PAEDIATRICS
of deterioration and act quickly, and embeds patient safety, openness and learning into the culture and system of organisations. The framework is an attempt to demonstrate what collectively could make a difference to the recognition and response to children at risk of deterioration. It was developed by clinicians and experts to support organisations and local services in safe system thinking, to improve clinical team working and partnerships with families and children. A copy of the resource can be downloaded from
www.rcpch.ac.uk/sites/ default/files/user158/A-safe-system-for- children-at-risk-of-deterioration-2016-07.pdf.
Whole system approach
The framework aims to set out the idea of taking a ‘whole system approach’ to more effectively identify and address deterioration. Its core elements – which are all wrapped around the patient – include:
Patient safety culture – A crucial element of the framework is to develop a culture which is committed to overall improvement in patient safety, prioritising safety, leadership and executive accountability, and monitoring and measuring patient safety. It is important to engage the patient, parents and family in delivering improvement activities. Clinicians and the wider healthcare team needs to employ an open and robust communication model, such as routine safety briefings; structured communication for escalation; open disclosure and comprehensive investigations for patient safety incidents. Positive case scenarios should be identified and learnt from.
Partnership with patients and their family – Care and systems need to keep a central focus on the patient and family. This requires the involvement of children, their families and carers as well as clinicians and the wider healthcare teams to make individualised care decisions. Patient or family led care activities and key periods for family to remain with the patients are also important and there needs to be a focus on the uniqueness of young people’s needs.
Recognising deterioration – The ability to spot physiological deviations before significant changes in care are required or harm occurs. It is important to include the patient, their family and carers in care decisions and there should be an opportunity for them to contribute to the recognition of
the deteriorating child – such as safety netting; being taught what matters with regard to the patient’s condition and empowering families to express their concerns. An example would be to give family members the ability to activate a system of escalation to senior staff as part of a Paediatric Early Warning (PEW) chart.
Responding to deterioration – Ensuring a timely and accurate response encompassing all necessary support and treatment from all those involved in the care of the patient. Again, the framework highlights the importance of involving patients and their families in individualised care decisions and sharing communication protocols, standards or principles with them. For clinicians it suggests the use of a structured communication model for escalation, such as SBAR, and local response protocols (such as review, rapid response teams, medical emergency teams and transfer). It also highlights the need for awareness of negative attitudes towards escalation that may be downgraded on review. Care and systems should always keep a central focus on the patient and family.
Parents can often spot small changes that others may miss and they should play a key role in the care of their child.
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Open and consistent learning – This relates to consideration of the system errors and individual responsibility, recording, investigating and evaluating incidents as well as best practice in order to continually learn and improve. It is important that clinicians and the wider team have the appropriate skills and updates to ensure they accurately take and record physiological observations. Patients, families and staff involved or witnessing a patient safety incident need to be supported, including the use of de-briefing and follow up, and thorough and timely investigations need to be carried out with actions for learning. Regular activities to measure, monitor and report on the processes and outcomes around spotting and treating deterioration are also important.
Education and training – Consistently building clinical knowledge and capability as
OCTOBER 2016
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