Nursing - Research Publications
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ItemNurses' role in recognising and responding to clinical deterioration in surgical patients(WILEY, 2018-05)AIM AND OBJECTIVES: To explore nurse' role in recognising and responding to deteriorating post-operative patients. BACKGROUND: Clinical deterioration is a significant problem in acute care settings. Nurses play a vital role in post-operative patient monitoring; however, there is limited understanding of the nurses' role in recognising and responding to clinical deterioration in surgical patients. METHODS: This qualitative exploratory study was conducted at a metropolitan teaching hospital in Melbourne, Australia. Data were collected through focus groups from 1 September to 31 October 2014. Four focus groups of 2-5 surgical nurses (n = 14) were conducted to explore the nurses' perception of their role in managing deterioration over the first 72 hr postoperatively. Qualitative data were recorded, transcribed and key themes identified. RESULTS: Nurses demonstrated a high level of awareness of their role in recognising and responding to early signs of deterioration. The themes that arose from the focus group interviews were "struggling with blood pressure," and "we know our patient is sick." The nurses were confident about the clinical indicators of deterioration and the appropriate channels to use to escalate care. Using track and trigger observation charts enabled nurses to identify deteriorating patients prior to the patient fulfilling rapid response system escalation criteria. CONCLUSIONS: These findings highlight the importance of a collective team approach to preventing, recognising and responding to clinical deterioration across the whole patient journey. Initiatives to ensure accurate written and verbal communication between medical and nursing staff warrants further assessment. RELEVANCE TO CLINICAL PRACTICE: Nurses working in acute surgical wards are highly engaged in the process of recognising and responding to clinical deterioration in post-operative patients. Many nurses reported being able to anticipate deterioration occurring but are required by current organisational frameworks to escalate care to rapid response systems. How nurses anticipate and manage deterioration prior to the patient fulfilling rapid response system criteria warrants further investigation.
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ItemFrequency, nature and timing of clinical deterioration in the early postoperative period(WILEY, 2018-10)AIMS AND OBJECTIVES: To establish the frequency of clinical deterioration in the early postoperative period in patients who have undergone general or orthopaedic surgery. BACKGROUND: Worldwide, clinical deterioration is a significant problem in acute care settings. Early recognition and response to clinical deterioration is one of the ten National Safety and Quality Health Service Standards in Australia. However, there is limited understanding of the frequency of clinical deterioration in surgical patients. METHODS: A point prevalence study was conducted from September-October 2014. The records of 100 consecutive in patients admitted for orthopaedic (n = 48) or general surgery (n = 52) to a health service in Melbourne, Australia, were audited. The frequency of clinical deterioration episodes was summarised using descriptive statistics. RESULTS: Baseline characteristics of the two patient groups were equivalent except that orthopaedic patients were older than the general surgery patients (median age 71 [IQR 19] years vs. 62 [IQR 17] years). There were 17 medical emergency team calls and 23 calls for urgent clinical review in 28 patients. The main indications for emergency calls were hypotension (26%), fever (19%), hypoxia (15%), tachycardia (13%) and altered blood glucose level (11%). The majority of episodes were managed on the ward, and there were one ICU transfer and no cardiac arrest calls. CONCLUSION: One in four patients experienced early postoperative clinical deterioration. Hypotension was the most common trigger for escalation of care highlighting a need to optimise fluid and haemodynamic management of postoperative patients. RELEVANCE TO CLINICAL PRACTICE: Haemodynamic instability leading to the activation of rapid response systems is very common in the immediate postoperative period. There is the need for locally tailored interventions to optimise fluid management and decrease incidence of further complications.