OD seminar Flashcards
what is clinical deterioration
a dynamic state experienced by a patient compromising hemodynamic stability, marked by a physiological decompensation accompanied by subjective or objective findings
failure to recognize clinical deterioration
-in a timely manner is a global safety concern
-all hospitalized patients are at risk
-avoidable high mortality events still occuring
what is failure to rescue
-failure to recognize and respond to acute deterioration in an effective and timely manner
early warning signs of clinical deterioration
-unrecognized leads to lethal results
-virtually every inpatient event is preceded by warning signs approx 6-6.5h in advance
risks of clinical deterioration in the early warning phase
-normalization of abnormal findings
-brushing off familial concerns
-ineffective communication/assessment
-hesitating to bring forward concerns
-missing/skipping vitals
-not checking test results
-missing assessment/no documentation
-only escalated when changes are significant
contributing factors to failure to rescue
-lack of awareness of s&s
-lack of continuity of care
-vitals not monitored
-inexperience
-ineffective communication
-subtle changes not picked up
-unsure of how to escalate
-lack of confidence
-confirmation bias
-distractions
-inc work load
risk for clinical deterioration
-pre-existing conditions
-comorbidities
-immunocompromised
causes for clinical deterioration
-post-op comps
-sepsis
10 warning signs of clinical deterioration in a patient
- Temp (H or L)
2.HR or RR changes
3.BP not in range
4.changes in mental state
5.changes in urine output/appearance
6.pt states something is wrong
7.pt doesn’t look right to family
8.SOB
9.acute pain (esp abdo)
10.very pale/diaphoretic
recognizing clinical deterioration
-use ABCDE to assess
-full set of vitals and compare w trends
managing clinical deterioration
-get help
-collect more info
-position pt
-consider o2 therapy
-prepare equipment
indicators of serious illness
RR of <9 or >30
SBP >100 in HTN pt (on BB’s)
o2 <93 & abnormal
cap refill <2s
temp up or down
GCS changes
initial nursing management of clinical deterioration
-get help (RT, MD, CCRN)
-position appropriately
-collect more info (trends, meds, etc)
-consider o2 tx
-prepare equipment for medical emergency team
-handover using ISBAR
what is NEWS2 score
early warning score based on vitals
-provides pathways to take based on physiologic parameters
-standardized assessment, monitoring, and tracking of acute pts
6 parameters of NEWS2
- temp
- HR
- RR
- SBP
- O2 sat
- LOC
