Assessing beyond vital signs to detect early patient deterioration

Chua, Wei Ling; Liaw, Sok Ying

doi:10.1136/eb-2015-102092

Cited by 9 publications

(5 citation statements)

References 5 publications

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“…The inadequacy of the activation criteria to detect subtle and early deterioration highlights that acquiescent reliance on the activation criteria, with vital signs derangements as the optimal cue for RRS activation, can marginalize other assessment cues [ 76 , 77 ]. Overreliance on vital signs abnormalities also risks devaluing the merit of subjective data and intuitive senses within assessment reflecting early deterioration [ 78 ].…”

Section: Discussionmentioning

confidence: 99%

Factors influencing the activation of the rapid response system for clinically deteriorating patients by frontline ward clinicians: a systematic review

Chua

See

Legio-Quigley

et al. 2017

International Journal for Quality in Health Care

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PurposeTo synthesize factors influencing the activation of the rapid response system (RRS) and reasons for suboptimal RRS activation by ward nurses and junior physicians.Data sourcesNine electronic databases were searched for articles published between January 1995 and January 2016 in addition to a hand-search of reference lists and relevant journals.Study selectionPublished primary studies conducted in adult general ward settings and involved the experiences and views of ward nurses and/or junior physicians in RRS activation were included.Data extractionData on design, methods and key findings were extracted and collated.Results of data synthesisThirty studies were included for the review. The process to RRS activation was influenced by the perceptions and clinical experiences of ward nurses and physicians, and facilitated by tools and technologies, including the sensitivity and specificity of the activation criteria, and monitoring technology. However, the task of enacting the RRS activations was challenged by seeking further justification, deliberating over reactions from the rapid response team and the impact of workload and staffing. Finally, adherence to the traditional model of escalation of care, support from colleagues and hospital leaders, and staff training were organizational factors that influence RRS activation.ConclusionThis review suggests that the factors influencing RRS activation originated from a combination of socio-cultural, organizational and technical aspects. Institutions that strive for improvements in the existing RRS or are considering to adopt the RRS should consider the complex interactions between people and the elements of technologies, tasks, environment and organization in healthcare settings.

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Section: Discussionmentioning

confidence: 99%

Factors influencing the activation of the rapid response system for clinically deteriorating patients by frontline ward clinicians: a systematic review

Chua

See

Legio-Quigley

et al. 2017

International Journal for Quality in Health Care

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“…This factor is consistent with the theme of “primacy of vital signs” in nurses' patient assessment practice to pick up changes to patients' conditions, as recorded in Osborne et al (2015) and Chua et al (2019). The heavy reliance of vital signs abnormalities as the optimal cue for clinical deterioration risks devaluing the importance of recognising early and subtle cues of deterioration that may be observed through vigilant patient assessment and surveillance (Chua & Liaw, 2016; Osborne et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Development and psychometric evaluation of the Attitudes Towards Recognising Early and Noticeable Deterioration (ATREND) scale

Chua

Smith

Wee

et al. 2022

Journal of Clinical Nursing

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Aims and objectives: To develop and evaluate the psychometric properties of an instrument that measures nurses' Attitudes Towards Recognising Early and Noticeable Deterioration (ATREND).Background: General ward nurses play an important role in recognising patient deterioration. However, their attitudes towards early recognition of clinical deterioration have not been adequately explored due to the lack of a valid and reliable scale. Design: An instrument development and validation study.Methods: A three-phase structure that followed the STROBE checklist was used: (1) item generation, (2) content and face validity assessment and (3) psychometric properties evaluation. The scale items were developed based on a comprehensive literature review and content validity assessment by 15 international experts from five countries. The psychometric properties of the ATREND scale were tested on 434 registered nurses, with retest evaluations (n = 100) at two hospitals. Exploratory and confirmatory factor analyses were used to examine the factor structure of the scale. The scale was also evaluated for its internal consistency, test-retest reliability and convergent validity.Results: The scale's content validity was 0.95. A 3-factor solution was identified from the final 11 items: (1) beliefs about importance of patient observation, (2) use of broader patient assessment skills and (3) confidence in recognising clinical deterioration. The internal consistency reliability of the scale was supported with an acceptable Cronbach's alpha value of 0.745. Test-retest reliability of the scale was excellent, with an intraclass correlation coefficient of 0.825. The ATREND scale shows evidence of good convergent validity.

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“…The Web-based educational intervention improved the ENs' assessment and management of a deteriorating patient. The need to develop nurses' assessment skills beyond routine vital signs measurement to include physical assessment has been highlighted (Chua & Liaw, 2015;Elliott, Worrall-Carter, & Page, 2013;Osborne, Douglas, Reid, Jones, & Gardner, 2015). As a result of homoeostatic compensatory mechanisms, early signs of a patient's deterioration, such as patient colour and agitation, may appear well before vital signs changes (Cioffi, Conwayt, Everist, & Scott, 2009).…”

Section: Discussionmentioning

confidence: 99%

The impact of a Web‐based educational program on the recognition and management of deteriorating patients

Liaw

Chng

Wong

et al. 2017

Journal of Clinical Nursing

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Assessing beyond vital signs to detect early patient deterioration

Cited by 9 publications

References 5 publications

Factors influencing the activation of the rapid response system for clinically deteriorating patients by frontline ward clinicians: a systematic review

Factors influencing the activation of the rapid response system for clinically deteriorating patients by frontline ward clinicians: a systematic review

Development and psychometric evaluation of the Attitudes Towards Recognising Early and Noticeable Deterioration (ATREND) scale

The impact of a Web‐based educational program on the recognition and management of deteriorating patients

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