the deteriorating adult recognition and assessment of the deteriorating adult @DrChrisWilliams Rural General Hospital GP VC education network NHS Highland September 2016

Where we were in August 2011 Survey in late 2009 830 nurses responded Staff not noticing deterioration Policies not followed Observations left to staff who did not have skills to interpret the findings

Case Discussion 1 60 year-old man admitted with cellulitis of toe still requiring intravenous antibiotics Now you suspect cognitive impairment

SIGN 139 May 2014 Observations Sepsis six Identify patients with limited response Graded response Formalise communication Collect data

Observation SIGN 139 Physiological observations at admission Clear written monitoring plan- specify what and when Performed by trained staff who understand clinical relevance Assess competency of these staff regularly As a minimum: HR, Resp Rate, BP, consciousness, O2 sats (with note of administered concentration), temp, state of hydration Some patients require other measurements: glucose, lactate or pain score

NEWS

Case Discussion 2 80 year-old lady stepped-down from acute DGH ward still requiring assistance to increase mobility post-op following #NOF telephone call to say positive C. Diff result nausea, given oral antiemetic

Value of your initial assessment…

Patient perceptions (of the monitoring of their condition)… What are patients aware of ? What do patients want ? What is the role of patients in improving patient monitoring ? Does communication tend towards offering reassurance ? Will patients understand the detail ? Who thinks they have ownership ?

Taking the message beyond hospital

Questions ?