Clinical indicators of acute deterioration in persons who reside in residential aged care facilities: A rapid review

Chambers, Shirley; Spooner, Amy J.; Parker, Christina; Jack, Leanne; Schnitker, Linda; Beattie, Elizabeth; Yates, Patsy; MacAndrew, Margaret

doi:10.1111/jnu.12819

Cited by 3 publications

(1 citation statement)

References 48 publications

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“…However, staff skills and confidence are over-estimated. Chambers et al (2023) highlighted that staff confidence is vital to identifying acute deterioration in residents. This evaluation found that despite training, some staff lacked the confidence to take observations and were not prepared for the challenges of taking observations in a setting with residents who may be unwell, agitated or uncooperative.…”

Section: Discussionmentioning

confidence: 99%

Implementation of RESTORE2 in Care Homes in England: A Mixed-Methods Evaluation

Nwolise,

Peters,

Taylor

et al. 2024

JLTC

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Context: Older adults are more susceptible to acute deterioration. Delayed recognition or response is linked to poor health outcomes and adverse events. Identification and management of deterioration is more difficult in this population due to increasingly complex healthcare needs and limited/no healthcare knowledge of some staff. Enhancing ability of care home staff to recognise and communicate concerns could reduce avoidable harm for residents at risk of or experiencing physical deterioration. Objective: To evaluate the implementation of RESTORE2, a physical deterioration and escalation tool, in care homes. Methods: A mixed-methods approach, comprising individual semi-structured interviews and online survey, was used. A total of 35 care home staff from 34 care homes took part in this evaluation. Findings: Implementation of the full RESTORE2 tool was low. Several challenges that impeded successful implementation including complexity, uncertainty over carers’ role in carrying out clinical observations, inadequate training and buy-in from health-service providers, need to be addressed. Nevertheless, some benefits including improved staff knowledge/confidence to identify deterioration, escalate and communicate concerns, as well as potential to reduce unnecessary healthcare utilisation particularly 999 calls and hospital admissions were reported. Limitations: This study was limited by the small sample size of the quantitative phase. The Covid-19 pandemic affected recruitment and engagement with care homes. Implications: RESTORE2 has a long way to go to become a common language in social care. Collaboration between health professionals and care staff is important for RESTORE2 to become embedded into practice. Further quantitative and qualitative research is required to strengthen the evidence base.

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Section: Discussionmentioning

confidence: 99%

Implementation of RESTORE2 in Care Homes in England: A Mixed-Methods Evaluation

Nwolise,

Peters,

Taylor

et al. 2024

JLTC

View full text Add to dashboard Cite

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Clinical indicators of acute deterioration in persons who reside in residential aged care facilities: A rapid review

Chambers

Spooner

Parker

et al. 2022

J of Nursing Scholarship

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Purpose: To identify the clinical indicators of acute deterioration in residents and the factors that influence residential aged care facility staff's identification of these.Design: Rapid review and narrative synthesis. Methods:The WHO and Cochrane Rapid Review Methods Group recommendations guided the review processes. CINAHL, Medline, PubMed, and the Cochrane Library were searched from 2000 to January 2022. Data related to clinical indicators of deterioration were categorized using the Airway, Breathing, Circulation, Disability, Exposure assessment framework, and factors influencing detection were grouped as consumer (resident and family), aged care workforce, and organization factors. Results: Twenty publications were included of which 14 informed clinical indicators; nine highlighted factors that influence staff's identification of these and three informed both. Included article were collectively below moderate quality. Most clinical indicators were grouped into the 'Disability' category with altered level of consciousness, behavior, and pain identified most frequently. Few studies reported more traditional indicators of deterioration used in the general population -changes in vital signs. The most common factors influencing the detection of acute deterioration were organizational and workforce-related including resource, knowledge, and confidence deficits. Conclusion:Findings suggest subtle changes in resident's health status, rather than focusing primarily on physiologic parameters used in early warning tools for acute care settings, should be recognized and considered in the design of early warning tools for residential aged care facilities.

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Mapping Quality Indicators to Assess Older Adult Health and Care in Community-, Continuing-, and Acute-Care Settings: A Systematic Review of Reviews and Guidelines

Karimi-Dehkordi,

Hanson,

Kennedy

et al. 2024

Healthcare

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Quality indicators (QIs) play a vital role in enhancing the care of older adults. This study aimed to identify existing QIs relevant to the health and care of older adults in community-care, continuing-care, and acute-care settings, along with available information such as definitions and calculation methods. A systematic review of published review studies, grey literature, and guidelines was undertaken, utilizing six electronic databases searched for materials dated from 2010 to 2 June 2023. To be included in this study, the literature had to provide data on QIs in a setting involving older adults. This study included 27 reviews and 44 grey literature sources, identifying a total of 6391 QIs. The highest number of indicators (37%) were relevant to continuing care; 32% and 28% were pertinent to community- and acute-care settings, respectively. The process domain had the highest number of QIs (3932), while the structure domain had the fewest indicators (521). A total of 39 focus areas were identified, with the five most common areas being, in descending order, orthopedics/hip fractures, end-of-life/palliative care, appropriate prescribing, neurocognitive conditions, and cardiovascular conditions; these areas ranged between 10% and 6%. When mapped against the Quadruple Aim framework, most QIs (85%) were linked to improving health outcomes. This inclusive compilation of QIs serves as a resource for addressing various focus areas pertinent to the Quadruple Aims. However, few quality indicators have been designed to provide a comprehensive and thorough evaluation of a specific aspect, taking into account all three key domains: structure, process, and outcomes. Addressing the description and psychometric properties of QIs is foundational for ensuring their trustworthiness and effective application.

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Clinical indicators of acute deterioration in persons who reside in residential aged care facilities: A rapid review

Cited by 3 publications

References 48 publications

Implementation of RESTORE2 in Care Homes in England: A Mixed-Methods Evaluation

Implementation of RESTORE2 in Care Homes in England: A Mixed-Methods Evaluation

Clinical indicators of acute deterioration in persons who reside in residential aged care facilities: A rapid review

Mapping Quality Indicators to Assess Older Adult Health and Care in Community-, Continuing-, and Acute-Care Settings: A Systematic Review of Reviews and Guidelines

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