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Responding To Clinical Deterioration Annotated Bibliography

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Table of Contents
Introduction
Annotated Bibliography
How these Studies inform Nursing Practice
Conclusion
Reference List

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Introduction

In medical practice nurses play a very important role in that they are always responsible for the continuous assessment of the patients and clinical surveillance. Research has however found that adverse outcomes in health facilities are in most cases preceded by unusual physiological results for instance heart attacks.

Annotated Bibliography

Odell, M., Victor, C., & Oliver, D. (2009). Nurses’ Role in Detecting Deteriorating In Ward Patients: Systematic Literature Review. Journal of Advanced Nursing, 65(10).

This is a report about a review carried out to categorize and decisively assess research investigating nursing practice in the area of identifying and managing deteriorating general ward patients. The paper is based on the premise that failing to recognize and act on the deteriorating condition in the general wads was becoming a major problem in health facilities. This has called for implementation of early warning model of scoring and acute care outreach work group and the evidence of efficiency of these systems is indistinct. 14 studies met the threshold to be included for review and were classified in four groups; identification, recording and review, reporting and reaction or response.

The review concluded that there is greater understanding of the context in which deteriorating is recorded. This means that there is possible designing of efficient strategy to educate nurses and design support systems. The challenge of the responding program is because of inexperience and limited knowledge of the bedside nurses and the relationship they have with other medical staff.

Preston, R., & Flynn, D. (2010). Observation in Acute Care: Evidence-Based Approach to Patient Safety. British Journal of Nursing, 19(7), 442- 447.

Nurses are required to competently execute functions of observing, accurately interpreting data and making rational decisions based on critical thought after meticulous assessment of data. This will go a long way in reducing the number of deaths in hospitals as the National Institute for clinical excellence recommends. This paper is a review of the skills, knowledge and practices that nurses currently possess and use in their duty of making observation and recording the situation in critical care setting. Some of the important measures include blood oxygen saturation level, blood pressure, and blood sugar among others.

Several of the studies researched show that respiration rate was specifically very sensitive indicator of clinical deterioration; nonetheless it was one of the variables that are never done or poorly conducted in critical care.

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Electronic devices and early warning system are available to help recognize risk of deterioration among patients. The paper also provides what knowledge nurses need to have in physiological compensation to be able to accurately detect and report clinical deterioration in acute care. Several recommendations have been made which include training in Acute Life Threatening Events and Recognition Treatment (ALERT) for nurses who qualify to work in acute care section and also do exercises in simulation of best practices in acute care services.

Thomas, T., Force, M.V., Rasmussen, D., Dodd, D., & Whildin, S. (2007). Rapid Response Team: Challenges, Solutions, Benefits. Crit Care Nurse, Vol. 27 No. 1, Pp. 20-27.

This study was centred on the fact that many hospital administrators are facing problems of managing human resources (workers) and other resources capital resources to attain the best possible results. The challenge of this has been the faster admission rates and discharge processes, shortage of nurses and high acuity levels of patients. Response to clinical deterioration is sometime not effective and patients develop critical complications such as death, and this is described as failure to rescue. This phrase does not depict negligence or any misconduct rather it portrays the general performance of a health facility with regard to the nurses’ abilities to identify and respond autonomously to complications.

Sign of deterioration may not be recognized early enough by the nurses or they could be responded to very late to reverse the patients outcome. This report has identified major problems that fail to rescue, the challenges of setting up a rapid response team and the benefits of the rapid response groups in service delivery. Benefits of rapid responders include increased patient safety, shorter stay in hospital, reduced cases in ICU and increased attentiveness of identification of deterioration.

Tait, D. (2010). Nursing Recognition And Response To Signs Of Clinical Deterioration. Nursing Management,17(6), 31-37.

The insufficient or suboptimal care which has resulted in admittance of critically sick patients to the intensive care units was noted over ten years ago as being available in most instances. The subject of insufficient care and clinical deterioration has also been identified as being a serious problem on global scale in terms of care delivery. It’s on this basis that this research was developed. There are possible solutions, for instance using physiological track-and-trigger tools in the assessment of risk of deterioration among patients.

These solutions have been implemented as part of the modified response to the changes in the healthcare situation. Outreach teams or rapid response are also usually set up to support the reaction as part of the approach of decreasing suboptimal care and encouraging patient safety for instance management and prevention of sepsis. Track and trigger instruments are sometimes inadequate in offering optimal care because of several patient factors that affect their progress. Clinical knowledge and skills which caregivers possess are pertinent to this process and attainment of safe patient care.

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Moldenhauer, K., Sabel, A., Chu, E.S., & Mehler, P.S. (2009). Clinical Triggers: An Alternative to A Rapid Response Team. J Comm. J Qual Saf, 35(3),164-167.

There are a number of alternatives that have been proposed as alternatives to the Medical Emergency Team (MET) and are based on clinical triggers which instigate rapid response. The clinical triggers approach has been found to surmount the characteristic constraint of the MET system, as related to excessive use of resources and division of patient care. There is an archetypal clinical triggers program that can be referred to when addressing response to deteriorating clinical service. This is well-known at Denver Health Medical Centre and it entails standardized ‘afferent’ branch of patient recognition based on objective physiological response for rapid response intensification.

This ‘efferent’ limb is offered by assigned primary house employee team taking care of individual patients. The DHMC is a promising approach addressing unmet patient needs. It has brought dramatic decline of cardiac arrests outside ICU and lesser bounce back rates to ICU. The RRT’s form the main means of preventing unobserved patient deterioration and can offer benefits like DHMC. The goal of this system is to prevent premature deaths hospitalized patient therefore improving their safety.

How these Studies inform Nursing Practice

From the research studies reviewed, the investigator can draw important insights that address the current standard of the important symptoms recording and how the nurses respond (Guyton & Hall, 2010, p. 67). These researches inspire strong concerns and support from nurses to the new strategies of ensuring timely realization of clinical deterioration. The outcomes are a benchmark and assist in assessing changes to the current hospital response systems and policies (Hall 2010, p. 74).

There are a number of themes that are addressed in these studies and are very relevant to judicious recognition and response to clinical deterioration in healthcare facilities (Elliott et al, 2007, p. 58). The main theme of concern to this paper is the human barriers that prevent timely recognition and response. From this, it’s easy to deduce that any system established to enhance the process of recognizing and responding to the clinical deterioration has to take into account the human obstacles some that have existed for many years (Urden et al, 2006, p. 123).

Being able to offer patient with proper and timely care when their health deteriorates is very important in ensuring their safety and quality care (Morton et al, 2009, p. 82). The above researches consistently show that there are observable physiological symptoms that come before adverse effects of deterioration are experienced like cardiac arrest and emergency admission in the ICUs (Curtis et al, 2007, p. 102). Because there has been increased awareness of the matter, there are consequently significant types of initiatives that are employed in certain health systems even to international level. Being able to recognize and respond to health emergencies is one of the major roles of the nurses in patient care (Pierce, 2007, p. 71).

The objective of the recognition and response programs in healthcare facilities are identified by these researches as seeking to save lives decrease damage to the patients by improving health monitoring and surveillance systems as well as practices that allow recognition and response to clinical deterioration in critical care facilities (Iyengar et al, 2009, p. 130).

Several models have also been highlighted as being effective in identifying deterioration symptoms. Several models are often applied for the same purpose of rapid response. These models have great variation in terms of their makeup of the teams involved when responding to patients who are indicated to be deteriorating led by doctors or RN’s (Woods et al, 2010, p. 104). There is also need to apply relevant skills by the responding team like intubation and the team should be well managed for instance having a structured educative duty and reacting methodically to immediate medical need. Currently, there are no studies that have demonstrated differing result of different approaches used to address the problem (Simmonds, 2005, p. 143).

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However the different models that are employed are mostly a reflection of the differing situations in organization, especially in terms of the issues that they have to deal with which could be workforce mix and staffing. Some facilities use rapid response team and medical emergency team interchangeably like in Australia but the US the RRT tend to refer to nurse-led teams. The UK has critical care outreach teams for the same reason (Sirio, 2009, p. 163). These studies show that it is practically impossible to develop a robust model of recognizing and responding to clinical deterioration without spirited organizational support.

Conclusion

The main problem has been to find out why nurse is not able to identify and respond to the problems by taking appropriate measures towards clinical deterioration. This has become an ongoing problem where there is failure to collect relevant and accurate information, problem in detecting the problem or reluctance in reporting unusual data and failing to react to clinical deterioration even when abnormal results are noted.

Reference List

Curtis, K., Ramsden, C. & Friendship, J. (2007). Emergency and Trauma Nursing, Sydney: Mosby Elsevier.

Elliott, D., Aitken, L. & Chaboyer, W. (2007). ACCCNs Critical Care Nursing, Sydney: Mosby Elsevier.

Guyton, A.C. & Hall, J.E. (2010). Textbook Of Medical Physiology (12th Ed.). St Louis, Mo: Saunders Elsevier.

Hall, J.E., (2010). Pocket Companion to Guyton & Hall, Textbook of Medical Physiology (12th Edn.) St Louis, Mo: Saunders Elsevier.

Iyengar, A., Baxter, A., & Forster, A.J. (2009). Using Medical Emergency Teams to Detect Preventable Adverse Events. Crit Care, 13:R126.

Moldenhauer, K., Sabel, A., Chu, E.S., & Mehler, P.S. (2009). Clinical Triggers: An Alternative to A Rapid Response Team. J Comm. J Qual Saf, 35(3),164-167.

Morton, P., Fontaine, P., Hudak, C., & Gallo, B.,(2009). Critical Care Nursing: A Holistic Approach. (9th Edn). Philadelphia: Lippincott.

Odell, M., Victor, C., & Oliver, D. (2009). Nurses’ Role in Detecting Deteriorating In Ward Patients: Systematic Literature Review. Journal of Advanced Nursing, 65(10).

Pierce, L. (2007). Management of the Mechanically Ventilated Patient (2nd Edn.). St. Louis, MO. Elsevier Saunders.

Preston, R., & Flynn, D. (2010). Observation in Acute Care: Evidence-Based Approach to Patient Safety. British Journal of Nursing, 19(7), 442- 447.

Simmonds, T. (2005). Best Practice Protocols: Implementing A Rapid Response System of Care. Nurs Manage, 36:41–59.

Sirio, C.A. (2009). Clinical Triggers Or Rapid Response Teams: Do The Emperor Need “New” Clothes? J Comm. J Qual Patient Saf, 35(3), 162-163.

Tait, D. (2010). Nursing Recognition And Response To Signs Of Clinical Deterioration. Nursing Management, 17(6), 31-37.

Thomas, T., Force, M.V., Rasmussen, D., Dodd, D., & Whildin, S. (2007). Rapid Response Team: Challenges, Solutions, Benefits. Crit Care Nurse, 27(1), 20-27.

Urden, L., Stacy, K. & Lough, M. (2006). Thelan’s Critical Care Nursing: Diagnosis And Management. (5th Edn). St Louis, Mo: Saunders Elsevier.

Woods, S., Froelicher, E., Underhill Motzer, S., & Bridges, E. (Eds) (2010). Cardiac Nursing, Philadelphia: Lippincott Williams & Wilkins.

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