disclose an in-depth knowledge she has about her patients with the team (Reid 2012).
Marquis and Huston (2015) also suggest that to be an exceptional nursing leader, nurses need to build relationships and personal credibility with other professionals, have skills such as self-awareness, fairness and transparency which are skills needed in decision making. All these qualities are associated with transformational leadership in health setting. All these skills will be essential for the nurse to complement other inter-professionals on the surgical ward which impacts any patients with pressure ulcer to get person-centred care.
Another skill an adult nurse needs to possess is computer skills because during COVID-19 pandemic, Informatics tool such as technology and social media integration in health care can promote patient safety and practice e.g., using zoom or Teams for MDT meeting, sending online referral instead of filling forms and patient’s take home medications was accessed online (NHS England, 2020)
On reflection, the nurse on the surgical wards still fills a form which must be sent down to the medical photographers/ imaging which takes time to review before they come up to take patient’s wound image, then sent to TVN for review and recommendation is given. The referral could be faster if it was done online, and the nurse could also consider other novel ways of sharing information with other professional groups using information and communication technology, which according to NHS England et al (2014) this gives most health care professionals less time and effort in accessing information about patients, remote monitoring which ultimately help to deliver better health outcomes and patient can get involved in their own care. Even though authors such as (Sheikh & Barber, 2012; Chao et al., 2013 highlighted the barriers to using health systems like Meditech or Lorenzo as lack of integration with other health and care systems, for example, Sheikh & Barber, (2012) stated that most health care professionals cannot access both Meditech and Lorenzo because they are both different systems and Chao et al., (2013) also stated that most health professionals ends up logging in and using multiple systems for instance TVN nurse comes to review a patient, logs into Meditech and the System One to document everything done with a patient, Meditech for inter-professionals in hospitals and System One for GPs and community health professionals. This put a lot of pressure on the professionals using multiple systems when it can be one system. Therefore, using online referral and online MDT, which is integrated, and all inter-professionals can access it will be better for patient care.
The NHS Five Year Forward View Plan published in 2014 [1] sets out how services need to change, and emphasises the requirement for greater integration of care [2]. It is argued that increased service integration will enable the achievement of a financially sustainable health and social care system in the NHS by 2020.

One of the initiatives that were developed recently to target end of life care is the ICP for the dying. ICPs are a workflow system and a documented record of care. Allen (2009) acknowledged that unlike guidelines, pathways specify the activities to be accomplished and require documentation to indicate compliance or non-compliance with the planned trajectory of care. Care pathways according to Jenkins & Jones (2007, p61) contain
- Algorithms defining the planned pathway within a time frame
- Referral, transfer and discharge guidance
- Local and national standards
- Evidence-based guidelines
- Patient information
- Information recording which will make the care pathway a full ICP and will structure all clinical records. For example, medical record, variance tracking, tests, charts, assessments, diagrams, letters, forms, information leaflets, (Appendix 1) satisfaction questionnaires and so on. To individualise the care for a specific patient, scales for measurement and outcomes of clinical effectiveness and space to add activities or comments to a standard ICP are also available.
ICPs for end-of-life care management are used widely around the world and have been considered as the gold standard. They have been developed as a model to improve the end-of-life care of all patients, by guiding the care and aiding decision making, while providing efficient care. They aim to ensure that appropriate management occur at the most appropriate time, and are provided by appropriate health professional, while ensuring a consistent high quality provision. ICPs are patient centred and focus on the holistic needs of the patient whilst transferring evidence based care into practice. It incorporates the physical, psychological, social, spiritual and religious aspect of care (Ellershaw 2007) and sets out goals for adequate communication regarding patient and care giver insight (Becker, Sarhatlic, Olschewski, Xander, Momm, & Hubert, 2007). Additionally, Jenkins & Jones, (2007) argued that it provides evaluation of the impact of team service re-design and improvement.
One example is the Liverpool Care Pathway for the dying patient (LCP), (Appendix 2) which was developed in the 1990s. A project was structured between the Royal Liverpool University Hospitals NHS Trust and the Marie Curie Hospice Liverpool, to develop an ICP based on care of the dying within the hospice setting, with the aim to transfer best practice to the hospital setting. The LCP provides a multi-disciplinary, care evidence based and comprehensive template, for the last days and hours of life. It provides guidance for comfort measures, anticipatory prescribing of medicines and discontinuation of inappropriate interventions.

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