Early Recognition and Activation of Urgent Medical Help for Clinically Deteriorating Patients

By YEUNG Nga Man, Karen, RN, BSc (Nursing), MNurs, FHKAN (Nursing & Health Care Management)

Purpose

The purpose of study is to enhance nurses’ awareness, knowledge, and confidence in identifying and responding to patient deterioration, by developing a standardized education programme on early recognition and activation of Urgent Medical Help for the clinically deteriorating patient according to evidence based practices.

Background

Abnormal signs and symptoms frequently occur before cardiac arrest as early as 6-8 hours before cardiac arrest with increased risk of mortality. These warning signs provide sufficient time to identify clinical deterioration in patient before significant adverse event occurs5 and thus interventions can be implemented for reducing the chances of unplanned ICU admission, cardiac arrest, or mortality. As a result, patient outcomes, safety and patient satisfaction will be enhanced. HKSH has guidelines for in-house support of cardiac arrest and provides BLS and ACLS training for more than 50% of nurses. However, nurses have expressed concern about the handling of deteriorating patients. To reduce the number of instances where nurses either miss the warning signs or lack of confidence in identifying deteriorating condition, evidence shows that a sufficient knowledge-base and appropriate attitude are essential in an early recognition and response system. Communication also plays a vital role in managing a clinically deteriorating patient.

Methods

Survey of 16 nurses who worked in a Medical/Surgical Unit was performed in HKSH with 3 stages: before intervention, immediately after intervention and 2 weeks after intervention. Data of nurses’ self-perceived knowledge and extent of experience, confidence level, communication method and current practices of nurses was collected. Intervention was a standardized education programme with 4 components: Learning Session, Reference Guide For Staff, Exercise for practising on how to communicate with doctor, and ISBAR telephone handover reminder.

Results

The project proved that a standardized education programme on early recognition and activation of Urgent Medical Help for the clinically deteriorating patient enhance nurses’ awareness in activating urgent medical help, improve their knowledge in recognizing deteriorating patient and understanding in Urgent Medical Help Support System in HKSH, increase their confidence towards activating for Urgent Medical Help and communicating with doctors.

Discussion

Education program should develop based on both evidences and staff feedback as it can have the greatest impact and sustainability. It empowers nurses to seek help accurately, efficiently, and effectively. However, limitation in generalizing result was noted as it had a small sample size. It requires longer study period and objective data collection to look for clinical significance. A small decrease is to be expected after a time gap from the training so providing continuous reinforcement afterward is necessary. Therefore, education programme should be extended to all clinical units within HKSH and train-the-trainer helps to sustain its impact. Regular review of the programme to update relevant information and continuous evaluation of the outcomes to look for sustainability is needed.