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PAEDIATRICS
Preventing deterioration: awhole system approach
Suzanne Callander reports on a new framework which advises a whole system approach to ensure that deterioration in children is recognised and responded to quickly and appropriately in hospitals.
Failure to recognise and treat children and young patients whose condition is deteriorating is a cause of significant unintended harm within the healthcare environment. If their condition deteriorates during their time in hospital and this is not picked up and treated quickly enough it can lead to severe harm, or even death. Research has shown that over one-
quarter of preventable deaths in children or adults were due to them not being properly monitored and the right systems not being in place to quickly identify and act on deterioration.1
Further, 7% of patient safety
incidents reported to the National Reporting and Learning System (NRLS) in 2015 as causing death or severe harm relate to a failure to recognise or act on deterioration. UK paediatric mortality was found to be the highest in Europe in a 2011 report2
there is also evidence which suggests that missed deterioration3,4
and difference in hospital performance contributes to this.5 In
a bid to improve outcomes and reduce the incidence of deterioration in acutely ill infants, children and young people, a joint initiative with the Royal College of Paediatrics and Child Health, NHS Improvement has introduced the first whole-system framework for tackling deterioration of health in children. It calls on healthcare providers and parents to work together as a team, and urges medical and nursing staff to encourage parents to speak up if they have concerns.
System, not score
Evidence from patient safety incidents reported to NRLS has indentified that the greatest potential for improvement would
come as a result of implementing an early warning system, rather than score. This takes in the whole system of recognition and response to deterioration and not simply the measurement of observations. Speaking at the launch of the new framework, Dr Mike Durkin, NHS national director of patient safety, urged medical and nursing staff to work more closely with parents in observing a child’s behaviour from admission to discharge. He said: “If the NHS is to reduce deterioration in children’s health, parents and healthcare providers need to work together as a team. Parents should be supported to speak up to nurses or doctors if
Research has shown that over one-quarter of preventable deaths in children or adults were due to them not being properly monitored and the right systems not being in place to quickly identify and act on deterioration.
OCTOBER 2016
they feel their child’s health is deteriorating. Too often parents worry about ‘time-wasting’ with any repeated concerns or feel that they will not be listened to. However, it is imperative that parents feel welcome and encouraged to speak up. “There have been far too many cases covered in the media on the failure to treat sepsis that have highlighted the instances of parents repeatedly flagging concerns about their children. Recent NICE guidelines also re-emphasise the work that providers should be doing to prevent sepsis and help protect patients. “Although sepsis is a leading cause of deterioration in children, there are many other causes that can have equally tragic consequences if not paid attention to and this is why NHS Improvement is calling on providers, parents and staff to tackle deterioration by taking a whole system approach.” Such an approach still requires the use of early warning scores or symptom monitoring. However, it also highlights the need to engage parents and families – from admission to discharge. It helps to spot signs
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