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

3. 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

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

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

6. 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

7. NEWS

8. 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

9. Value of your initial assessment…

10. 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 ?

11. Taking the message beyond hospital

12. Questions ?