• Choose a category
• All
• Classic-Fiction

By Root 1779 0

rather than being relied on as an absolute measure of the patient’s condition (Critical Care Stakeholders Forum and National Outreach Forum 2007). They are of use in helping ward nurses to improve and focus their recognition of patients who may need further support and monitoring (DH 2000). Critical care outreach teams are available in many hospitals now and where present, they must be informed of any patients who are deteriorating or at risk of deteriorating, so that they can provide support to ward staff and assess the patient (DH 2000).

One tool that has been found to assist with structuring and standardizing communication is the SituationBackgroundAssessmentRecommendations (SBAR) tool (see Figure 12.2). SBAR is an easytoremember, concrete mechanism useful for framing any conversation, especially critical ones, requiring a clinician’s immediate attention and action. It allows for an easy and focused way to set expectations for what will be communicated and how between members of the team, which is essential for developing teamwork and fostering a culture of patient safety (Woodhall 2008).

Figure 12.2 SituationBackgroundAssessmentRecommendations (SBAR) tool.

Anticipated patient outcomes

Physiological observations are extremely important in recognizing if a patient’s condition is deteriorating or indeed improving (Kisiel and Perkins 2006).

Legal and professional issues

Nurses are accountable and responsible for providing optimum care for their patients. The Nursing and Midwifery Council’s (NMC) The Code provides the main source of professional accountability for nurses (NMC 2008a). It is essential that nursing staff objectively examine the information gathered from assessments and observations as well as any information previously recorded (Crouch and Meurier 2005).

For nurses’ own professional accountability and for the achievement of safe, effective and proficient care of the patient, it is essential that nurses are able to discuss (using physiological rationale) the potential reasons for the observations they have recorded (Kisiel and Perkins 2006). Professional accountability demands more than nurses just undertaking observations. It is about nurses being able to interpret them and then to take appropriate action (Kisiel and Perkins 2006).

Observations should be taken by staff who have undergone the appropriate training regarding the procedure, not only so that they are able to perform the procedure correctly and accurately but also, crucially, so they are able to act on and understand the clinical relevance of the results (NICE 2007b). The degree of training should be suitable to the level of care which the practitioner is providing (NICE 2007b). However, all staff should have competencies in relation to measuring, monitoring, interpretation and when to respond promptly (NICE 2007b).

Preprocedural considerations

Equipment

All practitioners need to be aware of the strengths and limitations of the devices they are using and need to have adequate training on the use of all equipment. They must ensure that the devices are validated, checked, maintained and recalibrated regularly according to the manufacturer’s instructions (NICE 2006). In addition, the use of the device should be within the permitted manufacturer’s guidelines.

Prior to the procedure, check when the device was last serviced. All devices, manual or automated, are only accurate if they are working and used correctly. Most trusts have the devices checked annually and the date documented on the device and staff should check this and report when it is due for servicing (Woodrow 2004a).

Postprocedural considerations

Documentation

Adequate training on good record keeping and documentation is essential. The NMC (2009) states that the quality of good record keeping is also a reflection of the standard of the individual’s professional practice. All records must be contemporaneous, accurate and unambiguous (Dawes and Durham 2007).

Pulse

Definition

The pulse is a pressure wave that is transmitted through the arterial tree with each