The emergency ward at times gives out wrong treatment to patients or refers patients to wrong

departments after which patients are referred back to the ward. Mahmoudi et al, (2013)
identifies a range of different tools that may be used to improve service in a hospital. Cause and
effect tool or Ishikawa or ‘fishbone’ was used as a service improvement tool to graphically
displays the relationship between cause and effect and this may help in drafting possible
solutions that help improve the service in the ward (Eisenberg, et al, 2005 and Burley, 2011)
Mahmoudi et al, (2013) stated barriers to effective nurse work which are nature of
environment, performance of nurses, communication barriers and poor management. The
diagram in appendix 1 shows the four categories of causes of error in treatments which are
people, communication, procedures and environment. It was evident that these categories
affect the treatment process emergency patients and their referral after emergency. The fish
bone tool was used because it identifies specific areas to focus on for improvement and.
Emergency personnel are required to communicate effectively between patients and other
departments. Increases in number of patients flowing into the ward increase pressure and
workload and reduce time with patients thus affecting noting off patient history, and
communication leading to treatment errors. Redfern et al (2009) noted errors are due to
miscommunication in the ward. Communication factors mainly responsible or errors in
treatment and referral are unreadable handwriting and not paying attention to team members
perceptive. There was also often communication breaks between nurses and emergency
technicians. A possible solution to remove communication error would be to train personnel to
manage pressure, communicate effectively with patients and other departments and closing
curtains to reduce interruptions. (Burley, 2011, Redfern et al, 2009 and Eisenberg, et al, 2005)
Poor management of the ward meant that staff was not aware of responsibilities and duties.
This meant at many times staffs are running around without actual progress and many conflicts
were witnessed and because of the nature of the ward, there was little or no feedback given.
The management was ineffective and this led to disengaged teams. The emergency ward
experiences and heavy flow of patients at the same time and this requires motivated teams
that are engaged and motivated to deal with such workload. Lack of motivation made the staff
have indifferent attitude towards their responsibilities and made other staff tired. Those that
carried out their duties were made to do more than they could accomplish and nurse fatigue
was a common scene especially during periods of many patients coming in. This led to error in
treatment and referrals as there was no proper management of the staff in the ward. There is
thus need to emphasis on management’ awareness of the essentiality of staff members.
(Backhouse and Ogunlayi, 2020, Phillips and Simmonds, 2013 and Coccia, 2017)
Staffs were not aware of the Standard Operating Procedures that were designed to help them.
Those that were aware did not frequently refresh their memories by reading them frequently.
This resulted in errors in referrals as the many mistakes were noted. Adverse scenarios are
witnessed when the staff is either indifferent towards the procedures, not aware of them or not
trained to use them. (Craig and Machin, 2020 and WHO, 2020)
The environment of the emergency ward was at times not conducive for the strenuous
workload in the ward. The ambulance park area was a bit far from the doors of the emergency
unit. The ward was always overcrowded and noisy as patients and their companions would
always want to be attended to first. Such an environment was very stressful for staff to be able
to do their work well and follow procedures thus many errors would occur. The crowdedness
disengaged the teams and disrupted communication among teams and with patients. The ward
was structured in way that cubicles were open. This led to patients not getting the privacy they
deserved and would at times withdraw information when taking patient history only to whisper
to the nurse midway treatment. This always resulted in treatment errors. (Bleetman, et al, 2012
and Harveen, et al, 2020)
Service improvement; engagement off everyone in making changes to better patient health,
system performance and professional development; is important in the emergency ward
(Batalden and Davidoff, 2007). The emergency ward was one of the busiest and high risk
wards. Patient care requires consistent analysis of nurse work and changing of practice.
WHO(2020) provided certain tools that help improve emergency ward ranging from training
courses, management courses and standardized procedures.
REFERENCES

Backhouse, A., And Ogunlayi, F. (2020). Quality Improvement Into Practice. British
Medical Journal; 368.
Batalden, P. B., And Davidoff, F., (2007). What Is ‘Quality Improvement’ And How
Can It Transform Healthcare?. Quality Safety And Health Care, 16(1),2-3.
Bleetman, A., Sanusi, S., Dale, T. (2012). Human Factors And Error Prevention In
Emergency Medicine. Emergency Medicine Journal, 29, 389-393.
Burley, D. (2011) Better Communication In The Emergency Department.
Emergency Nurse, 19(2):32-6
Coccia, M., (2017).The Fishbone Diagram To Identify, Systematize And Analyze
The Sources Of General Purpose Technologies, 4. DO10.410.1453/Jsas.V4i4.1518
Craig, L. And Machin, A. (2020). Developing And Sustaining Nurses' Service
Improvement Capability: A Phenomenological Study. British Journal Of Nursing,
29(11).
Eisenberg, E., Murphy, A., Sutcliffe, K., Wears, R., Schenkel, S., Perry, S.,
Vanderhoef, M., (2005). Communication In Emergency Medicine: Implications For
Patient Safety. Communication Monographs, 72.
Harveen, B. B., Taylor, W. B., Osama, A. Muhammad, A., Yasein, O., And Lee, A.
W.,(2020). Considerations For Service Delivery For Emergency Care In Low
Resource Settings. African Journal Of Emergency Medicine, 10(1), 7-11.
Mahmoudi, H., Mohammadi, E. And Ebadi, A. (2013). Barriers To Nursing Care In
Emergency Wards. Journal Of Nursing And Midwifery Research, 18(2). 145-151.
Phillips, J., And Simmonds, L. (2013). Using Fishbone Analysis To Investigate
Problems. Nursing Times. 109(15),18-20.

Redfern, E., Brown, R., And Vincent, C. A., (2009).Improving Communication In

The Emergency Department. Emergency Medicine Journal.26(9),658-61.

WHO (2020). WHO Tools for strengthening emergency care systems. Retrieved
from, https://www.who.int/emergencycare, on 16/04/23.
APPENDIX 1