Action 8.10 states

The health service organisation has processes that support timely response by clinicians with the skills required to manage episodes of acute deterioration

Intent

Clinicians have the skills and knowledge to deal with deterioration, as appropriate for their role.

Reflective question

How does the health service organisation ensure that clinicians are competent in the skills required to respond to patients whose condition is acutely deteriorating?

Key task

Develop systems to ensure that clinicians are competent in the skills required to respond to patients whose condition is deteriorating.

Strategies for improvement

Hospitals

This action means different things for people in different roles and settings. It applies to both the workforce providing the initial response while awaiting help, and to the response team who bring extra skills to the patient. Take a risk assessment approach to identify and prioritise training needs.

Clinicians who provide clinical care need skills in providing essential emergency interventions for common causes and symptoms of life-threatening physiological deterioration while awaiting help. These include skills in essential emergency management of conditions such as airway obstruction, hypoxia, respiratory distress or suppression, arrhythmia, hypotension, fluid overload, seizures and sepsis.

Clinicians who provide clinical care need skills in responding to aggressive behaviour when attempts to de-escalate the situation have failed and there is potential harm to the patient or to others.

Clinicians working in specific specialties or settings may need training in extra skills to provide an immediate response while awaiting help. For example, clinicians working in a coronary care unit need cardiac resuscitation skills, while those working in maternity settings need skills in managing obstetric emergencies.

Clinicians who have particular roles also need training in other skills. For example, medical emergency team responders need advanced clinical assessment skills and competence in specialist procedures such as intubation.

Clinicians who respond to acute deterioration also require non-technical skills such as graded assertiveness, negotiating patient goals of care, communicating bad news and team leadership.1

Day Procedure Services

This action means different things for people in different roles and settings. It applies to both the workforce providing the initial response while awaiting help, and to the response team who bring extra skills to the patient. Take a risk assessment approach to identify and set priorities for training needs.

Clinicians who provide clinical care need skills in providing essential emergency interventions for common causes and symptoms of life-threatening physiological deterioration while awaiting help. These include skills in essential emergency management of conditions such as airway obstruction, hypoxia, respiratory distress or suppression, arrhythmia, hypotension, fluid overload and seizures.

If the response to acute deterioration is provided by clinicians within the day procedure service (rather than an external service such as an ambulance), ensure that responders are competent in the required skills. These include advanced clinical assessment skills and other, non-technical skills, such as graded assertiveness and team leadership.1

Examples of evidence

Select only examples currently in use:

  • Employment documents that describe roles and responsibilities in the event of episodes of acute deterioration
  • Training documents about emergency interventions in the event of acute deterioration, including specialist training for responders, such as members of medical emergency teams
  • Evidence of clinician competency assessment (for example, through simulation exercises, peer review or formal assessments)
  • Records indicating that clinicians have met the ongoing professional development requirements of a specialist college in relation to responding to acute deterioration (for example, through the College of Intensive Care Medicine).

MPS & Small Hospitals

MPSs and small hospitals should develop systems relevant to their service context to ensure that clinicians are competent in the skills required to respond to patients whose condition is deteriorating. This should be based on a risk assessment approach to identify and prioritise training needs.

Clinicians who provide clinical care need skills in providing essential emergency interventions for common causes and symptoms of life-threatening physiological deterioration while awaiting help. These include skills in essential emergency management of conditions such as airway obstruction, hypoxia, respiratory distress or suppression, arrhythmia, hypotension, fluid overload, seizures and sepsis.

Clinicians who provide clinical care need skills in responding to aggressive behaviour when attempts to de-escalate the situation have failed and there is potential harm to the patient or to others.

Clinicians working in specific specialties or settings may need training in extra skills to provide an immediate response while awaiting help. For example, clinicians working in maternity settings need skills in managing obstetric emergencies.

Clinicians who have particular roles also need training in other skills. For example, medical emergency team responders need advanced clinical assessment skills and competence in specialist procedures such as intubation.

Clinicians who respond to acute deterioration also require non-technical skills such as graded assertiveness, negotiating patient goals of care, communicating bad news and team leadership.1

If possible, use resources developed by the Local Hospital Network, state or territory health department or nearby larger hospital to support the education of clinicians working in an MPS or small hospital.

Hospitals

This action means different things for people in different roles and settings. It applies to both the workforce providing the initial response while awaiting help, and to the response team who bring extra skills to the patient. Take a risk assessment approach to identify and prioritise training needs.

Clinicians who provide clinical care need skills in providing essential emergency interventions for common causes and symptoms of life-threatening physiological deterioration while awaiting help. These include skills in essential emergency management of conditions such as airway obstruction, hypoxia, respiratory distress or suppression, arrhythmia, hypotension, fluid overload, seizures and sepsis.

Clinicians who provide clinical care need skills in responding to aggressive behaviour when attempts to de-escalate the situation have failed and there is potential harm to the patient or to others.

Clinicians working in specific specialties or settings may need training in extra skills to provide an immediate response while awaiting help. For example, clinicians working in a coronary care unit need cardiac resuscitation skills, while those working in maternity settings need skills in managing obstetric emergencies.

Clinicians who have particular roles also need training in other skills. For example, medical emergency team responders need advanced clinical assessment skills and competence in specialist procedures such as intubation.

Clinicians who respond to acute deterioration also require non-technical skills such as graded assertiveness, negotiating patient goals of care, communicating bad news and team leadership.1

Day Procedure Services

This action means different things for people in different roles and settings. It applies to both the workforce providing the initial response while awaiting help, and to the response team who bring extra skills to the patient. Take a risk assessment approach to identify and set priorities for training needs.

Clinicians who provide clinical care need skills in providing essential emergency interventions for common causes and symptoms of life-threatening physiological deterioration while awaiting help. These include skills in essential emergency management of conditions such as airway obstruction, hypoxia, respiratory distress or suppression, arrhythmia, hypotension, fluid overload and seizures.

If the response to acute deterioration is provided by clinicians within the day procedure service (rather than an external service such as an ambulance), ensure that responders are competent in the required skills. These include advanced clinical assessment skills and other, non-technical skills, such as graded assertiveness and team leadership.1

Examples of evidence

Select only examples currently in use:

  • Employment documents that describe roles and responsibilities in the event of episodes of acute deterioration
  • Training documents about emergency interventions in the event of acute deterioration, including specialist training for responders, such as members of medical emergency teams
  • Evidence of clinician competency assessment (for example, through simulation exercises, peer review or formal assessments)
  • Records indicating that clinicians have met the ongoing professional development requirements of a specialist college in relation to responding to acute deterioration (for example, through the College of Intensive Care Medicine).

MPS & Small Hospitals

MPSs and small hospitals should develop systems relevant to their service context to ensure that clinicians are competent in the skills required to respond to patients whose condition is deteriorating. This should be based on a risk assessment approach to identify and prioritise training needs.

Clinicians who provide clinical care need skills in providing essential emergency interventions for common causes and symptoms of life-threatening physiological deterioration while awaiting help. These include skills in essential emergency management of conditions such as airway obstruction, hypoxia, respiratory distress or suppression, arrhythmia, hypotension, fluid overload, seizures and sepsis.

Clinicians who provide clinical care need skills in responding to aggressive behaviour when attempts to de-escalate the situation have failed and there is potential harm to the patient or to others.

Clinicians working in specific specialties or settings may need training in extra skills to provide an immediate response while awaiting help. For example, clinicians working in maternity settings need skills in managing obstetric emergencies.

Clinicians who have particular roles also need training in other skills. For example, medical emergency team responders need advanced clinical assessment skills and competence in specialist procedures such as intubation.

Clinicians who respond to acute deterioration also require non-technical skills such as graded assertiveness, negotiating patient goals of care, communicating bad news and team leadership.1

If possible, use resources developed by the Local Hospital Network, state or territory health department or nearby larger hospital to support the education of clinicians working in an MPS or small hospital.

Reference

  1. Yeung MS, Lapinsky SE, Granton JT, Doran DM, Cafazzo JA. Examining nursing vital signs documentation workflow: barriers and opportunities in general internal medicine units. J Clin Nurs 2012;21(7–8):975–82.