RECOGNISING WHEN TO ESCALATE Flashcards
Benefits of using iSBAR to hand over?
Structured
Easy to remember and fall back on in a crisis
Succinct
Recognised by all clinicians
It improves information transfer and pt outcomes
What does iSBAR stand for?
Introduction
Situation - “I’m calling about a pt i am concerned that…”
Background - “pt was admitted on…”
Assessment - “i think the problem is xyz and i have given…”
Recommendation - “i need you to… and is there anything i need to do in the meantime”
What are the levels of critical care?
Ward care
Level 1 - enhanced care
Level 2 - critical care
Level 3 - critical care
Which pts should be under “ward care” in terms of levels of care?
Patients whose needs can be met through normal ward care in an acute hospital.
Patients who have recently been relocated from a higher level of care, but their needs can be
met on an acute ward with additional advice and support from the critical care outreach team.
Patients who can be managed on a ward but remain at risk of clinical deterioration.
Which pts should be under “level 1- enhanced care” in terms of levels of care?
Patients requiring more detailed observations or interventions, including basic support for a single organ system and those ‘stepping down’ from higher levels of care.
● Patients requiring interventions to prevent further deterioration or rehabilitation needs which cannot be met on a normal ward.
● Patients who require on going interventions (other than routine follow up) from critical care outreach teams to intervene in deterioration or to support escalation of care.
● Patients needing a greater degree of observation and monitoring that cannot be safely provided on a ward, judged on the basis of clinical circumstances and ward resources.
● Patients who would benefit from Enhanced Perioperative Care.(3)
Which pts should be under “level 2- critical care” in terms of levels of care?
atients requiring more detailed observations or interventions, including basic support for a single organ system and those ‘stepping down’ from higher levels of care.
● Patients requiring interventions to prevent further deterioration or rehabilitation needs which cannot be met on a normal ward.
● Patients who require on going interventions (other than routine follow up) from critical care outreach teams to intervene in deterioration or to support escalation of care.
● Patients needing a greater degree of observation and monitoring that cannot be safely provided on a ward, judged on the basis of clinical circumstances and ward resources.
● Patients who would benefit from Enhanced Perioperative Care.(3)
Which pts should be under “level 3 - critical care” in terms of levels of care?
Patients needing advanced respiratory monitoring and support alone.
● Patients requiring monitoring and support for two or more organ systems at an advanced level.
● Patients with chronic impairment of one or more organ systems sufficient to restrict daily activities (co-morbidity) and who require support for an acute reversible failure of another organ system.
● Patients who experience delirium and agitation in addition to requiring level 2 care.
● Complex patients requiring support for multiple organ failures, this may not necessarily include
advanced respiratory support.
Under which level of care should this patient be:
A patient with DKA who is on appropriate treatment and was initially very acidotic but is gradually improving and requiring no organ support.
Ward level care
Under which level of care should this patient be:
A patient requiring NIV/CPAP for single organ failure.
Level 1
Under which level of care should this patient be:
A patient requiring NIV/CPAP who has borderline blood pressure and also needs vasopressor support
Level 2
Under which level of care should this patient be:
A patient requiring mechanical ventilation
Level 3
Under which level of care should this patient be:
A patient requiring NIV/CPAP who has borderline blood pressure, vasopressor support and is agitated or delirious?
Level 3
What are the human factors or non-technical skills that are important for successful rescutation of a pt?
The cognitive, social and personal resource skills that complement technical skill and contribute to safe and efficient task performance
Deficiencies in these are a cvommon cause of adverse events
What are examples of human factors for successful resuscitation?
Situational awareness
Decision making
Team working including clear roles, effective communication and leadership
Task management
Stress management
Reflection and debriefing
Distraction
Lack of resources
Fatigue
Frequency of monitoring and NEWS score?
0 - 12 hourly
1-4 - 4-6 hourly
3 in a single parameter - at least 1 hourly
5 or more - at least 1 hourly
7 or more - continuous monitoring
Who can be admitted to ICU?
It’s appropriate for pt requiring or likely to require advanced respiratory support, pts requiring support of 1 or more organ systems and pts with chronic impairment of 1 or more organ systems who also require support for an acute reversible failure of another organ
They must require higher level of monitoring organ support, reversible pathology and a physiological reserve to survive intensive and invasive treatment
