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PAT I ENT DET E RIORATION


Detecting deterioration: technology is key


Dr Ron Daniels BEM, chief executive of the UK Sepsis Trust, provides his thoughts on the importance of standardising the national track and trigger systems across primary and secondary care to improve early detection in the deterioration of patients.


Standardising the process of monitoring patients to quickly and effectively detect deterioration, is a problem faced by healthcare professionals across the UK. With staffing issues, inter-observer discrepancies and transcription error there are many variables that impact on patient assessments which can subsequently lead to poor outcomes. Studies show that respiratory rate (RR) changes 6-8 hours before a major event. By using a standardised track and trigger process such as NEWS2 to identify a change in accurate RR earlier, the patient data can be mapped and patient outcome could be improved.


The infrequent nature of observations due to staffing levels is a major problematic factor in the monitoring of patients. Typically taken by non-nursing staff, such as healthcare assistants, current guidelines recommend that patient observations are conducted every 12 hours as a minimum frequency. However, it is widely acknowledged that this ‘12-hour wait’ could be too long a period to effectively detect and manage patient deterioration. Inter-observer variability also impacts readings – successfully making a note of an observation requires the close attention of the healthcare professional to the patient. However, this is rarely possible. Disruptions by the surrounding setting such as patient/ family discussions and interruptions make taking an accurate reading very difficult. Even the background


noises of a busy ward environment can impact on how successfully RR or heart rate is measured. In addition, it is also fairly common for observation numbers to be rounded up or down which obviously compromises accuracy. In fact, many Trusts report transcription error rates at between 2% and 5%, with some suggesting that the true figure may be as high as 18%. Observing a change in Respiratory Rate


If a patient develops sepsis and needs to be moved to an intensive care bed, this treatment costs the NHS around £30,000. However, if the deterioration is spotted earlier, patients can be treated using the ‘Sepsis Six’ on a ward.


SEPTEMBER 2020


can identify a patient at risk of deterioration before other parameters begin to show. RR is a very sensitive marker and tends to change before other markers indicating serious illness. Listed as one of the key red flags by NICE, if a patient with an infection develops an RR of over ‘25’, NICE recommends that the patient is treated as having sepsis. This early identification, before septic shock takes hold, is key and allows for a patient to be treated quickly on the ward using the ‘Sepsis Six’ (which changed in 2019); request a senior clinician to attend: give oxygen if saturations are low; obtain access and take bloods (including cultures); administer IV antibiotics; give IV fluid, and monitor including NEWS2 and urine output.1 If we allow patient deteriorations to progress, it not only increases the risk of a more complicated, compromised and in many cases tragic patient outcome, it


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