Transcript No Slide Title

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 criticalthinking, 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 criticalthinking, 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
Program Content (cont...)
Module 3: Responding to clinical deterioration
– managing common acute conditions
• 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
• 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
• 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
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