PAT I ENT MONI TORING
“The doctor said he wasn’t a dental specialist and told me to go the dentist. Within two minutes of being at the dentist, she said I needed to be on IV antibiotics, right now! My parents took me to hospital, as there was work going on at the Royal Sussex County Hospital, so there was no car park, and it would have taken extra time to call an ambulance. Within two minutes of being in the hospital I was seen by triage and the maxillofacial team were with me. Within five minutes I had an X-ray; then I was put on an IV and my bloods were taken. This shows the importance of the Sepsis Six. “They wanted to do an MRI, but I have a bone-anchored hearing aid which meant they had to change plans and give me a CAT scan instead. I was on a bed for around five-and-a-half hours before going down to surgery. They needed two anaesthetists because they were scared that they were going to have to perform a tracheotomy. “One person was having to put general anaesthetic in my arm, while the other anaesthetist was having to prepare me for intubation down my right nostril as my throat had swollen and they couldn’t get it down my windpipe. I was still awake at this point as it is too dangerous to intubate a person with Ludwigs angina, if they are asleep. It took 20 minutes for them to get me to sleep and, when I woke up, I was in immense pain. As I started to come round, I remember overhearing them say that if I’d waited for an ambulance, I wouldn’t be here today.” Laura’s experience highlighted the
importance of gut instinct and why observations are so important – her breathing wasn’t checked when she was at the doctors.
“Had the GP checked my blood pressure, O2
saturation and breathing, I believe I would have received treatment much sooner. Vital signs need to be taken and there needs to be improved awareness at the GP level to ensure prompt action when it comes to sepsis,” she commented. Although she spent only four days in hospital, after a month at
home she started to get flashbacks and signs of Post-Traumatic Stress Disorder. “Sepsis has changed my life. I have had to learn to eat again but it has driven me to want to help save other lives,” commented Laura.
Why are vital signs missed? During a Q&A session, the panel were asked “why are vital signs missed or inaccurately recorded?” Siân explained that there is a tendency to take observations at set times – i.e. at 6 am, 10 am, 12pm etc. However, this means staff are not responding to the patient as an individual as they deteriorate. “We need to change the mindset on how
we perform the observations. If the patient has a NEWS score of six for example, the observations may need to become hourly. If you have electronic observation technology, this can give you reminders on a dashboard to offer a prompt. Other issues can arise from incorrectly calculating the maths around the NEWS score. The nurse may forget to perform the calculations if, for example, they don’t have a thermometer or piece of equipment with them and therefore don’t have the full score. This can lead to errors. People can be seen writing the observations on the back of their gloves and then writing it on the chart or typing it into the computer. This inevitably leads to transcription errors,” she commented.
Completing the Picture
Completing the Picture recognises that procuring, maintaining and managing medical equipment goes beyond the workshop and it is now a multidisciplinary team that is involved with this. The latest event comprised a ‘digital festival’, taking place over a period of two weeks, covering a wide range of topic areas, including: NHS Going Digital: Strategic Policy Update and Impact Assessment, Business Case Preparation, Clinical Practice Review: Respiratory Monitoring, A Connectivity Masterclass with IMS Maxims, Project
Management, Pagers Are Passé: It’s Time to Transition to a Smartphone-Based Communications Platform, Advancing Connected Care Through Smart Bed Technology, The Art of Flexible Leadership and NHS Going Digital: Informatics – Underpinning Issues. The Completing the Picture events are CPD accredited and supported by an unrestricted grant from Hillrom. On demand sessions and further details on Completing the Picture can be accessed at:
www.completingthepicture.com
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WWW.CLINICALSERVICESJOURNAL.COM
The future of vital signs monitoring Dr. Daniels suggested that there could be a role for clinical commissioning groups to ensure improved provision of monitoring of observations, recording and escalation. “The days of seeing paper-based
reporting and infrequent observations, as a gold standard, are probably gone. We need to look at how we can improve this in the future,” he commented.
The panel were also asked “how can vital signs recording be improved and what role can technology play?” Karen Nagalingam responded: “I am very excited about the contribution technology can offer – there is so much scope for development in terms of how this can be used to manage patients. “The ultimate goal is to implement automated, interoperable technology capable of reading, capturing and recording vital signs from devices – such as blood pressure readings – not just for patients in ITU but also on the ward. It would be fantastic to have this immediate transmission of observations. “However, we also need to bear in mind that taking the patient’s pulse, holding their hand, feeling the depths of the beat and the temperature of their skin, gives us so much information. We need to integrate technology, while also keeping those basic nursing skills.”
CSJ Further information
Laura Williams now educates health professionals on sepsis and helps to raise awareness, with her own You Tube channel, podcasts and ‘Sepsis Zoom academy’. To view more from Laura, visit: l
https://podcasts.apple.com/gb/podcast/ sepsis-survivor-stories/id1521453294
l
https://www.youtube.com/channel/ UCxPLBNNdpiRHCwRnAnwESlQ
For educational resources on Sepsis, visit:
https://sepsistrust.org
MARCH 2021
©Yurii Zushchyk -
stock.adobe.com
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