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What were the four main factors of the Garling Report regarding the deteriorating patient
- Systems for early identification of at risk pts
- Escalation protocols to manage deteriorating pt
- Development/implementation education and training programs
- Collection and analysis of data to monitor these implementations.
What are the requirements of the Garling Report that every facility must implement
- Escalation protocols
- Rapid response
- Clear processes
- Data collection and improvements
- Education programs
What does DETECT stand for?
- Detecting deterioration
- Communicating in
What are the standard or minimal requirements regarding the observations of vital signs?
- A complex set of obs taken every 8 hours including
- Heart rate
- Respiratory rate
- Blood Pressure
- O2 requirements
What are the early warning signs of a patients deterioration?
- Sp02 90-95%
- Respiratory Rate 5-9 bpm or 30-40bpm
- Pulse Rate 40-50 or 120-140
- Systolic BP 80-100 mmHg or 180-240 mmHg Poor peripheral circulation Urine output <200mls over 8 hours
- Greater than expected drainage fluid loss
- A drop in GCS of 2 points or GCS <12 or any seizure
- New or uncontrolled pain (including chest pain)
- ABG’s Pa02 50-60, PCO2 50-60, pH 7.2-7.3, BE -5 to -8 mmol/L
- BSL 1-3 mmol/L
- Partial airway obstruction (excluding snoring
What are the late signs of a patients deterioration?
- Airway obstruction or stridor
- Sp02 <90%
- Respiratory Rate <5 bpm or >40bpm
- Pulse Rate <40 or >140
- Systolic BP <80 or >240 mmHg
- Excess blood loss not controlled by ward staff
- Unresponsive to verbal command or GCS<8
- Urine output <200mls in 24 hours or anuria
- ABG’s Pa02 <50, PCO2 >60, pH <7.2, BE <-7
- BSL <1 mmol/L
What are the 7 E's of deterioration?
- Existing co morbidities
- Extreme illness
- Emerging from anaesthesia
- Exiting CCU
What are the steps to ISBAR?
- Introduction (urself, role and location)
- Situation (pt diag, reasons for admis and current problem
- Background (clinical background/context)
- Assessment (Pt obs, what the problem is)
- Recommend (what u want for the pt, be clear of your request and time frames. Repeat back what you are told)
What are the nursing responsibilities regarding the deteriorating patient?
- Attend BTF orientation and complete DETECT e-learning and practical.
- Monitor the patient’s vital signs. Current NSW Ministry of Health policy states that the minimum frequency of observations is three (3) times per day, at eight hourly intervals, unless otherwise documented.
- Initiate clinical review/rapid response if meets the criteria (hospital policy)
- Return to and remain with the patient and repeat a set of observations.
- Initiate initial patient management within the scope of clinical practice limitations and assist the clinical review team as required.
- Document comprehensively and legibly
- Initiate a Code Blue/PACE/Rapid response call if required