Observations and the Deteriorating Patient for Registered Nurses. Shane Moody, Lead for Critical Care Services Vikki Crickmore, Sister. Critical Care Outreach Service September 2013. Competency framework. Objectives. Gain awareness of the national approach and MEWS.
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Shane Moody, Lead for Critical Care Services Vikki Crickmore, Sister.
Critical Care Outreach Service
CCOS to assess Band 7’s
CCOS to do Train the Trainer sessions for senior nurses
Band 7’ and senior nurses to assess own staff
Station 1 ←→ Station 2
Practical taking obs Case studies &
and documenting completing competency
in pairs document
Conclude and finish
2005 – NCEPOD: An Acute problem
2007 – NPSA: Safer care for the acutely ill patent
2007 – NPSA: Recognising & responding appropriately to early signs of deterioration
Consistent themes are obvious throughout these documents:
The key priorities of this document are:
Used to aid recognition of deteriorating patients, and are based on physiological parameters.
An aggregated score calculated. Escalation pathway activated if specific scores. Track and Trigger approach.
The escalation pathway outlines actions required for timely review ensuring appropriate interventions.
Blood pumped from
Heart is rich in O2
Blood pumped back
to heart is low in O2
If oxygen delivery to the body falls below what is demanded, the tissues extract more oxygen from the haemoglobin and the saturation of blood falls.
Drugs / medications
Injury / Insult
Competency frameworkEffects on Heart Rate
Systolic = pumping pressure
Diastolic = resting pressure
The pressure in the arteries is carefully regulated by the body. If it drops, immediate circulatory changes occur:
► Heart rate increases
► Constriction of vessels (so BP may remain adequate) - ↓ CRT, ↓ Urine output.
Measure observations and Document↓Recognise Deterioration↓Communicate Appropriately↓Respond efficiently & reassess
succinctly and briefly
Anxious about escalating?
Frequency / exposure to deterioration?
Knowledge and Skills?
Difference of opinion?
“To become worse” (English dictionary, 2013)
Updates on amendments to revised policy