The pre-Medical Emergency Team response: Nurses' decision-making escalating deterioration to treating teams using urgent review criteria.
Registered Nurse
clinical decision-making
clinical deterioration
escalation
hospital rapid response system
hospitals
interview
Journal
Journal of advanced nursing
ISSN: 1365-2648
Titre abrégé: J Adv Nurs
Pays: England
ID NLM: 7609811
Informations de publication
Date de publication:
Aug 2020
Aug 2020
Historique:
revised:
24
03
2020
received:
20
10
2019
accepted:
04
05
2020
medline:
21
5
2020
pubmed:
21
5
2020
entrez:
21
5
2020
Statut:
ppublish
Résumé
To describe nurses' decision-making, experiences and perceptions of escalating deteriorating patients to the treating medical team using urgent clinical review criteria. A qualitative design comprising individual in-depth interviews with nurses from a major Australian metropolitan tertiary teaching hospital. A purposive sample of 30 Registered Nurses from nine surgical and medical wards were interviewed in April 2018 using semi-structured interviews. An inductive thematic analysis was conducted. Identified themes included: detecting the deterioration; countering the problem; getting a response; and challenges faced in the process of escalation. Nurses reported an important awareness, sense of responsibility, and critical thinking to ensure the safe management and escalation of deteriorating patients. However, barriers to escalation necessitated individual workarounds and organizational structures to mitigate patient risk. This study supports the importance of communication between clinical teams and recognizes that it is crucial to enable a fail-safe experience for patients and families. Recognition of disciplinary contributions to patients' goals of care is required to better understand and address the prevalence of deteriorating patients. Our study is among the first to explore the actual experience of nurses who articulate balancing uncertainty and managing complex team dynamics on wards for patients experiencing deteriorating health status. The information may assist in determining team training strategies and structures to facilitate patient management during deterioration. This is among the first study to investigate barriers influencing decision-making of RNs prior to escalation using qualitative methods. This study provides a foundation to inform and develop policies and strategies aimed at ensuring escalation occurs for deteriorating patients. 目的: 本研究旨在阐述护士利用紧急临床评价标准将病情恶化的患者上报给主治医疗团队的决策、经验和看法。 设计: 采用定性设计,包括对澳大利亚大都会一家重点三级教学医院的护士进行个人深入访谈。 方法: 2018年4月,采用半结构式访谈法,对来自9个外科和内科病房的30名注册护士进行了目的性抽样调查。在本研究中,进行了归纳性主题分析。 结果: 已确定的主题包括:发现病情恶化;应对问题;获得回应;在上报过程中面临的挑战。护士表示,他们对自己有深刻认知,有责任感,具有批判性思维,以确保安全管理和上报病情恶化的患者。但若在上报时遇到障碍,则需要个人采取灵活变通办法和组织结构,以降低患者的风险。 结论: 本研究对临床团队之间保持沟通的重要性予以支持,并认识到为患者及其家属提供容错体验至关重要。需要认识到专业知识对实现患者护理目标的贡献,以便更好地了解和处理病情恶化患者的发病率问题。本研究首次探索了护士在病房向健康状况恶化的患者阐明平衡不确定性和管理复杂的团队动态等方面的实际经验。这些信息可能有助于确定团队培训策略和结构,从而促进患者病情恶化期间的管理工作。 影响: 这是首次采用定性方法探讨影响注册护士在上报患者病情恶化情况之前作出决策的障碍因素的研究之一。本研究为宣传和制定一些旨在确保患者病情恶化得以上报的政策和战略提供了一个依据。.
Autres résumés
Type: Publisher
(chi)
目的: 本研究旨在阐述护士利用紧急临床评价标准将病情恶化的患者上报给主治医疗团队的决策、经验和看法。 设计: 采用定性设计,包括对澳大利亚大都会一家重点三级教学医院的护士进行个人深入访谈。 方法: 2018年4月,采用半结构式访谈法,对来自9个外科和内科病房的30名注册护士进行了目的性抽样调查。在本研究中,进行了归纳性主题分析。 结果: 已确定的主题包括:发现病情恶化;应对问题;获得回应;在上报过程中面临的挑战。护士表示,他们对自己有深刻认知,有责任感,具有批判性思维,以确保安全管理和上报病情恶化的患者。但若在上报时遇到障碍,则需要个人采取灵活变通办法和组织结构,以降低患者的风险。 结论: 本研究对临床团队之间保持沟通的重要性予以支持,并认识到为患者及其家属提供容错体验至关重要。需要认识到专业知识对实现患者护理目标的贡献,以便更好地了解和处理病情恶化患者的发病率问题。本研究首次探索了护士在病房向健康状况恶化的患者阐明平衡不确定性和管理复杂的团队动态等方面的实际经验。这些信息可能有助于确定团队培训策略和结构,从而促进患者病情恶化期间的管理工作。 影响: 这是首次采用定性方法探讨影响注册护士在上报患者病情恶化情况之前作出决策的障碍因素的研究之一。本研究为宣传和制定一些旨在确保患者病情恶化得以上报的政策和战略提供了一个依据。.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2171-2181Subventions
Organisme : Alfred Health Research
Informations de copyright
© 2020 John Wiley & Sons Ltd.
Références
Aneman, A., Frost, S. A., Parr, M. J., & Hillman, K. M. (2014). Characteristics and outcomes of patients admitted to ICU following activation of the Medical Emergency Team: Impact of introducing a two-tier response system. Critical Care Medicine, 43(4), 765-773.
Australian Commission on Safety and Quality in Health Care. (2017). National consensus statement: Essential elements for recognising and responding to acute physiological deterioration (2nd ed.). Sydney, Australia: ACSQHC. Retrieved from https://www.safetyandquality.gov.au/sites/default/files/migrated/National-Consensus-Statement-clinical-deterioration_2017.pdf
Bell, M., Konrad, D., Granath, F., Ekbom, A., & Martling, C. (2006). Prevalence and sensitivity of MET-criteria in a Scandinavian University Hospital. Resuscitation, 70(1), 66-73. https://doi.org/10.1016/j.resuscitation.2005.11.011
Bingham, G., Fossum, M., Barratt, M., & Bucknall, T. (2015). Clinical review criteria and Medical Emergency Teams: Evaluating a two-tier rapid response system. Critical Care Resuscitation, 17(3), 167-173.
Brennan, T. A., Leape, L. L., Laird, N. M., Hebert, L., Localio, A. R., Lawthers, A. G., … Hiatt, H. H. (1991). Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice Study I. New England Journal of Medicine, 324(6), 370-376. https://doi.org/10.1056/nejm199102073240604
Bucknall, T. (1996). Clinical decision making in critical care nursing practice: Decisions, processes and influences. Melbourne, Vic., Australia: La Trobe University Australia.
Bucknall, T. (2003). The clinical landscape of critical care: Nurses' decision-making. Journal of Advanced Nursing, 43(3), 310-319. https://doi.org/10.1046/j.1365-2648.2003.02714.x
Bucknall, T., Forbes, H., Phillips, N. M., Hewitt, N. A., Cooper, S., & Bogossian, F. (2016). An analysis of nursing students' decision-making in teams during simulations of acute patient deterioration. Journal of Advanced Nursing, 72(10), 2482-2494. https://doi.org/10.1111/jan.13009
Bucknall, T., Fossum, M., Hutchinson, A. M., Botti, M., Considine, J., Dunning, T., … Manias, E. (2019). Nurses' decision-making, practices and perceptions of patient involvement in medication administration in an acute hospital setting. Journal of Advanced Nursing, 75(6), 1316-1327. https://doi.org/10.1111/jan.13963
Bucknall, T. K., Harvey, G., Considine, J., Mitchell, I., Rycroft-Malone, J. O., Graham, I. D., … Hutchinson, A. M. (2017). Prioritising Responses Of Nurses To deteriorating patient Observations (PRONTO) protocol: Testing the effectiveness of a facilitation intervention in a pragmatic, cluster-randomised trial with an embedded process evaluation and cost analysis. Implementation Science, 12(1), 85. https://doi.org/10.1186/s13012-017-0617-5
Bucknall, T., Jones, D., Bellomo, R., & Staples, M. (2013). Responding to medical emergencies: System characteristics under examination (RESCUE). A prospective multi-site point prevalence study. Resuscitation, 84(2), 179-183. https://doi.org/10.1016/j.resuscitation.2012.06.015
Bucknall, T., Kent, B., & Manley, K. (2008). Evidence use and evidence generation in practice development. In K. Manley, B. McCormack, & V. Wilson (Eds.), International practice development in nursing (pp. 84-104). Oxford, UK: Wiley-Blackwell.
Chen, J. (2017). In search of the 'best' rapid response early warning system - The journey has just begun. Resuscitation. https://doi.org/10.1016/j.resuscitation.2017.12.005
Chen, J., Bellomo, R., Flabouris, A., Hillman, K., Assareh, H., & Ou, L. (2015). Delayed emergency team calls and associated hospital mortality: A multicenter study. Critical Care Medicine, 43(10), 2059-2065. https://doi.org/10.1097/ccm.0000000000001192
Churpek, M. M., Yuen, T. C., & Edelson, D. P. (2013). Predicting clinical deterioration in the hospital: The impact of outcome selection. Resuscitation, 84(5), 564-568. https://doi.org/10.1016/j.resuscitation.2012.09.024
Considine, J., & Currey, J. (2015). Ensuring a proactive, evidence-based, patient safety approach to patient assessment. Journal of Clinical Nursing, 24(1-2), 300-307. https://doi.org/10.1111/jocn.12641
Considine, J., Trotter, C., & Currey, J. (2016). Nurses' documentation of physiological observations in three acute care settings. Journal of Clinical Nursing, 25(1-2), 134-143. https://doi.org/10.1111/jocn.13010
Currey, J., Allen, J., & Jones, D. (2018). Critical care clinician perceptions of factors leading to Medical Emergency Team review. Australian Critical Care, 31(2), 87-92. https://doi.org/10.1016/j.aucc.2017.03.003
Downey, C. L., Tahir, W., Randell, R., Brown, J. M., & Jayne, D. G. (2017). Strengths and limitations of early warning scores: A systematic review and narrative synthesis. International Journal of Nursing Studies, 76, 106-119. https://doi.org/10.1016/j.ijnurstu.2017.09.003
Elliott, D., Allen, E., McKinley, S., Perry, L., Duffield, C., Fry, M., … Roche, M. (2016). User acceptance of observation and response charts with a track and trigger system: A multisite staff survey. Journal of Clinical Nursing, 25(15-16), 2211-2222. https://doi.org/10.1111/jocn.13303
Foley, C., & Dowling, M. (2019). How do nurses use the early warning score in their practice? A case study from an acute medical unit. Journal of Clinical Nursing, 28(7-8), 1183-1192. https://doi.org/10.1111/jocn.14713
Franklin, C., & Mathew, J. (1994). Developing strategies to prevent inhospital cardiac arrest: Analyzing responses of physicians and nurses in the hours before the event. Critical Care Medicine, 22(2), 244-247. https://doi.org/10.1097/00003246-199402000-00014
Goldhill, D. R., & McNarry, A. F. (2004). Physiological abnormalities in early warning scores are related to mortality in adult inpatients. British Journal of Anaesthesia, 92(6), 882-884. https://doi.org/10.1093/bja/aeh113
Goldhill, D. R., McNarry, A. F., Mandersloot, G., & McGinley, A. (2005). A physiologically-based early warning score for ward patients: The association between score and outcome. Anaesthesia, 60(6), 547-553. https://doi.org/10.1111/j.1365-2044.2005.04186.x
Guinane, J. L., Bucknall, T. K., Currey, J., & Jones, D. A. (2013). Missed medical emergency team activations: Tracking decisions and outcomes in practice. Critical Care and Resuscitation, 15(4), 266-272.
Hillman, K., Chen, J., & Jones, D. (2014). Rapid response systems. The Medical Journal of Australia, 201(9), 519-521. https://doi.org/10.5694/mja14.01088
Hosking, J., Considine, J., & Sands, N. (2014). Recognising clinical deterioration in emergency department patients. Australasian Emergency Nursing Journal, 17(2), 59-67. https://doi.org/10.1016/j.aenj.2014.03.001
Jones, D., Bhasale, A., Bailey, M., Pilcher, D., & Anstey, M. H. (2018). Effect of a national standard for deteriorating patients on intensive care admissions due to cardiac arrest in Australia. Critical Care Medicine, 46(4), 586-593. https://doi.org/10.1097/ccm.0000000000002951
Jones, D., Hicks, P., Currey, J., Holmes, J., Fennessy, G. J., Hillman, K., … Fugaccia, E. (2015). Findings of the first ANZICS conference on the role of intensive care in Rapid Response Teams. Anaesthesia and Intensive Care, 43(3), 369-379. https://doi.org/10.1016/j.resuscitation.2010.01.024
Le Lagadec, M. D., & Dwyer, T. (2017). Scoping review: The use of early warning systems for the identification of in-hospital patients at risk of deterioration. Australian Critical Care, 30(4), 211-218. https://doi.org/10.1016/j.aucc.2016.10.003
Lincoln, Y. S., & Guba, E. G. (1986). But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Directions in Evaluation, 30, 73-84. https://doi.org/10.1002/ev.1427
Ludikhuize, J., de Jonge, E., & Goossens, A. (2011). Measuring adherence among nurses one year after training in applying the Modified Early Warning Score and Situation-Background-Assessment-Recommendation instruments. Resuscitation, 82(11), 1428-1433. https://doi.org/10.1016/j.resuscitation.2011.05.026
Manias, E., Botti, M., & Bucknall, T. (2002). Observation of pain assessment and management - The complexities of clinical practice. Journal of Clinical Nursing, 11(6), 724-733. https://doi.org/10.1046/j.1365-2702.2002.00691.x
Marshall, S. D., Kitto, S., Shearer, W., Wilson, S. J., Finnigan, M. A., Sturgess, T., … Buist, M. D. (2011). Why don't hospital staff activate the rapid response system (RRS)? How frequently is it needed and can the process be improved? Implementation Science, 6, 39. https://doi.org/10.1186/1748-5908-6-39
Marshall, S., Warren, B., Roodenburg, O., Smolenaers, F., Leon, G., McKimm, A., & Stripp, A. (2016). An Electronic Task Management (ETM) system for after hours hospital work and subsequent socially mediated effects of task completion. Proceedings of the Human Factors and Ergonomics Society annual meeting, 60, 566-570. https://doi.org/10.1177/1541931213601130
Martland, J., Chamberlain, D., Hutton, A., & Smigielski, M. (2016). Communication and general concern criterion prior to activation of the rapid response team: A grounded theory. Australian Health Review, 40(5), 477-483. https://doi.org/10.1071/ah15123
Massey, D., Chaboyer, W., & Aitken, L. (2014). Nurses' perceptions of accessing a Medical Emergency Team: A qualitative study. Australian Critical Care, 27(3), 133-138. https://doi.org/10.1016/j.aucc.2013.11.001
Massey, D., Chaboyer, W., & Anderson, V. (2017). What factors influence ward nurses' recognition of and response to patient deterioration? An integrative review of the literature. Nursing Open, 4(1), 6-23. https://doi.org/10.1002/nop2.53
McQuillan, P., Pilkington, S., Allan, A., Taylor, B., Short, A., Morgan, G., … Collins, C. H. (1998). Confidential inquiry into quality of care before admission to intensive care. British Medical Journal, 316(7148), 1853-1858. https://doi.org/10.1136/bmj.316.7148.1853
Mohammmed Iddrisu, S., Hutchinson, A. F., Sungkar, Y., & Considine, J. (2018). Nurses role in recognising and responding to clinical deterioration. Journal of Clinical Nursing, 27, 1920-1930. https://doi.org/10.1111/jocn.14331
Odell, M., Victor, C., & Oliver, D. (2009). Nurses' role in detecting deterioration in ward patients: Systematic literature review. Journal of Advanced Nursing, 65(10), 1992-2006. https://doi.org/10.1111/j.1365-2648.2009.05109.x
Osborne, S., Douglas, C., Reid, C., Jones, L., & Gardner, G. (2015). The primacy of vital signs - Acute care nurses' and midwives' use of physical assessment skills: A cross sectional study. International Journal of Nursing Studies, 52(5), 951-962. https://doi.org/10.1016/j.ijnurstu.2015.01.014
Petersen, J. A., Rasmussen, L. S., & Rydahl-Hansen, S. (2017). Barriers and facilitating factors related to use of early warning score among acute care nurses: A qualitative study. BMC Emergency Medicine, 17(1), 36. https://doi.org/10.1186/s12873-017-0147-0
QSR International Pty Ltd. (2015). NVivo qualitative data analysis software (version 11). Retrieved from http://www.qsrinternational.com/default.aspx
Rihari-Thomas, J., DiGiacomo, M., Phillips, J., Newton, P., & Davidson, P. M. (2017). Clinician perspectives of barriers to effective implementation of a rapid response system in an academic health centre: A focus group study. International Journal of Health Policy and Management, 6(8), 447-456. https://doi.org/10.15171/ijhpm.2016.156
Ritchie, J., & Spencer, L. (1994). Qualitative data analysis for applied policy research. In A. Bryman & R. Burges (Eds.), Analysing qualitative data (pp. 173-194). London, UK: Routledge.
Sandelowski, M. (1995). Sample size in qualitative research. Research in Nursing & Health, 18(2), 179-183. https://doi.org/10.1002/nur.4770180211
Schein, R. M., Hazday, N., Pena, M., Ruben, B. H., & Sprung, C. L. (1990). Clinical antecedents to in-hospital cardiopulmonary arrest. Chest, 98(6), 1388-1392. https://doi.org/10.1378/chest.98.6.1388
Shearer, B., Marshall, S., Buist, M. D., Finnigan, M., Kitto, S., Hore, T., … Ramsay, W. (2012). What stops hospital clinical staff from following protocols? An analysis of the incidence and factors behind the failure of bedside clinical staff to activate the rapid response system in a multi-campus Australian metropolitan healthcare service. BMJ Quality & Safety, 21(7), 569-575. https://doi.org/10.1136/bmjqs-2011-000692
Sprogis, S. K., Currey, J., Considine, J., Baldwin, I., & Jones, D. (2017). Physiological antecedents and ward clinician responses before medical emergency team activation. Critical Care Resuscitation, 19(1), 50-56.
Thompson, C., Bucknall, T., Estabrookes, C. A., Hutchinson, A., Fraser, K., de Vos, R., … Saunders, J. (2009). Nurses' critical event risk assessments: A judgement analysis. Journal of Clinical Nursing, 18(4), 601-612. https://doi.org/10.1111/j.1365-2702.2007.02191.x
Tirkkonen, J., Huhtala, H., & Hoppu, S. (2018). In-hospital cardiac arrest after a rapid response team review: A matched case-control study. Resuscitation, 128, 98-103. https://doi.org/10.1016/j.resuscitation.2018.03.007
Trinkle, R. M., & Flabouris, A. (2011). Medical reviews before cardiac arrest, medical emergency call or unanticipated intensive care unit admission: Their nature and impact on patient outcome. Critical Care Resuscitation, 13, 175-180.
Wilson, R. M., Runciman, W. B., Gibberd, R. W., Harrison, B. T., Newby, L., & Hamilton, J. D. (1995). The quality in Australian health care study. Medical Journal of Australia, 163(9), 458-471. https://doi.org/10.5694/j.1326-5377.1995.tb124691.x