RECOGNISING AND RESPONDING TO EARLY DETERIORATION OF ACUTELY ILL PATIENTS ON THE WARDS Presented by Primary Health Care Team 2013/2014
Aims of Session
Any patient in hospital may become acutely ill, however, the recognition of acute illness is often delayed and its subsequent management may be inappropriate.. This may result in late referral, avoidable admissions to critical care and may lead to unnecessary patient deaths, particularly when initial patient care is suboptimal. NICE, 2007, Acutely ill patient in hospital
The NICE Clinical Guideline makes evidence based recommendations on the recognition and management of acute illness in hospital NICE, 2007. Acutely ill patients in hospital
The More recent NPSA (National Patient Safety Agency) Nov 07. Recognising and responding appropriately to early signs of deterioration in hospitalised patients. Explores patient deterioration and helps NHS staff working in hospitals to improve patient safety.
Andrew Dillon chief executive of NICE states; We welcome this report as a further contribution to improving patient care in this area.
Patient Centred Care Treatment and care should take into account a patients individual needs and preference. Good communication is essential, supported by evidence based information to allow patients to reach informed decisions about their care.
Key Priorities for implementation Physiological observations recorded at the time of admission or initial assessment. A clear written monitoring plan that specifies which physiological observations should be recorded and how often.
Key priorities cont d Physiological observations should be recorded and acted upon by staff who have been trained to undertake these procedures and understand their clinical relevance. Education and training should be provided annually to ensure staff have these competencies and should be assessed to prove this, (link nurses).
Early Warning Score ASSESSMENT TOOL 0-3 (GREEN) 0-3 (or patient causing concern) (AMBER) 4-5 (or patients causing concern) (AMBER) 6 or above (RED) Confirm score Confirm score In hours contact Health Centre or Ward Doctor Out of hours contact Duty Manager Repeat review by Doctor / Health Centre if Early Warning Score remains above 4 or is increasing 3333 For immediate transfer to hospital via 999 ambulance. ROUTINE PHYSICAL OBSERVATIONS Hourly Observations AN EARLY WARNING SCORE OF 3 ON ANY SINGLE PARAMETER MUST BE REPORTED TO A DOCTOR
Early Warning Scoring Tool Score 3 2 1 0 1 2 3 Pulse Per Minute Resp Per minute Temp C Systolic BP Oxygen saturation (%) Inspired oxygen AVPU 40 OR BELOW 8 or below 35 or below 90 or below 91 or below 91-100 41-50 51-90 91-110 111-130 9-11 12-20 21-24 35.1-36 101-110 92-93 94-95 YES 36.1-38 38.1-39 111-219 96 or above Greater than 39.1 131 or above 25 or above 220 OR ABOVE AN EARLY WARNING SCORE OF 3 ON ANY SINGLE PARAMETER MUST BE REPORTED TO A DOCTOR/NURSE PARCTIONER NO Alert... Voice Pain Unrespon -sive
Example of an A1 return form Ward: Month: (FORM A1) Routine Health Checks High Secure Services Primary Health Service Patient Name Time Pulse Respirations Temperatu re Blood pressure Saturation (%) AVPU MEWS MUST Score / Care Plan Weight Kgs BMI Waist circumference
Scenarios 1 32 year old male routine obs. On Clozapine. Well, no complaints. Pulse 108 Resps 14 Temp 37 BP 190/100 Sats 97% (air) AVPU Alert
Scenarios 2 40 year old male, on no meds. Has flu like symptoms Pulse 110 Resps 16 BP 120/70 Sats 98% (air) Temp 38.5 AVPU Alert
Scenarios 3 50 year old male, on no meds. Has cough and breathless Pulse 119 Resps 8 Temp 38.5 BP 100/60 Sats 93% (air) AVPU Voice
Scenarios 4 70 year old male, on no meds. Chest pain Pulse 76 Resps 12 Temp 37 BP 100/70 Sats 97% (air) AVPU Alert
Scenarios 5 21 year old male, on Clozapine abdominal pain Pulse 131 Resps 14 temp 38 BP 170/70 Sats 96% (air) AVPU Alert
Scenarios 6 24 year old male, known asthmatic, short of breath following gym session, oxygen therapy given Pulse 90 Resps 20 Temp 37.5 BP 120/70 Sats 98% (15 litres oxygen) AVPU Alert
STAFF EVALUATION SHEET
Recognising and Responding to Early Deterioration of Acutely Ill Patients on the Wards Name.. 1) Which words would you choose to describe your feelings at the end of your Recognising and Responding to Early Deterioration of Acutely Ill Patients on the wards session? Please indicate by circling your choices. Interesting Helpful Difficult Superficial Confusing Irrelevant Waste of Time Boring Rewarding Exciting Intrusive Stimulating Fun Constructive 2) Which parts of the presentation did you find most useful? 3) Which part of the presentation did you find least useful? 4) I felt that the standard of the presentation was:- a) Excellent b) Competent c) Professional d) Could have been better 5) How would it help in your job, will you do anything differently as a result of the presentation? 6) Do you have any suggestions for improving the presentation content? Thank you for your co-operation in completing this evaluation
Feed-back from staff questionnaire Over all feed-back was excellent. Staff found the training helpful and constructive as part of their mental health role. Depending on staff s position at ward level or within HSS, some were resistant to participate in the training as they felt it wasn t part of their role
Early Warning Score (2013-2014) I felt that the standard of presentation was;
Early Warning Score (2013-2014) I felt that the standard of presentation was; 3 90 Excellent Competant 225 Professional 102 Could have been better
Early Warning Score (2013-2014) Which words would you choose to describe your feelings at the end of the session?
Audit and Quality Control of A1 Physical Observation Recordings Jan/Feb/March 2014
Effectiveness of EWS at Ward Level Staff are utilising the tool regularly to bring awareness of physical health changes: i.e. patients that are acutely unwell. Early intervention and appropriate referrals have occurred in accordance to the assessment tool. However, as part of routine monitoring of physical health observations (A1 forms) abnormalities are only routinely highlighted through audits and quality control measures that are in place. Not always actioned at time of recording.
What next We are aware more work still needed: Offering further support and 1:1 training Staff competencies Making EWS a standing item on Link Nurse training High-light trends through graphs, data collection and audits Wards where errors regularly occur contacting ward mangers to address staff training issues and accountability