School of Nursing and Midwifery and Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Australia.
Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Australia.
J Clin Nurs. 2023 Oct;32(19-20):7310-7320. doi: 10.1111/jocn.16810. Epub 2023 Jun 27.
AIM(S): To explore vital sign assessment (both complete and incomplete sets of vital signs), and escalation of care per policy and nursing interventions in response to clinical deterioration.
This cohort study is a secondary analysis of data from the Prioritising Responses of Nurses To deteriorating patient Observations cluster randomised controlled trial of a facilitation intervention on nurses' vital sign measurement and escalation of care for deteriorating patients.
The study was conducted in 36 wards at four metropolitan hospitals in Victoria, Australia. Medical records of all included patients from the study wards during three randomly selected 24-h periods within the same week were audited at three time points: pre-intervention (June 2016), and at 6 (December 2016) and 12 months (June 1017) post-intervention. Descriptive statistics were used to summarise the study data, and relationships between variables were examined using chi-square test.
A total of 10,383 audits were conducted. At least one vital sign measurement was documented every 8 h in 91.6% of audits, and a complete set of vital signs was documented every 8 h in 83.1% of audits. There were pre-Medical Emergency Team, Medical Emergency Team or Cardiac Arrest Team triggers in 25.8% of audits. When triggers were present, a rapid response system call occurred in 26.8% of audits. There were 1350 documented nursing interventions in audits with pre-Medical Emergency Team (n = 2403) or Medical Emergency Team triggers (n = 273). One or more nursing interventions were documented in 29.5% of audits with pre-Medical Emergency Team triggers and 63.7% of audits with Medical Emergency Team triggers.
When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration.
Medical and surgical ward nurses in acute care wards frequently engage in vital sign assessment. Interventions by medical and nurgical nurses may occur prior to, or in parallel with calling the rapid response system. Nursing interventions are a key but under-recognised element of the organisational response to deteriorating patients.
IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Nurses engage in a range of nursing interventions to manage deteriorating patients, (aside from rapid response system activation) that are not well understood, nor well described in the literature to date.
This study addresses the gap in the literature regarding nurses' management of deteriorating patients within their scope of practice (aside from RRS activation) in real world settings. When rapid response system triggers were documented, there were gaps in escalation of care per policy; however, nurses undertook a range of interventions within their scope of practice in response to clinical deterioration. The results of this research are relevant to nurses working on medical and surgical wards.
The trial was reported according to the Consolidated Standards of Reporting Trials extension for Cluster Trials recommendations, and this paper is reported according to the Strengthening the Reporting of Observational Studies in Epidemiology Statement.
No Patient or Public Contribution.
探讨生命体征评估（完整和不完整的生命体征集），以及根据政策和护理干预措施对临床恶化进行的护理升级。
这是一项针对 Prioritising Responses of Nurses To deteriorating patient Observations 集群随机对照试验的二次分析，该试验对护士对恶化患者的生命体征测量和护理升级进行了促进干预。
研究在澳大利亚维多利亚州四家大都市医院的 36 个病房进行。在同一周内随机选择的三个 24 小时期间内，对研究病房的所有纳入患者的病历进行了审核，共进行了三次审核：干预前（2016 年 6 月）、干预后 6 个月（2016 年 12 月）和 12 个月（2017 年 6 月）。使用描述性统计数据总结研究数据，并使用卡方检验检查变量之间的关系。
共进行了 10,383 次审核。在 91.6%的审核中，每 8 小时记录一次至少一项生命体征测量值，在 83.1%的审核中，每 8 小时记录一次完整的生命体征测量值。在 25.8%的审核中存在医疗急救小组、医疗急救小组或心脏骤停小组的触发因素。当存在触发因素时，在 26.8%的审核中发生了快速反应系统呼叫。在有医疗急救小组（n=2403）或医疗急救小组触发因素（n=273）的审核中，有 1350 次记录的护理干预。在有医疗急救小组触发因素的审核中，有 29.5%记录了一项或多项护理干预，在有医疗急救小组触发因素的审核中，有 63.7%记录了一项或多项护理干预。
当记录到快速反应系统触发因素时，护理升级存在政策方面的差距；然而，护士在临床恶化时在其执业范围内进行了一系列干预措施。
急性护理病房的内科和外科病房护士经常进行生命体征评估。在调用快速反应系统之前或与之同时，医疗和外科护士可能会进行干预。护理干预是组织对恶化患者做出反应的一个关键但未被充分认识的要素。
对专业和/或患者护理的影响：护士在其执业范围内进行了一系列护理干预措施来管理恶化的患者，（除了快速反应系统的激活）这些干预措施在文献中尚未得到很好的理解和描述。
本研究解决了文献中关于护士在真实环境中管理恶化患者（除了 RRS 激活）的实践范围内的护理升级方面的差距。当记录到快速反应系统触发因素时，护理升级存在政策方面的差距；然而，护士在临床恶化时在其执业范围内进行了一系列干预措施。这项研究的结果与在医疗和外科病房工作的护士有关。
该试验按照《集群随机对照试验扩展的统一报告标准》的建议进行报告，本论文按照《加强观察性研究报告的流行病学声明》进行报告。
无患者或公众贡献。
