RESUMO
During disasters, health care providers are faced with limited resources, harsh environments, and an increased amount of sick and injured patients. These conditions sometimes require health care providers to deviate from existing treatment protocols. Deviating from these protocols results in a perception of increased legal risk for health care providers. This has led to a national debate regarding the necessity of establishing altered standards of care for health care providers during crisis events. This chapter explores the development of disaster preparedness, the issue of health care provider liability, and national and local efforts to protect providers in disaster situations.
RESUMO
According to the Joint Commission, dysphagia, which occurs in anywhere from 27% to 50% of stroke patients and often leads to aspiration, is a significant quality/safety indicator. As such, it is identified as a standard of performance when awarding disease-specific certification in stroke care. Application for this certification required one institution to assign a multidisciplinary process improvement team to develop and implement a dysphagia screening protocol to replace their current practice, which was being used on an inconsistent basis. This article outlines the steps necessary to identify and tailor a tool for dysphagia screening, develop a protocol to ensure appropriate use of said tool, and use a multiphase implementation process to identify strengths and weaknesses as well as create caregiver support for the practice change.
