Unreported Patient Deterioration Case Study

It is widely known that early recognition of a deteriorating patient can contribute largely to a successful outcome, through recognising and taking action on the deteriorating health status of the patient (National Consensus Statement, 2010). This report will explore the ways in which deteriorating patients and clinical reasoning are used in the public health care system in New South Wales (NSW).

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

The study revealed several issues in this department. Voluntary emergency patients have to wait extended periods of time before being transferred to the appropriate department. The majority of those who have to wait are those seeking mental health assistance. Keeping people in the emergency department longer than necessary cause operational costs skyrocket, and worse, keeps the needs of patients from properly being met.

The aim of this reflection is to discuss patient safety in an acute setting according to the Scottish Patient Safety Programme. I will be using a model of reflection, Gibbs Reflective Cycle to structure my essay (Gibbs 1988 cited in Paterson and Chapman, 2013). In accordance with the Nursing and Midwifery Council identifiable information will not be written, maintaining confidentiality (NMC, 2010a).

The implications and effects on patients waiting long hours to be seen in the ED are immense. In a recent study done over five years in Ontario hospitals showed the risk of adverse events and even deaths increased with the length of stay in the ED (Science Daily, 2011). When EDs become overcrowded the quality of care changes and declines; which is extremely dangerous. Authors of the study calculated that if ED length of stay was cut by only an hour that 150 fewer Ontarians would die each year (Science Daily, 2011). Wait times can also negatively affect patients financially, untreated medical conditions can lead to reduced productivity and inability to work leading to increased financial strains (Fraser Institute, 2014). As well as delayed access to care can result in more complex interventions needed. Therefore an initiative is needed to provide patients with timely, efficient care when accessing

The National Safety and Quality Health (NSQHS) standards ultimately were established to protect the public from harm and to develop and enhance the quality of care delivered by health care organisations (NSQHS 2012). These standards are used as a guideline to aid health care organisations to support the quality improvement programs using the NSQHS framework to ensure patient safety and quality care is being delivered. Standard 9 of the NSQHS specifically addresses the recognition and response to clinical deterioration in acute health care with the aim of early recognition of patient deterioration and suitable action is taken.

From my experience volunteering in the emergency department at my county’s largest healthcare provider, Union Hospital, I recognize the medical issues,

Management of the acutely ill adult is a complex and perplexed procedure. It requires underpinning knowledge of the pathophysiology of the disease currently affecting the patient, as well as ensuring that professionals are equipped to deal with the development of a rapid deterioration. The National Institute for Clinical Excellence (2007) explain that patients are sometimes inadequately treated due to staff not acting in a sufficient time manner, and so a systematic assessment of the patient recommended by the Resuscitation Council (2006) should initially be followed (Jevon, 2009).

looking at mortality rates in patients seeking emergency care conclude that the rate of death is substantially higher during times of crowding (Richardson, 2006, p. 213).

Early recognition of deteriorating patients in the clinical setting has been connected with increasingly successful interventions and effectively improved health outcomes (Parham, 2012). The worsening physiology of a clinically deteriorating patient is strongly tied to an increase in hospital mortality (Mitchell et al., 2010), and thus the importance of identifying the patient decline is of paramount to effective nursing care. This essay will investigate this current nursing issue in the paediatric environment within NSW in an Australian context. It will examine the impact clinical deterioration identification and management has on the nursing profession, the paediatric patients and their families, primarily through the exploration of the ‘Between the flags’ program and DETECT junior. Further discussion regarding the legal and ethical principles surrounding clinical deterioration will follow together with an evaluation of best nursing practice as supported by the literature.

Long Term Conditions (LTC) are illnesses for which there is no cure, yet can be managed with the correct medications and treatments. Common LTCs include high blood pressure, chronic obstructive pulmonary disease and arthritis (The King’s Fund 2015). The following essay will discuss LTCs and their prevalence in today's society, by first looking at statistics and the government policies that were developed as a result of said research. Secondly, this essay will examine different methods of developing a care plan for an individual following a biopsychosocial model. Lastly, a Long Term Condition will be examined that was experienced when interacting with a patient from a previous community placement; this individual was living with Chronic Heart Failure and this essay will critically evaluate CHF, including the ailments, causes and the various

This essay sets out to discuss the importance of comprehensive and accurate assessment on a registered nurses’ ability to make excellent clinical decisions. It will examine what factors can change a nurses’ capability to be aware of, and act on abnormal assessment findings. As well as assessment being part of the nursing process that is used in every day nursing, it is also a critical part of patient safety (Higgins, 2008). Assessment findings are used to determine what needs to be done for the patient next. Early warning scoring systems currently exist to aid in the early detection of patient deterioration (Goldhill, 2005). The rationale for the use of these systems is that early recognition of deterioration in the vital signs of a

Neither staff member identified the downward trending of the patients available vital signs and did not evaluate consciousness of the patient. Failure to assess appropriately and recognize deterioration of the patient resulted in a prolonged period of time in which the patient was not adequately oxygenated. Research has shown that short staffing, with decreased nurse to patient ratio, has been found to be associated with increased mortality (Aiken, Clarke, Sloane, Sochalski, & Silber, 2002; Joint Commission on Accreditation of Healthcare Organizations, 2005; Needleman, Buerhaus, PKankratz, Leibson, Stevens, & Harris, 2011). This reinforces the need to match staffing with patient census, acuity, and need for nursing care.

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

Patients that need intensive care are more than likely to decline in health do to the substitute not know how to care for the patient. Nurses