Duncan Smith

Illustration showing the five elements of the ABCDE approach to assessing deteriorating patients

Patient assessment: do you use your ABCDE?

The pros of the ABCDE approach are accepted, yet ‘doing the obs’ remains common practice

Investigating ward nurses’ responses to deteriorating patients

Investigating ward nurses’ responses to deteriorating patients

Why you should read this article: • To enhance your understanding of the factors that can influence nurses’ responses to deteriorating patients • To optimise recognition of, and responses to, deteriorating patients to reduce the risk of serious complications and possibly death • To ensure that your knowledge and skills are evidence-based and underpinned by the latest research Deteriorating patients often present with suboptimal vital signs. If these are not recognised by healthcare staff, the patient’s condition can deteriorate further, potentially leading to serious complications and even death. Despite efforts to improve ward nurses’ recognition of, and responses to, deteriorating patients, this aspect of care has been found to be suboptimal. Aim To identify factors that influence ward nurses’ responses to deteriorating patients. Method A literature review was undertaken, based on the research question ‘What factors influence the trigger component of ward-based registered nurses’ afferent response to deteriorating patients?’ Several electronic databases were searched electronically to identify relevant articles, alongside hand-searching. Inclusion and exclusion criteria were set to determine which articles should be included in the literature review. Findings Nine studies were identified for inclusion in the literature review. Four main themes that influenced ward nurses’ responses to deteriorating patients emerged: communication, diurnal and weekend variation, knowledge and attitudes, and nurse staffing levels. Conclusion Effective communication was identified as an important factor in improving ward nurses’ responses to deteriorating patients, as was improved knowledge of ‘do not attempt cardiopulmonary resuscitation’ (DNACPR) orders. It was also identified that increased ward nurse numbers improved responses to deteriorating patients, as did increased availability of senior healthcare staff, which enabled junior staff to escalate care.

Assessing patient

Using the ABCDE approach to assess the deteriorating patient

Learn the ABCDE (airway, breathing, circulation, disability, exposure) process

Crash cart

An overview of adult cardiopulmonary resuscitation equipment

Nurses have many roles and responsibilities in relation to cardiopulmonary resuscitation (CPR), including: recognising that a patient is deteriorating; recognising cardiac arrest and commencing CPR while waiting for the resuscitation team to arrive; ensuring the contents of the resuscitation trolley are present, in date and in full working order; and completing documentation for the National Cardiac Arrest Audit in participating healthcare organisations. Many patient safety incidents involving resuscitation trolley equipment and resuscitation have been reported, and predominantly relate to a lack of equipment, missing equipment and inadequately stocked trolleys. This article provides an overview of the contents of the standard resuscitation trolley and a rationale for the use of each item. It discusses the importance of checking and restocking the resuscitation trolley, as well as the documentation of CPR efforts.