Background:
Resuscitation of critically ill paediatric patients is complex and challenging even for experienced clinicians. Fortunately in-hospital paediatric cardiopulmonary arrests remain rare events, occurring in only 0.1-0.3% of children admitted to hospital, with the majority occurring in critical care environments.1 Early recognition of respiratory compromise or shock in hospitalized paediatric patients with rapid intervention,2 and involvement of the critical care team for severe or refractory cases, remain fundamental measures to minimize patient progression to pulmonary or cardiac arrest.
Unfortunately, response times for formal in-hospital resuscitation teams frequently exceed 3 minutes;3-5 therefore the current poor performance6 of in-patient ward teams should be addressed as an important hospital quality assurance issue. Illustrating the importance of the initial response, one study demonstrated that all adult patients who survived to hospital discharge from cardiac arrest on the wards were resuscitated by ‘first responders’ (including medical personnel) restoring circulation prior to the arrival of the cardiac arrest team.7
Medical Students (clinical clerks) care for paediatric in-patients under the supervision of residents and staff physicians. They are not primarily responsible for caring for acutely deteriorating paediatric patients but they may, by chance, be the first ‘medical’ professional to evaluate such patients and may assist with resuscitation efforts until more experienced personnel arrive. Evaluating patients, appropriately calling for help and initiating therapy for deteriorating patients or those with sudden decompensation, such as seizures, syncope or arrhythmias should arguably form part of...
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...alue of written-knowledge tests and a multiple-station examination for actual medical performance in daily practice. Med Educ 1999;33:197-203.
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...006). Effect of practice on standardised learning outcomes. Medical Education, 40(8), Retrieved from http://0-web.ebscohost.com.lib.utep.edu/ehost/pdfviewer/pdfviewer?vid=12&hid=106&sid=265b8200-d816-4fa5-aa4f-f99400f42b76%40sessionmgr104 doi: 10.1111/j.1365- 2929.2006.02528.x
Nobody is perfect. We all make mistakes. Some of the best lessons in life are learned from making a mistake. But in the healthcare world making mistakes means losing lives. This has started to happen so frequently there has been a term coined – Failure to Rescue or FTR. Failure to rescue is a situation in which a patient was starting to deteriorate and it wasn’t noticed or it wasn’t properly addressed and the patient dies. The idea is that doctors or nurses could’ve had the opportunity to save the life of the patient but because of a variety of reasons, didn’t. This paper discusses the concept of FTR, describes ways to prevent it from happening; especially in relation to strokes or cerebrovascular accidents, and discusses the nursing implications involved in all of these factors.
Hammer, L., Vitrat, F., Savary, D., Debaty, G., Santre, C., Durand, M., et al. (2009). Immediate prehospital hypothermia protocol in comatose survivors of out-of-hospital cardiac arrest. American Journal of Emergency Medicine, 27(5), 570-573.
Rocognising and Responding Appropriately to Early Signs of Deterioration in Hospitalised Patients (NPSA, 2007) stemmed from the investigation as to why patient deterioration was not being acted on or recognized by healthcare workers. The exploration identified a number of failures centered on lack of proper observation and recordings of observations, and lack of proper communication between hospital staff members. The study uncovered concerns from staff members not observing patients at night, to undertrained staff left to interpret vital signs and perform work outside of their level of expertise. It also showed a pattern of little to no communication between medical colleagues ...
I appreciate that you have decided to share your personal experience within this post. Pediatric care is an entity within itself within the medical field. Ill children are extremely difficult to manage as patients and have the tendency to have a rapid change in status while patients in the hospital. Providing safe care for pediatrics during hospitalization is an area that I am not too familiar with. Working the ER I have had many pediatric patients, but the parents always remain with the patient. When peds patients are admitted, hospital protocol states that the patient must be present during the transfer of the patient to the admitting floor. So, in my experience the parent always provides the safety aspect of care in the ER, patient are expected
Recent studies have shown patients suffering from cardiac arrest are treated with mild therapeutic hypothermia is now recognized as standard therapy in patients resuscitated from out-of-hospital cardiac arrest (OHCA) leading to unexpected death 1 in 1500 adults each year in this hi tech world (Zheng et al 2001). Therapeutic hypothermia (TH) may increase survival and reduce the amount of neurologic damage after cardiac arrest. According to the recent guidelines, comatose survivors of out-of-hospital ventricular fibrillation cardiac arrest should be cooled with internal or external cooling techniques to a target temperature of 32 °C to 34 °C (patients with in-hospital cardiac arrest or other primary rhythms may also be cooled. This target temperature should be maintained for 12 to 24 hours, and after this cooling period the patients should be rewarmed at a rate of 0.25 °C to 0.5 °C hour to normothermia. Significant survival and functional benefit impelling increased acceptance of use of TH.
(10) Levi B.H., Thomas N.J., Green M.J., Rentmeester C.A. & Ceneviva G.D. (2004), jading in the paediatric intensive care unit: implications for healthcare providers of medically complex children. Paediatric Critical Care Medicine 5 (3), 275–277. (11) Ward. E [1990] Ch. 359.
Nurses form an important role in influencing patient safety from everyday tasks and gradually obtaining the patient vital signs have increasingly been seen as a chore instead of collecting clinical evidence. This then creates an extreme danger to patient’s as irregular monitoring of vital signs prevented early detection of deterioration in a patient’s condition, which postpones transfer to intensive care unit ( Kyriacos U et al 2011; Boulanger, 2009). Due to this, a...
The assessment includes a brief manual which appears to be written for a clinician to conduct. It gives directions on how to administer and score the items. The test kit also includes answer sheets and a computer scoring package. The test is also cohesive with the other assessment tests developed by Beck and they results can be easily combined with one another.
The societal taboo associated with death and dying is only worsened when death becomes imminent for an infant or child. Pediatric death and dying is a seldom discussed and often evaded topic in healthcare. This topic, although somber and challenging, is relevant for those nurses who encounter pediatric death and dying first hand. The following discussion will define death and dying in a pediatric population, identify the role of the bedside nurse in support of the dying child and parents of child, the bedside nurse’s role in an interdisciplinary team on a floor where death is a common occurrence, and promotion of nursing self-care to combat compassion fatigue and burnout.
In order behave professionally, first of all, one needs the willingness to learn and be self-aware. Self-awareness would allow the respondent to realise her limitation on “between the flags” policy and be willing to learn and improve her clinical knowledge. If she had done so, she would realise the importance of documentation and the urgent need to arrange medical review for Patient A, preventing her condition from further deteriorating instead of making assumption that urgent medical assistant was unnecessary as long as the continuous administration of antibiotics. Additionally, with a sound professional experience and knowledge, clinical reasoning skills are also essential in professional behaviour. If the respondent had used problem solving, critical thinking and intuitive thinking skills to recognise and respond on Patient A’s deteriorating condition, she would have applied clinical judgement and decision making skill to prioritise the patient’ need to be urgently medical reviewed by the ED doctor even though she may receive some verbal abuse. Once she is confident with her clinical reasoning and judgement, she would take action on arranging urgent medical review, documenting her assessment for further examination and
There are many members of the inter-professional team, all of which are contributing to the healthcare of acute and critically ill patients. Every member of the team has had education and obtained a license of practice compatible to their level of knowledge (Prater, Fundamentals of Nursing, 2013). As a practical nurse you need to be mindful of your scope of practice in relation to registered nurses, certified nurses’ assistants and other healthcare professionals. With so many different people involved in the immediate care of a patient, there is always the possibility of a mix up. The purpose of this paper is to help differentiate between the roles of the healthcare staff, which will in turn help develop a knowledge base for prioritizing care;
Yates, P, Evans, A, Moore, A, Heartfield, M, Gibson, T, & Luxford, K, 2007, ‘Competency
Imagine finding your child pulse less and not breathing. What a terrifying thought! Would you know how to save your child’s life? The number of parents that do not know CPR is astounding. Simply knowing CPR could make a dramatic difference in the lives of you and your loved ones.