Patient Deterioration in the Adult Progressive Care Unit

Abstract

Background The American Heart Association set a goal in 2010 to double the percentage of hospitalized adult patients who survive cardiac arrest by 2020. Because of acuity and interventions, progressive care patients are a population of interest to address this goal. The state of the literature involving patient deterioration, which can lead to cardiac arrest, in the progressive care setting has yet to be explored. Objective A scoping review was done to investigate the literature involving patient deterioration in adult progressive care units in order to map knowledge, identify themes, and discover areas for research potential. Methods The scoping review began with an extensive literature search and a multistep review. The characteristics of the final group of studies were charted and grouped according to common themes. Results There were 13 studies in the final group. All studies were conducted in the United States and most by interprofessional teams. Three themes were evident in the review, training methods, surveillance, and monitoring systems. Discussion Patient deterioration in the progressive care unit may benefit from team-based training methods involving checklists or protocols. Nurses can use surveillance, including physical assessment and technology, to recognize early warning signs. Lastly, the use of systems that identify patterns in vital signs can be useful to reduce patient harm. Further research in this area care is warranted and could potentially improve patient outcomes and nursing practice.

Q-15 Minutes Vital Sign Documentation Is a Poor Surrogate for Assessing Quality of Care After Acute Ischemic Stroke

“…It is well established that nurses observe (practice surveillance) almost continuously. 19 Rather, the results extend suggestions that q15min documentation of NIHSS and vital signs does not predict outcome. 11 The study analyzed the documentation of q15min vital signs and NIHSS documentation after initiating alteplase administration in AIS patients.…”

“…The results should not be interpreted as a measure of the relevance of frequent observation. It is well established that nurses observe (practice surveillance) almost continuously 19 . Rather, the results extend suggestions that q15min documentation of NIHSS and vital signs does not predict outcome 11 .…”

Physical assessment competencies for nurses: A quality improvement initiative

“…Being able to assess the patient's current condition can help identify early changes. Knowledge of a patient's clinical status and usual behaviors gained through a full (head‐to‐toe) physical assessment is a key influence on a nurse's ability to recognize subtle changes in a patient's condition 1–4 . The importance of early recognition of deterioration before overt physiologic signs, such as vital sign changes, cannot be overstated given the link between unrecognized patient deterioration and serious adverse events 5–9 .…”

“…Knowledge of a patient's clinical status and usual behaviors gained through a full (head-to-toe) physical assessment is a key influence on a nurse's ability to recognize subtle changes in a patient's condition. [1][2][3][4] The importance of early recognition of deterioration before overt physiologic signs, such as vital sign changes, cannot be overstated given the link between unrecognized patient deterioration and serious adverse events. [5][6][7][8][9] However, physical assessment as practiced daily in contemporary nursing focuses more on vital signs than physical assessment; this is likely due to time restraints and a reliance on technology to determine patient's clinical status.…”