Search the hub
Showing results for tags 'Deterioration'.
Found 141 results
-
Content ArticleThe aim of this study in Australian Critical Care was to develop an evidence-based paediatric early warning system for infants and children, that takes into consideration a variety of paediatric healthcare contexts and addresses barriers to escalation of care. The development process resulted in an agreed uniform ESCALATION system incorporating a whole-system approach to promote critical thinking, situational awareness for the early recognition of paediatric clinical deterioration as well as timely and effective escalation of care. Incorporating family involvement was an important and new component of the system.
-
Content ArticleThis study in Health Expectations aimed to identify barriers and facilitators to implementing a parent escalation of care process: Calling for Help (C4H). Guided by the Theoretical Domains Framework, the authors carried out audits, semi-structured interviews and focus groups in an Australian paediatric hospital where a parent escalation of care process was introduced in the previous six months. The authors found that although there was a low level of awareness about C4H in practice, there was in-principle support for the concept. Initial strategies had primarily targeted policy change without taking into account the need for practice and organisational behaviour changes.
-
Content ArticleThis Australian study in Health Expectations aimed to evaluate the implementation of 'Calling for Help'(C4H), an intervention for parents to escalate care if they are concerned about their child's clinical condition. The study used a convenience sample of 75 parents from inpatient areas during the audit, and the authors held interviews with ten parents who had expressed concern about their child's clinical condition and five focus groups with 35 ward nurses. The authors found that there was an improvement in the level of parent awareness of C4H, which was viewed positively by both parents and nurses. To achieve a high level of parent awareness in a sustainable way, a multifaceted approach is required and further strategies will be required for parents to feel confident enough to use C4H and to address communication barriers.
-
Content ArticleThis document outlines the standard operating procedure (SOP) adopted by University Hospitals Bristol NHS Foundation Trust, relating to parental involvement in escalation of clinical care for acutely ill children. It aims to clarify the process of empowering parents to escalate concerns if they are worried about the clinical condition and care being delivered to their child, or themselves if they are a patient. It also aims to ensure accurate and appropriate information is provided to parents on admission (elective and acute) regarding how they should escalate concerns about the care their child is receiving.
-
Content ArticleThis document outlines the Escalation Policy for Leicester Children’s Emergency Department. It identifies five particular factors that lead to difficulty within the department. Acknowledging that these issues can be closely interlinked and may not occur in isolation, it provides practical way to deal with these factors to try and prevent secondary events. Staffing Overcrowding Inflow Outflow Acuity
-
Content ArticleThe REACH Toolkit provides information, resources and quality improvement (QI) tools for managers and clinicians to improve patient, carer and family recognition and escalation of clinical deterioration in NSW health services. The resources can be adapted to suit local needs including initial program implementation, to review and improve current practices or to support current practice.
-
Content ArticleREACH is a system that helps patients, carers and family members to escalate their concerns with staff about worrying changes in a patient's condition. It stands for Recognise, Engage, Act, Call, Help is on its way. REACH was developed by the New South Wales Government Clinical Excellence Commission in collaboration with local health districts and consumers. It builds on the surf life‐saving analogy for recognition and appropriate care of deteriorating patients by encouraging patients, carers and their families to 'put their hands in the air' to signal they need help.
-
Content ArticleRyan Saunders is a little boy who died in 2007 from an undiagnosed streptococcal infection, which led to Toxic Shock Syndrome. According to the Queensland Clinical Excellence Division, when Ryan’s parents were worried he was getting worse, they did not feel their concerns were acted on in time. This blog outlines Ryan's Rule, a process introduced by the Queensland Department of Health to try and prevent similar events happening in future. Ryan's Rule allows patients and their families and carers to escalate serious concerns about their own or a family member's condition.
-
Content ArticleThis investigation by the Healthcare Safety Investigation Branch (HSIB) explores issues around patient handover to emergency care. Patients who wait in ambulances at an emergency department are at potential risk of coming to harm due to deterioration or not being able to access timely and appropriate treatment. This is the second interim bulletin published as part of this investigation, and findings so far emphasise that an effective response should consider the interactions of the whole system: an end-to-end approach that does not just focus on one area of healthcare and prioritises patient safety. The reference event in this investigation involves a patient who was found unconscious at home and taken to hospital by ambulance. They were then held in the ambulance at the emergency department for 3 hours and 20 minutes and during this time their condition did not improve. The patient was taken directly to the intensive care unit where they remained for nine days before being transferred to a specialist centre for further treatment.
-
Content ArticleThis opinion piece by GP educator and writer John Launer looks at the current delays and cancellations to routine appointments facing patients with long term conditions. He describes his personal experience of waiting three years with no face-to-face of phone appointment to review his condition, when this should happen every six months. John outlines the fact that routine outpatient care in some hospitals is unravelling, but with no monitoring of the situation and without publicity. He highlights the risks for patients who are not receiving the regular contact with healthcare professionals that they need, including medical complications, emergency admissions and even preventable deaths. There is particularly risk to patients who do not feel able to contact their consultant or specialist. When speaking to the hospital department about how the risks were being mitigated, John was concerned to discover that there were no screening procedures in place for clinicians to determine which patients were at highest risk; no prioritisation as going on and there was no system in place to monitor the consequences of this.
-
Event
Deteriorating Patient Summit
Patient Safety Learning posted an event in Community Calendar
The Deteriorating Patient Summit focuses on recognising and responding to the deteriorating patient through improving the reliability of patient observations and ensuring quality of care. The conference will include National Developments including the recent recommendations from the Royal College of Physicians on NEWS2 and COVID-19, and implementing the recommendations from the Healthcare Safety Investigation Branch Report Investigation into recognising and responding to critically unwell patients. The conference will include practical case study based sessions on identifying patients at risk of deterioration, improving practice in patient observations, responding to the deteriorating patient, improving escalation and understanding success factors in escalation, sepsis and COVID-19, involving patients and families in recognising deterioration, and improving the communication and use of NEWS2 in the community, including care homes, and at the interface of care. Follow the conference on Twitter #deterioratingpatient Register -
Content ArticleFamily members are a vital part of the healthcare team and are often best positioned to recognize the sometimes subtle, yet very important changes in their loved one's condition that may indicate deterioration. You may not know WHAT is wrong, but you know something just isn't right. Empower yourself and your loved ones with the following information and resources from the Canadian Patient Safety Institute (CPSI). They will both help you recognize the signs of deteriorating patient condition, and effectively discuss your concerns with the healthcare provider.
-
Content Article
UCL Partners: Proactive care frameworks
Patient Safety Learning posted an article in Care pathways
UCL Partners have developed a series of proactive care frameworks to restore routine care by prioritising patients at highest risk of deterioration, with pathways that mobilise the wider workforce and digital/tech, to optimise remote care and self-care, while reducing GP workload. The frameworks include atrial fibrillation, high blood pressure, high cholesterol, type 2 diabetes, asthma and COPD. -
Content ArticleDelays in evaluation and escalation of needed care can compromise outcomes of the patient significantly and, in many cases, may lead to death. The assembly of a rapid response team would not only provide timely multidisciplinary evaluation of a potentially deteriorating patient, but it would also help reinforce the organization’s culture of collaboration and interprofessional support for safety. Patients often exhibit signs of deterioration before experiencing the adverse event. The rapid response team’s timeliness in evaluation, coupled with the recommendations from multiple, interprofessional individuals, instead of solely the bedside nurse, would significantly prevent a plethora of adverse events and save financial resources. Specifically, the implementation of rapid response teams has been associated with reductions in cardiac arrests, inpatient deaths, and number of days in the hospital. Many healthcare organisations have successfully implemented and sustained improvements with the advent of rapid response teams. These organizations have focused on projects that included establishing standardized calling criteria for both clinicians and patients and family members, and delineating roles and responsibilities for all upon rapid response team arrival. This Patient Safety Movement Actionable Patient Safety Solutions (APSS) provides a blueprint that outlines the actionable steps organisations should take to successfully implement and sustain rapid response teams and summarises the available evidence-based practice protocols.
-
Content ArticleRyan's Rule is a three step process to support patients of any age, their families and carers, to raise concerns if a patient’s health condition is getting worse or not improving as well as expected. Ryan’s Rule applies to all patients admitted to any Queensland Health public hospital including the emergency department, and in some Hospital in the Home (HITH) services.Ryan’s Rule has been developed in response to the tragic death of Ryan Saunders, who died in 2007 from an undiagnosed Streptococcal infection, which led to Toxic Shock Syndrome. When Ryan’s parents were worried he was getting worse they did not feel their concerns were acted on in time. In light of his death, the Department of Health made a commitment to introduce a patient, family, carer escalation process (Ryan’s Rule), to minimise the possibility of a similar event occurring.Follow the link below to the Queensland Government website to find out more about Ryan's Rule and how it works in practice.
-
Content ArticleThe aim of this systematic review in the Journal of Patient Safety was to determine the impact of automated patient monitoring systems (PMSs) on sepsis recognition and outcomes. Authors Gale and Hall found that automated sepsis PMSs have the potential to improve sepsis recognition and outcomes, but current evidence is mixed on their effectiveness. More high-quality studies are needed to understand the effects of PMSs on important sepsis-related process and outcome measures in different hospital units.
-
Content ArticleResponding to abnormalities in patients’ vital signs is a fundamental aspect of nursing. However, failure to respond to patient deterioration is common and often leads to adverse patient outcomes. This study from Smith et al., in the journal Resuscitation, aimed to determine the association between registered nurse (RN) and nursing assistant (NA) staffing levels and the failure to respond promptly to patients’ abnormal physiology. The authors found that RN, but not NA, staffing levels influence the rates of failure to respond for patients with the most abnormal vital signs (NEWS values ≥ 7). These findings offer a possible explanation for the increasingly reported association between low RN staffing and an increased risk of patient death during a hospital admission.
-
Content ArticleThis alert, from the National Institute for Health Research, provides a synopsis of a new study which suggests that many early warning scores are based on flawed research. It looks at the issue and the next steps in terms of patient safety.
-
Content ArticleThis animation has been made to help patients stay safe while they are in hospital. It has been developed by Haelo, an innovation and improvement centre in Salford, in partnership with Guy’s and St Thomas’, and is based on the airline-style safety card developed by Guy’s and St Thomas’. Designed as part of their award-winning Welcome Pack, the safety card supports our commitment to patient safety and enables patients to play an active role in their care.
-
Content Article
FIRST: Family Initiated Rapid Safety Team
Claire Cox posted an article in Keeping patients safe
Despite the introduction of rapid response systems and early warning scores, clinical deterioration that is not recognised or responded to early enough prevails in acute care areas. One intervention that aims to address this issue and that is gaining increased attention is patient- and family-initiated escalation of care schemes. This short video by the University of Michigan Health System explains more. -
Content ArticleDespite the introduction of rapid response systems and early warning scores, clinical deterioration that is not recognised or responded to early enough prevails in acute care areas. One intervention that aims to address this issue and that is gaining increased attention is patient-and family-initiated escalation of care schemes. Existing systematic review evidence to date has tended to focus on identifying the impact or effectiveness of these schemes in practice. However, they have not tended to focus on qualitative evidence to consider the experience of deterioration and the factors that may promote or hinder engagement with these schemes in the practice setting. The aim of this review, published in Systemic Reviews, is to explore patients’, relatives’ and healthcare professionals’ experiences of deterioration and their perceptions of the barriers or facilitators to patient and family-initiated escalation of care in acute adult hospital wards.
-
Content ArticleThis article from Perlin et al. discusses how a 173-hospital system used technology as a strategy to reduce sepsis-related mortality system-wide by real-time dissemination of basic laboratory and clinical data to alert teams to patients exhibiting signs of sepsis risk.
-
Content ArticleThis report, from the Healthcare Safety Investigation Branch (HSIB), provides insight into a current safety risk that was identified on a referral. The referral was about difficulties in identifying clinical deterioration in patients with COVID-19 on general wards. The Royal College of Physicians (RCP) highlighted the issue of rapid deterioration in oxygenation in patients with COVID-19 and how this might relate to the use of early warning scores.
-
Content Article
Scottish Patient Safety Programme: Acute Adult
Claire Cox posted an article in Resources for staff
This web page includes the four work streams that Health Improvement Scotland are undertaking. These include: Falls Deteriorating patient Catheter induced infections Pressure ulcers. -
Content Article
Escalation of deteriorating adults
PatientSafetyLearning Team posted an article in Deterioration and sepsis
This short film, produced by Homerton University Hospital, tells you how to manage a deteriorating patient on your ward. Dr Letty Dormandy, Chief Registrar, talks about the importance of early escalation and how to get help quickly.
