There are events, subtle or otherwise, leading up to a critical change in health status. As nurses at the bedside, we must have strategies and protocols implemented in order to monitor changes in vital signs and trends leading towards a cardiac, respiratory, or neurologic event. In a hospital setting, patients are monitored for changes in condition, whether it be improvement or deterioration, allowing clinicians to decide the course of action to follow in their care. In the Intensive Care Unit (ICU), patients are being monitored very closely while their vital signs, their neurological status, and their physical status are being managed with strong medications, lifesaving machines, and the clinical knowledge and skills of trained ICU nurses. Outside of the ICU, it is essential for staff nurses to identify the patient that is clinically deteriorating and in need of urgent intervention.
A Code Rescue or
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Calls to outpatient areas such as radiology, rehab, and the hospital lobby are also on the rise, with family members, visitors, and employees being added, besides the inpatients, to the list of eligible Code Rescue calls for the ICU nurse to respond to. With Code Rescues involving a Stroke Alert, the ICU nurse must accompany the patient to the CT Scan area for a STAT CT of the brain, which takes the nurse away from their assigned patients for an even longer period of time based on the status of that patient. When a nurses take their break, another nurse is required to monitor those patients as well as take care of their own patient assignment. The attention given to the other patients is not considered to be extensive, basically “keeping an eye” on them until their nurse returns. This patient assignment could be at a safety risk if their nurse is also the one assigned to respond to Code Rescues at any time during the
In the nursing profession, communication is a tool to be used effectively in shift-to-shift report to ensure continuity of care and patient safety (Matic, Davidson, & Salamonson, 2010, p. 184). Benson, Rippin-Sisler, Jabusch, and Keast (2007) explain “for a report to be meaningful, the information passed along to the receiver must be done in a way that is effective and efficient; otherwise, the point of communicating the information may be lost” (p. 80). The Joint Commission (TJC) defines barriers in communication as a leading threat to patient safety (Matic et al., 2010, p. 185). Patient safety and continuity of care can be maintained by implementing a handoff communication tool and bedside nurse-to-nurse handoff.
In fact, it is important to the patient’s healing. Before a patient comes to my floor, I look up their history and reasons for admission. This is the gathering or pre-orientation phase. The orientation phase for the bedside nurse would be when the patient arrives on the floor. The nurse introduces their self to the patient and begins establishing trust. The nurse asks the patient questions to see what their expectations are and clarifies the expectations of the hospital or unit. The nurse then explains the plan of care to the patient and answers any questions. In the working phase, the nurse is the patient’s advocate and addresses any problems the patient has. The nurse assures the patient they will research any problems and find out the answers as quickly as possible. Once the nurse finds the answers, he/she relays the information to the patient and the family. He/she may give the patient educational materials, show them a video or simply provide an explanation from the provider. During the resolution phase, the nurse provides discharge information. He/she answers any questions related to discharge and provides the patient with instructions post discharge from the hospital. If the nurse has established a relationship and trust with the patient, the hospital stay and discharge should leave the patient confident that they are well enough for discharge home or to a facility.
With patient safety always being the number one priority FTR is the worst case scenario for the hospitalized patient. In an article titled “Failure to Rescue: The Nurse’s Impact” from the Medsurg Nursing Journal author Garvey explains ways FTR can occur “including organizational failure, provider lack of knowledge and failure to realize clinical injury, lack of supervision, and failure to get advice.” Nurses are problem solvers by nature, they heal the sick and help save lives. FTR is a tragic experience for everyone involved. The recent surge in this happening across the country has given FTR cases widespread media coverage. Hospitals are trying to figure out what the root cause is and how they can be prevented. Fortunately, with the advancement of technology and extensive research many hospitals have developed action plans and procedures to help prevent the early warning signs from being
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 ...
According to the Registered Nurse (RN) Scope of Practice Position Statement, “the RN is responsible for providing safe, compassionate, and comprehensive nursing care to patients and their families with complex healthcare needs” (Texas Board of Nursing, 2011). Nurses often care for five to six patients at one time; therefore, in order to provide the best quality care, patients are often connected to monitoring devices such as, physiological monitors, venti...
Recognition, response and treatment of deteriorating patients are essential elements of improving patient outcomes and reducing unanticipated inpatient hospital deaths (Fuhrmann et al 2009; Mitchell et al 2010) appropriate management of the deteriorating patient is often insufficient when not managed in a timely fashion (Fuhrmann et al 2009; Naeem et al 2005; Goldhill 2001). Detection of these clinical changes, coupled with early accurate intervention may avoid adverse outcomes, including cardiac arrest and deaths (Subbe et al. 2003).
Firstly, Nurses must develop the right communication tools when dealing with their patients. For example most nurses do bedside reporting, before they change their shift in the morning, therefore they would be relaying information to the other nurse about the patient they dealt with during the night. The nurse that is going off shift would give a report to the incoming nurse in the presence of the patient. He or she has to discuss the condition of the patient, medications and the procedures so the next nurse would be on the same level. Most nurses in the General Hospital do their reporting by the bedside of their patients.
JB McKenzie, et al. "STRATEGIES USED BY CRITICAL CARE NURSES TO IDENTIFY, INTERRUPT, AND CORRECT MEDICAL ERRORS." American Journal of Critical Care 19.6 (2010): 500-509. CINAHL Plus with Full Text. EBSCO. Web. 7 Mar. 2011.
It’s hard to leave a loved one in a hospital bed when night falls. Family members leave with a sense of responsibility, guilt, and sadness. They leave relying on the nurse to watch and care for their sick family member. Therefore, it is heart breaking to find out the next morning your loved one has suffered great brain damage due to nurses failing to check on alarm sounds. Now, the family is put on the spot to continue life support or disconnect their family member. One can only imagine what went wrong; up to the minute that you left the hospital, your loved one was doing fine. You are relying on the health care providers to take care of your loved one, just as you would, while you are gone. Staff made an error by ignoring the alarms sounds, warning them that the patient was deteriorating, and costing the patient’s family a great deal of pain. Jenifer Garcia’s life shattered when this exact event happened to her husband in July, 2010 (Kowalczyk, 2011). She left her husband Friday night, alive, and returned the next morning to find out he was brain dead. Advancements in technology are used to decrease and catch medical errors made by health care providers that can harm or kill patients, but alarm fatigue has proven that even technology cannot fully protect a patient from nursing errors, thus taking the lives of patients.
The nursing profession is a profession where people put their trust in you to provide care that is not only effective, ethical, and moral, but safe. Not all health situations are simple or by the book. Not all hospitals have the same nurse-patient ratios, equipment, supplies, or support available, but all nurses have “the professional obligation to raise concerns regarding any patient assignment that puts patients or themselves at risk for harm” (ANA, 2009). When arriving at work for a shift, nurses must ensure that the assignment is safe for not only the patients, but also for themselves. There are times when this is not the situation. In these cases, the nurse has the right to invoke Safe Harbor, because according the ANA, nurses also “have the professional right to accept, reject or object in writing to any patient assignment that puts patient or themselves at serious risk for harm” (ANA, 2009).
In the patient situation described, the nurse characteristics enabled improved patient care, by ensuring the family understood the true nature of B.H.’s medical status and her prognosis. Experience enables CNS’s to create strategies to provide specialty based anticipatory coaching (Spross & Babine, 2014). The use of caring practice created a trust with the patient and the healthcare team permitting the CNS to coach and guide the family to change B.H.’s code status to include withholding resuscitation. Collaboration allowed the family to be involved in B.H.’s care and clinical judgement allowed the CNS to coach the family into accepting a facility transfer for an opportunity for improved care
Nurses are an equally important part of each client’s life. Nurses provide stable care to each client, answers their questions, gives medications and treatments, and assists with medical procedures. They also have the responsibility to explain to clients and family members what they should and should not do as they go through treatment and recovery. Nurses must quickly respond to patients needs. Every individual nurse has his or her own unique way of caring. There are so many ways to show caring that the possibilities are never ending. Nurse’s support, comfort, and help allow the patients to recover to the best of their ability. Their experiences in dealing with different patients that have unique situations on a daily basis helps the nurses become better caregivers. Therefore, every nurse is capable of demonstrating care in their respective environments.
According to Joint commission “a recent Globe investigation found that, from January 2005 to June 2010, 216 hospital patient deaths nationwide were linked to issues with patient monitor alarms. In many cases, medical staff failed to notice the alarm or take immediate action to help a patient in distress.” When the post ox is not in use to turn off the parameter on the monitor. Next step would be to place the monitor on standby when patient is off the unit to prevent the constant alarming. Retraining of the nurse to the monitor to help trouble shot can benefit the patient as well as the nurse to help them to be more proficient in their task. Small changes can lead to a better outcome for patient safety. The pilot will take place in ICU with all nurse educated on the process along with the doctors. Two monitor will be as to voluntary to monitor the alarms and the response time. Data will be collected for two weeks and reevaluated to ensure that Patient safety is first and foremost maintain. All information would be shared with nurses, management, Doctors and
Nursing assessments are to be completed at least once every 12 hours and include each physiological system. Assessments are documented in electronic medical records (EMRs) by charting by exception, or complete documentation of all physiological systems (Rothman, Solinger, Rothman, & Finlay, 2012). According to Weis and Levy (2014), EMRs have led to a series of techniques that are called content importing technology (CIT), which make it possible to import information about patients into the chart and move the information to other sections of the EMR. CIT techniques offer opportunities for efficiency, but they can be misused (Weis & Levy, 2014). Subbe and Welch (2013) defined failure to rescue (FTR) as the lack of the proper response to patients who are deteriorating in the hospital.
Nursing contributes strong emotional support for patients and family members especially severely ill patients. The presence of a caring and sympathetic nurse is extremely required and beneficial to the overall prognosis. Patients need a bedside nurse who listens to them with warmth and understanding without prejudice. And nurses are educated and able to stain a great deal of medical information and knowledge, which used to be physicians’ inherent territory before.