Rapid Response to Deteriorating Adult Patient - Essay Example

 Introduction Early detection of adult patients deteriorating is imperative for effective and efficient patient care in health systems. Patients who are acutely unwell are increasingly facing the risks of unprecedented deterioration of their medication without prior identification by medical practitioners. The development of a comprehensive program for the identification and detection of primary causal and contributory factors for the observed adult patient deterioration is imperative for the reduction of mortality rates associated with deterioration of acutely unwell patients. Although studies indicate the occurrence of patient deterioration at any duration of patient illness, identification of pathophysiological factors related to patient deterioration and subsequently mitigation measures may prevent the culmination of patient state to death. Alarmingly, studies Adam et al. (2010) indicated that the majority of adult patients who experienced health deterioration have been subjected to suboptimal care in medical institutions. Therefore, the fundamental remedial measures for the deterioration of adult patients should be focused on the development,assessment, and implementation of effective medical care and practices that would offer optimal care to acutely unwell patients. This present essay is aimed at the identification, development and improvement of health care delivery to acutely unwell patients to prevent the occurrence of patient's health deteriorates through implementation of a rapid response deterioration adult patient program. Pathophysiological Factors Related With Adult Patient Deterioration. According to Creed and Spiers, C. (2010, deterioration of adult patients has been associated with the occurrence of physiological abnormalities in patients that are recognizable by medical professionals. Therefore, deterioration of adult patients has often been preceded with observable pathophysiological factors which could range from changes in patient vital signs, deterioration of consciousness and oxygenation in the case of patients suffering from cardiorespiratory arrest. The same situation was observed in a range of medical complications. Pathophysiological factors related to deterioration in adult patients suffering from Parkinson’s diseases included constipation, acute pain, dehydration and extreme stress episodes. Further studies by Elling (2006) of patients in acute hospitals indicated that changes in the vital signs could also pre-empt deterioration of acutely unwell patients. The vital signs included the temperature, pulse, blood pressure, oxygen saturation and respiratory rates. Indications of extreme vitals sign values could be utilized to develop early warning scores that could drastically improve on the state of the patient through timely medical intervention.Furthermore, studies by Lippincott and Wilkins. (2011)Alsoindicated that arterial blood gas measures, peripheral circulation, urinary output, airway obstruction, drain fluid loss were general predictors of deterioration in acutely unwell patients. In the case of sudden cardiac deaths, identification of physiological abnormalities significantly preventedthe deterioration of the patients’status. According to Tait (2012), early signs of cardiac arrest have been identified as severe chest pain before suffering cardiac arrest and sudden episodes of syncope. In addition, minor pathophysiological factors that have been related to cardiac arrest include pre-syncope, palpitation and heart murmur. Onset of arrhythmic syncope could further be indicated by the occurrence of syncope in the supine, exercise-related syncope, syncope with prodromal symptoms. Subsequently, deteriorating cardiac arrest patients also showed failed nervous, respiratory and cardiovascular systems. Therefore, accurate monitoring and early detection of these physiological abnormalities are essential for the prevention of sudden cardiac arrest and deaths (Elliot and Coventry, 2012). Tsivgouliset. Al. (2012) also documented early pathophysiological factors that led to early neurological deterioration( END). The occurrence of acute cerebral ischemia indicated the first signs of END worsening. The author further noted that causal factors of for neurological deterioration could be classified into hemodynamic and nonhemodynamic. Hemodynamic factors included cardiac complications, arterial reocclusion, cerebral microembolization and intracranial arterial steal phenomenon. The Relationship Between Nursing Care And Adult Patient Deterioration An effective nursing care is paramount for early detection and prevention of adult patient deterioration. An elaborate nursing care system should adequately monitor and record the conditions of acutely unwell patients to prevent further adverse of their situation(Centre For Clinical And National Institute For Health And Clinical Excellence, 2007).However, studies indicate that suboptimal care to acutely unwell patients is the primary causal factor for undetected deterioration of adult patients which further leads to increased mortality rates. The nursing fraternity for the acutely unwell is mandated with the duties of recording and further monitoring of the vital signs of the patients among other tasks. Consequently, studies by Devita et al.(2006) indicated that the early detection of pathophysiological factors related to patient deterioration could aid in the improvement of patient condition hence avert further health complications and occurrence of deaths. According to Smith And Roberts (2011) two healthcare delivery issues resulted in increased patient risk. These included the substandard assessment of patients on admission and subspecilisation of medication schemes for acutely ill patients. In the case of sub-quality patient assessment, lack of comprehensive clinical examination and patient history hindered adequate monitoring of patient’s physiological factors and identification of early signs of deterioration (Paradis, 2007). Secondly, sub-specialization of patient’s medicine led to increased risks of patient deterioration due increased focus on patient's organs or a particular system as opposed to treatment of the entire patient's system. Consequently, the role of a comprehensive nursing care in the prevention and improvement of the deteriorating patients has been underpinned by the pertinence of education and experience. However, nursing care is vital for management, prevention and mitigation of deterioration incidences in acutely ill patients. Nurses are responsible for the health recovery of adult patients undergoing deterioration through implementation of patient-centered care,monitoring and proactive management. Critical care nurses further provide emotional and psychological support to acutely ill and deteriorating patients. However, one of the principle roles of the nursing care system in relation to deteriorating adult patients has been observed. Critical nurses are primarily expected to monitor patient’s physiological factors in addition to the supervision of the support equipments. Consequently, patient observation by critical nurses entails the identification, interpretation and evaluation of patient information relating to pathophysiological and psychological response to medical interventions. Vis a vis effective nursing care system coupled with professional nurses ensures the existenceof an extensive medical framework aimed at eliminating causal factors for adult patient deterioration. The nursing care systems, thus eliminate adult patient deterioration through enhanced recognition of patients at risks, prudent monitoring of vital signs, appropriate interpretation of clinical examinations and availability of necessary drugs and equipments. Influences On Clinical Decision Making In Relation To Adult Patient Deterioration The nursing care for the deteriorating patient is a highly complex processcharacterizedwith a myriad decision-making incidences. According to Thompson and Dowding (2001) clinical decision relating to deterioration of adult patients should incorporate communication as an essential tool of propagating the intended information from the nursing team to the patient’s family. One of the primary elements that influence decision making related to adult patient deterioration is patient privacy. Referring to Fonteyn and Grobe (2007) adult patient deterioration is highly characterizedby emotional instability that should be appropriately handled by medical professionals. The decision making relating nursing care is expected to respect the privacy of the patient and his/her family members. As a result of the need for privacy, medical intervention and flow of information highly be hindered as a consequence of patient or family preferences. Consequently, clinical decision making will further be based on the number and extent of pathophysiological factors being observed by medical professionals. Studies have evidently correlated physiological abnormalities with an increased deterioration rate of acutely unwell patients. Therefore, it is paramount that the decision-making process, consider the evident pathophysiological factors being exhibited by a deteriorating patient prior to commencement of clinical decisions. The severity and number of concurrent physiological abnormalities will thus determine the urgency and extremity of the particular decisions to be made. According to Devita et al. (2010) early identification of physiological abnormalities in acute patients forms the foundation of effective management of deteriorating cases in patients. Furthermore, the decision-making process in relation to the adult patient deterioration will be influenced by the experience and education of the medical practitioner. Higher tenure impacts nurses with requisite skills and knowledge which enable them to timely detect physiological abnormalities and relate them to patient deterioration. In addition, longer and tenure and higher level of education enhances nurse’s self-efficacy lead to effective decision-making in the case of patient deterioration. Further education of nurses facilitates the learning process which impacts skills and promotes professional development of oneself. Professional versatility from experiences and learning process culminates into effective decision-making capability. The structure and pattern of communication may also impact on the clinical decision-making process. The existence of an elaborate communication structurethat link nurses with their immediate superiors facilitates efficient flow of pathophysiological information of patients for prompt intervention. The decision-making process may further be hampered by ineffective communication skills of the nurses leading to late communication of risk factors that have been observed in acutely unwell patients. The communication between nurses and patients is also vital in the clinical decision-making process.It is paramount that clinical decisions also incorporate physiological information based on patient's feelings and perception. Therefore, the inability of the patient to communicate subsequently complicates and deteriorates the quality of the decision-making process. Additionally, communication could improve the quality of the clinical decision by identifying early deterioration signs in patients prior to physiological alerts through communicating with relatives and personal acquaintances of the patient. Rapid Response To Deteriorating Adult Patient Extensive studies by Youngberg (2013) have indicated a prevalence of sub-optimal nursing care and the inability of the medical professional to timely detect and identify pathophysiological factors fundamental causes of adult patient deterioration and related mortalities. Based on the critical analysis of the physiological abnormalities associated with acute patient risks to deterioration and the underpinned role of the nursing fraternity, the formulation of a rapid response program to the deteriorating adult patient could mitigate the adverse of acute patient deterioration. The design and formulation of the rapid response program identified the following factors as a prerequisite for effective rapid response undertaking procedure. Effective observation of vital signs of acutely unwell patients, adequate training and education of medical practitioners, development of track and trigger policies and procedure to manage deterioration of adult patients, effective communication skills and framework between the nursing community and the provision of an elaborate escalation process. By considering the aforementioned points, the rapid response to the deteriorating adult patient program constitutes the following elements, the administrative structure guideline, standard calling criteria, clinical emergency response system, tiered education packages and standard key performance indicators. Seamless integration of these elements will facilitate the implementation of rapid response to a deteriorating adult patient in the majority of acute hospitals. Administrative Structure Guideline The administrative structure guideline should provide detailed information pertaining to the implementation and running of the rapid response program in an acute hospital. The structure should detail the extent and the scope of the program further indicating legal and social implications of the project. The administrative structure will also provide a framework for the selection of project supervisors and key personals mandated with its implementation in the hospitals. Standard Calling Criteria The centrality of the rapid response program will be based on the standard calling criteria. The process entails the formulation of an effective mechanism for the early detection of adult patient deterioration through the use standardized observation charts. The program will utilize clinical observation and track and trigger system as the primary forms of calling techniques. The clinical observation charts should be designed to record key physiological factors including level consciousness, heart rate, temperature, blood pressure, oxygen saturation and the respiratory rate. The chart should further indicate physiological parameters that have been documented to escalate patient care with the related medical conditions. For rapid response, the clinical observation charts should also indicate the prerequisite care in case of escalation of patient care. The information should be displayed in a graphical format for rapid interpretation. For rapid detection of physiological abnormality, the chart should further indicate the normal range of patient’s vital signs. Similarly, the track and trigger will primarily track measurement of physiological observations and further specification of predetermined medical intervention in the event of stipulated parameter threshold thus the triggering effect. The rapid response program should utilize the aggregate weighted scoring system as opposed to other forms of the track and trigger systems (Safety and Quality, 2014).Unlike single parameter systems, the aggregate weighted scoring system distributes points according to the extent of the derangement of the physiological variables. The variables are further transformed into a composite value that is compared to the predetermined value of the trigger threshold. The resulting information indicates the nature of the medical intervention such as enhanced vitals monitoring and adjustment of equipment parameters. Clinical Emergency Response System The success of the rapid response system is underpinned by the clinical emergency response system (CERS) of the program. According to Hillman (2008), the clinical response system refers to acute hospital's response to the deteriorating patient under its care. Appropriate allocation of resources and training of the medical staff determines the capability of the CERS. Efforts to improve the time frame associated withthe CERS response to the occurrence of the deterioration case should institutionalizeclinical review team with the capability of responding within 30 minutes coupled with rapid response system that could be immediately availed to the deteriorating patient. In addition, the team should be appropriately equipped with equipment’s for the conduction of the complicated resuscitation. Furthermore, the rapid response procedure should entail an efficient escalation process to facilitate the transfer of patients in need of higher order care. Informed clinical judgement and decision making should highly characterize the entire rapid response program. The initiation of the CERS should document pertinent patient information such as date and time, identification of the notified staff, reason for alerting the CERS team, time of the rapid response, documentation of the treatment and intervention from the clinical review and the subsequent outcome of the intervention. Tiered Education Packages for medical professional in Kuwait This element is aimed at enhancing the acquisition of skills and knowledge of the entire medical staff engaging in a rapid response program. The tiered education packages should impact nurses with the ability to recognize timely and manage deterioration cases in acutely unwell patients. Additionally, entailed education should focus on the creation of awareness in relation to track and trigger and clinical emergency response systems. Further emphasis should be directed at the younger medical professionalin the Kuwait. Critical understanding of the physiological factors related with adult patient deterioration and effective detection of risk factors by Kuwait nurses will drastically mitigate complications and mortalities associated with deterioration of acutely unwell patients in Kuwait hospitals. Standard Key Performance Indicators It is further paramount that the rapid response program being assessed in terms of the project implementation and maintenance. Additional establishment and expansion of the rapid response program in the Kuwait hospitals will be informed by the assessment of the performance indicators of the program’s impact and sustainability in the country’s health care system. Some of the key indicators of performance could include a percentage of acceptance by the users, percentage reduction of deterioration and deaths of acutely unwell patients and increased efficiency of the nursing fraternity. Implications of Legal, Ethical and Professional Issues In Practice That Influence the Care ofthe Deteriorating Adult and Their Family The deterioration of the acutely unwell patients has been accelerated by the prevalence of sub-optimal care by the nursing fraternity according research by Salas and Frush (2013). Nurse and related medical professionals are faced with the ethical and professional challenge of increased workload due to medical personnel shortage. The inappropriate ratio of nurse to patient ratio has resulted to increased burnout in the nurses. Studies by Freeman and McdonnelL (2001) further noted that for every additional patient assigned to nurse the rate of catheter infection increased by one infection per 1000 patients.Although nurses are ethically mandated to provide medical care, inadequate staffing negatively impacts on the medical outcome of acutely unwell patients thus leading to deterioration of the adult patients.However, Pozgar (2007) wrote that medicalinefficiency related to nurse burnout could be immediately mitigated through appropriate management practices such as hiring of additional nurses and formulation of shorter work shifts. Furthermore, nursing care for the deteriorating patients is also affected by the legal. Provisions for patient consent in the event of rapid medical response. Patient and family indecision due to personaland cultural beliefs tend to enhance the deteriorating effects, hence lessening the impact of rapid response. In a country like Kuwait, religious doctrines also impact negatively on the rapid response program due tothe subordination of female nurses and patients. Barriers To Implementation Of The Rapid Response Program A pilot implementation of the rapid response system in Kuwait health care system is likely to be faced with numerous barriers. According to Marshall et al (2011), rapid response systems are greatly hindered by the existingculture and professional norms in a given acute hospitalsystem. The structure of the program is likely to obliterate the traditional hierarchical system, hence stiff opposition from the nursing community. Standing (2011) noted that the management could overcome the barrier by use of a multidisciplinary approach in the planning and implementation of the program. Through teamwork, the roles, composition and protocols for the rapid response team should be defined. Additionally Devita et al. (2011) added that limited information and data concerning the rapid response system in Kuwait may hinder appropriate allocation of resources by the hospital management. The management may not comprehend the feasibility and importance of the entire program.Initiation of an extensive awareness campaign on the detrimental effects of suboptimal nursing and care and the role of physiological factors in the early detection of deterioration in patients should inform relevant parties of the importance of the project. Lack of appropriate communication structure between the varied disciplines may hinder seamless the implementation and seamless transition of the rapid response system. Effective leadership role should ensure the establishment of elaborate communication system, emphasis on the vitality of the teamwork coupled with the multidisciplinary approach. 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