Recognising and responding to clinical deterioration is paramount when practicing as a nurse in the Emergency Department.
Recognising and responding to clinical deterioration requires nurses to have specific knowledge and skills to recognise the urgency of a patient situation and respond appropriately.
This skill set includes identifying and interpreting signs and symptoms, abnormal vital signs and initiating early interventions. Failure in recognising and responding to the deteriorating patient can result in serious adverse outcomes for the patient.
Resources within this module will provide you with interactive materials to assist learning and effectively manage a deteriorating patient.
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CEC - Between the Flags Program (Apr 2013)
Between the Flags was introduced in 2010 to improve the early recognition and response to deteriorating patients in NSW Hospitals. This video introduces the implementation of the standard observation charts in the electronic medical record (EMR). -
Patient Deterioration, the right way
This video demonstrates core knowledge, skills and behaviours required for quality patient assessment to recognise clinical deterioration. Tools used include the Q-ADDS form, A-J assessment and SBAR. -
Cardiac Arrest: Epidemiology & Initial Assessment – Emergency Medicine | Lecturio
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- What is the cardiac arrest?
- Causes of cardiac arrest
- Epidemiology of cardiac arrest
- Initial cardiac rhythm
- Patients in cardiac arrest
- First question when evaluating an unresponsive patient
- Initial assessment in cardiac arrest
- Carotid pulse
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FIRST2ACTWEB
Interactive video simulation. Highly recommended. Nominal fee of AUD15. Registration required to access content.
https://first2act.com/
Australian Commission on Safety and Quality in Health Care
Recognising and Responding to Clinical Deterioration.
https://www.safetyandquality.gov.au/our-work/recognising-and-responding-to-clinical-deterioration/
Australian Commission on Safety and Quality in Health Care
The National Consensus Statement.
https://www.safetyandquality.gov.au/our-work/recognising-and-responding-to-clinical-deterioration/implementing-r-and-r-systems/the-national-consensus-statement/
Australian Resuscitation Council
Welcome to the home of the Australian Resuscitation Council.
https://resus.org.au/
National Institute for Health and Care Excellence
Acutely ill adults in hospital: recognising and responding to deterioration.
https://www.nice.org.uk/guidance/cg50
Recognising and Responding to Acute Deterioration
The Recognising and Responding to Acute Deterioration Standard aims to ensure that acute deterioration in a person’s physical, mental or cognitive condition is recognised promptly and appropriate action is taken.
https://www.nationalstandards.safetyandquality.gov.au/8.-recognising-and-responding-acute-deterioration
Recognising acute deterioration
The health organisation has processes for clinicians to detect acute physiological deterioration.
https://www.nationalstandards.safetyandquality.gov.au/8.-recognising-and-responding-acute-deterioration/detecting-recognising-escalating/recognising
Escalating care
The health service organisation has protocols that specify criteria for escalating care.
https://www.nationalstandards.safetyandquality.gov.au/8.-recognising-and-responding-acute-deterioration/detecting-recognising-escalating/escalating-care
Responding to deterioration
Health service organisation processes for timely response, access or referral of care to patients whose condition is acutely deteriorating.
https://www.nationalstandards.safetyandquality.gov.au/8.-recognising-and-responding-acute-deterioration/responding-acute-deterioration/responding
Recognising and responding to acute deterioration
Many patients who experience a deterioration of their condition often exhibit warning signs (including abnormal vital signs) in the hours prior to the event. Early recognition and response to acute deterioration may prevent adverse events and potentially deaths in the hospital system.
https://ww2.health.wa.gov.au/Articles/N_R/Recognising-and-responding-to-acute-deterioration
Dalton, M., Harrison, J., Malin, A., & Leavey, C. (2018). Factors that influence nurses’ assessment of patient acuity and response to acute deterioration. British Journal of Nursing, 27(4), 212-218. doi:10.12968/bjon.2018.27.4.212
Della Ratta, C. (2016). Challenging graduate nurses’ transition: Care of the deteriorating patient. Journal of Clinical Nursing, 25(19-20), 3036-3048. doi:10.1111/jocn.13358
Felton, M. (2012). Recognising signs and symptoms of patient deterioration. Emergency Nurse, 20(8), 23-27.
Gluyas, H. (2017). Errors in the nursing management of a deteriorating patient. Nursing Standard, 32(12), 41-50. doi:10.7748/ns.2017.e10874
Lambe, K., Currey, J., & Considine, J. (2016). Frequency of vital sign assessment and clinical deterioration in an Australian Emergency Department. Australasian Emergency Nursing Journal, 19(4), 217-222. doi:10.1016/j.aenj.2016.09.001
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. doi:10.1002/nop2.53
Mohammmed Iddrisu, S., Hutchinson, A. F., Sungkar, Y., & Considine, J. (2018). Nurses’ role in recognising and responding to clinical deterioration in surgical patients. Journal of Clinical Nursing, 27(9-10), 1920-1930. doi:10.1111/jocn.14331