Trainee Advanced Nurse Practitioner
Place of work
Acorn Primary Health Care Centre, East Lancashire Hospitals NHS Trust
Deterioration can happen at any point, particularly following emergency admissions, surgery and even in primary care due to care closer to home incentives. By closely monitoring changes in observations, deterioration is more likely to be identified before a serious adverse event occurs (NPSA, 2007).
According to Hogan et al (2012), 26% of preventable deaths can be attributed to failure to set up systems, respond to deterioration and act on results. This failure in clinical monitoring was also highlighted in a 2016 audit of the intensive home support service. Only 53% of patients received a full set of 6 physical observations, which according to NICE (2007) is a minimum requirement. Also in 55% of patients, deterioration was present 12 hours prior to admission; however recognition or response was not documented.
To implement the National Early Warning Score (NEWS) and escalation protocol, specifically adapted for use in a community setting. This will standardise practice in line with national and local practice and aid early recognition of deterioration, supporting consistent clinical decision making.
1. Increase urgency - Audit current practice against benchmarks, present to key stakeholders.
2. Guiding coalition - To aid development of the escalation protocol.
3. Vision and strategy - Online and face to face training sessions and a pre-trial.
4. Communicate - Regular emails, team meeting’s, appropriate trust boards.
5. Empower - Promote involvement, encourage ideas, promote positive patient journeys.
6. Short term wins - Early audit and feedback.
7. Consolidation - Recognise and reward, continued audit.
8. Anchoring - Incorporate into trust policy, extend to community services.
Continued measurement utilising Plan, Do, Study, Act cycles (Langley et al, 2009) throughout a 3-month pilot with the final evaluation measured using CIPP (Context, Input, Process, Product) (Shufflebeam,2001).
Standardised practice in line with local and national guidelines. Initial data suggests an improvement in documentation of deterioration, recognition and response.
Three key learning points
1. Deterioration is not unique to the hospital
2. Importance of a standardised system in the recognition of deterioration
3. Excellent patient care in the home can have a positive impact on secondary care