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Learning Series: Recognising & Responding to Clinical Deterioration NWAHS Education & Research Team. Introduction Failure to recognise or respond appropriately to patients who deteriorate may result in increased morbidity and/or mortality

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Program content cont

Learning Series:

Recognising & Responding to Clinical Deterioration

NWAHS Education & Research Team

  • Introduction

  • Failure to recognise or respond appropriately to patients who deteriorate may result in increased morbidity and/or mortality

  • Most of the patients who suffer significant adverse events in hospitals and other healthcare facilities (such as cardiac arrest, unplanned admission to ICU and unexpected death) have objective evidence of clinical deterioration within the hours preceding the event (Buist et al. 2004, Hillman et al. 2001).

  • Recognition and response systems rely on the ability of bedside clinicians to appropriately monitor, and assess patients using critical-thinking, problem-solving and decision-making skills

  • A key recommendation of the Australian Commission of Safety and Quality in Health Care is that educational programs should include knowledge of clinical observations, identification of clinical deterioration, communication and clinical skills management (ACSQHC 2010).

  • Aims

  • A pilot educational program will be rolled out across from Oct.2011 – Oct 2012 across NWAHS to

  • Reduce the incidence of unrecognised clinical deterioration

  • Provide nurses with an educational program that supports the development of critical-thinking, problem-solving and decision-making skills

  • Provide nurses with the knowledge and skills to develop confidence and competence in managing an acutely unwell/deteriorating patient

  • Provide an educational program which meets the needs of adult learners

  • Objectives

  • At the completion of this educational program, the nurse will be able to:

  • Apply an analytical and reflective approach to patient assessment

  • Integrate theoretical knowledge to ‘real-life’ clinical problems

  • Communicate and document clinical concerns utilising a structured, systematic process

  • Recognise the key markers of critical illness in patients in a variety of clinical settings

  • Respond to common acute clinical emergencies utilising a priority management approach

  • Program Overview

  • The program will provide an overview of unrecognised clinical deterioration from a national safety and quality perspective, as well as targeting the key competencies nurses need to recognise and respond appropriately to patients evidencing early markers of critical illness.

  • It is intended where possible, that all program content will be based on the latest evidence or consensus of experts regarding best-practice.

  • The learning series consists of 3 modules which are designed to provide a comprehensive overview of the common acute clinical issues facing frontline nursing staff. It is intended to assist with the identification of patients who have (or are at risk) of clinical deterioration, and to provide a framework for clinical assessment and documentation of these events.

  • The sessions are designed to utilise case-based learning, and are intended to be interactive where possible

  • Nurses at all levels and from all clinical areas are eligible to participate in the Program.

  • Program Content

  • Module 1: ‘Failure to Rescue

  • Failure to Rescue—scope of the problem

  • National Consensus Statement; essential elements for recognizing and responding to clinical deterioration (ACSQHC)

  • Module 2: Detecting clinical deterioration

  • Using fluid balance charts to detect clinical deterioration

  • Using ‘Early Warning Systems’ to detect ‘sick’ patients

  • ‘Mandatory’ vs ‘Worried’ MET call criteria

  • Markers of clinical deterioration - looking beyond the obvious

  • Identification of patients at high risk of clinical deterioration

  • Systematic approach to clinical assessment and management —the ABCDE approach

  • The role of the ICU Liaison nurse

  • Post-anaesthetic patients who deteriorate—common causes and management priorities

  • Surgical patients who deteriorate—common causes and management priorities

  • Clinical deterioration in the paediatric patient

  • Clinical deterioration in the obstetric pateint

  • The ‘DANGERS’ program—preventing the crash in rural healthcare facilities

  • Program Content (cont...)

  • Module 3: Responding to clinical deterioration – managing common acute conditions

  • Communicating clinical concerns—using ISBAR communication tool

  • Managing the patient with low urine output

  • Managing the patient with hypoxia or other evidence of respiratory failure

  • Managing the hypotensive patient

  • Managing the patient with an acutely altered LOC

  • Managing the patient with prolonged or refractory seizures

  • Managing the patient with acute decompensating arrhythmias

  • Managing the patient on the ward having an AMI

References

Australian Commission on Safety and Quality in Healthcare 2010 National Consensus Statement: essential elements for recognising and responding to clinical deterioration, Commonwealth of Australia

Buist, M, Nguyen, B, Moor, G & Anderson, J 2004 ‘Association between clinical abnormal observations and subsequent in-hospital mortality: a prospective study’ Resuscitation, vol.62, pp.137-141


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