1. Engaging junior doctors and nurses in a patient safety project
Deteriorating Patient Care Pathway
Chris Morley
Deputy Chief Nurse

2. Introduction
Recognising and responding to deteriorating patients was established as a patient safety project in 2010
Established alongside projects in other areas such as medication safety, falls, ventilator acquired pneumonia etc

3. 23,000 preventable Cardiac Arrests
Background
Failure to recognise deterioration
23,000 preventable Cardiac Arrests
20,000 admissions to ITU per year deemed preventable Parliamentary Health Committee (2009)

4. Background Failure to respond to deterioration
ICU mortality 25% if deteriorating patients receive good ward care
ICU mortality 50% if patient received sub optimal care on the ward
Confidential inquiry into quality of care before admission to intensive care (1998)

5. Deteriorating Patient Project
Early recognition, treatment, escalation improves survival
Known policies in place: Sheffield Hospitals Early Warning Score (SHEWS)
Bleep Escalation Policy
Audit showed inconsistent compliance

6. Deteriorating Patient Project
Score 3 2 1
Resp Rate 8
or less
9 to 18
19-24
25 to 29 30
or more
Oxygen
Saturation
90%
61% O2
Pulse Rate 40
41 to 49
50 to 99
100 to 129
130
or more
Systolic BP 90
91 to 100
101 to 199
200
Urine Output
over 2hrs
20mls/hr
30mls/hr or less
More than 30mls/hr
Conscious
Level
New
Confusion /agitation
Alert
Responds to Voice
Responds to Pain
Un-responsive 6

7. Deteriorating Patient Project
Project focused on improvement with individual clinical teams
Multidisciplinary improvement group
Consultants
Senior Sisters/Charge Nurses & Matrons
Junior doctors
Junior nursing staff

8. Staff Engagement
Highlight the scale of the issue in relation to patient safety
Recognise how the abnormal becomes normalised
Discuss barriers to effective implementation of protocols/procedures
Communication issues

9. Staff Involvement Staff audited care in their area
Audit results discussed and changes proposed
In conjunction with frontline clinical staff a care pathway was designed and implemented

10. Importance of data Key to engagement
“Very compelling data from the rest of surgery and concerning pre audit data in Orthopaedics. This further convinces me we need to get on.”
Consultant Orthopaedic Surgeon

11. Importance of Local Leadership
Areas which have achieved more and faster have had the project championed by leaders in the clinical area

12. Importance of Context The use during training of a local example:
Deterioration over 12 hours
30yr old male
Poor compliance with observations
Sub-optimal medical assessment
Inadequate documentation
Ultimately transferred to ITU

13. Importance of Context Provides a ‘shock’ reaction during the training
Important that these events do happen within the organisation
Leads into raising awareness of human factors

14. Results

15. Results

16. Results

17. Summary Important aspect of Patient Safety
Project team was multi-disciplinary
Active involvement of clinical staff of all levels critical to gain true engagement
Project continues particularly looking to explore medical documentation