RSVP: a system for communication of deterioration in hospital patients.
ABSTRACT Communication failures are a prime cause of patient safety incidents. In a medical emergency, patient survival often depends on ward staff making an early and effective call for help. To improve communication with senior colleagues, ward staff need to create a picture that efficiently and reliably conveys their concerns so that they get the help that they need without delay. This can best be achieved though a structured call for help. The Reason-Story-Vital Signs-Plan system, used in the Acute Life-threatening Events--Recognition and Treatment (ALERT) course, is easy to remember in an emergency and includes the essential information enabling an experienced clinician to respond appropriate to a call for help from ward staff. The use of such a structured call for help could improve patient safety.
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ABSTRACT: Issues around the deterioration of hospitalised children are known: the failure to observe and monitor patients adequately, a failure to recognise the deteriorating patient, a failure to communicative effectively within the healthcare team and a failure to respond appropriately or in a timely manner (Pearson, 2008; NPSA, 2009). In response to this, a new 1-day course called RESPOND (Recognising Signs of Paediatric hOspital iNpatients Deterioration) was developed. To describe the development of the RESPOND course and present a preliminary evaluation of the first four courses. A written postcourse survey was completed by participants (junior doctors, medical students, nurses and health care assistants) immediately after the course and an electronic survey completed three months later in a large children's hospital in the North West of England. Data were analysed descriptively and by simple thematic analysis of free text responses. Sixty-five participants undertook the RESPOND course over four separate days. Overwhelmingly participants found the course positive, with the most frequently cited benefit being improved multidisciplinary communication. Despite a poor response to the second survey, 18% (12 of 65) of respondents remained positive about the impact of the course. This preliminary evaluation combined with a reduction in hospital cardiac arrest rates suggest that the multiprofessional RESPOND course (in conjunction with an early warning tool and response system) is successful as part of a targeted strategy to promote patient safety within a children's hospital.Nursing in Critical Care 10/2013; 19(4). DOI:10.1111/nicc.12050 · 0.87 Impact Factor
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ABSTRACT: To provide a series of recommendations based on the best available evidence to guide clinicians providing nursing care to patients with severe sepsis. Modified Delphi method involving international experts and key individuals in subgroup work and electronic-based discussion among the entire group to achieve consensus. We used the Surviving Sepsis Campaign guidelines as a framework to inform the structure and content of these guidelines. We used the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) system to rate the quality of evidence from high (A) to very low (D) and to determine the strength of recommendations, with grade 1 indicating clear benefit in the septic population and grade 2 indicating less confidence in the benefits in the septic population. In areas without complete agreement between all authors, a process of electronic discussion of all evidence was undertaken until consensus was reached. This process was conducted independently of any funding. Sixty-three recommendations relating to the nursing care of severe sepsis patients are made. Prevention recommendations relate to education, accountability, surveillance of nosocomial infections, hand hygiene, and prevention of respiratory, central line-related, surgical site, and urinary tract infections, whereas infection management recommendations related to both control of the infection source and transmission-based precautions. Recommendations related to initial resuscitation include improved recognition of the deteriorating patient, diagnosis of severe sepsis, seeking further assistance, and initiating early resuscitation measures. Important elements of hemodynamic support relate to improving both tissue oxygenation and macrocirculation. Recommendations related to supportive nursing care incorporate aspects of nutrition, mouth and eye care, and pressure ulcer prevention and management. Pediatric recommendations relate to the use of antibiotics, steroids, vasopressors and inotropes, fluid resuscitation, sedation and analgesia, and the role of therapeutic end points. Consensus was reached regarding many aspects of nursing care of the severe sepsis patient. Despite this, there is an urgent need for further evidence to better inform this area of critical care.Critical care medicine 07/2011; 39(7):1800-18. DOI:10.1097/CCM.0b013e31821867cc · 6.15 Impact Factor
Notfall 11/2010; 13(7):559-620. DOI:10.1007/s10049-010-1370-3 · 0.32 Impact Factor