NQCG3117 Recognising the Deteriorating Adult Patient
The aim of the module is for students to develop their knowledge and skills in relation to the identification, assessment, and management of the acutely unwell adult patient who is at risk of deterioration or critical illness.
Aims and Objectives
To develop their knowledge and skills in relation to the identification, assessment, and management of the acutely unwell adult patient who is at risk of deterioration or critical illness. As well as exploring issues relating to the assessment and interventions required for the critically unwell adult, the unit will encourage and enable students to take a ‘wider view’ of the care of the patient who is at risk of deterioration in the clinical environment. By the end of the module you will be able to identify a development, improvement or change in practice which may improve the care given to patients who are at risk of deterioration within your own practice setting.
Having successfully completed this module you will be able to:
- Identify and discuss a range of factors which place the acutely unwell adult at risk of deterioration / critical illness.
- Critically evaluate the evidence which underpins the planning, delivery and evaluation of care to the deteriorating adult patient.
- Identify and critically consider influences on clinical decision making in relation to the deteriorating adult patient.
- Utilise knowledge gained in the module to make recommendations which may improve the care delivered to patients at risk of deterioration / critical illness in your own clinical area.
- Practice competencies: 5a – Identifying the ‘at risk’ patient. 5b – Appropriate early assessment and early interventions for the deteriorating patient. 5c – Detailed and systematic patient assessment. 5d - Plan, deliver and evaluate interventions for the patient at risk of critical illness 5e - Make effective referrals to other members of the MDT in relation to the critically ill patient.
A range of subjects are taught within the module relating to the learning outcomes. • Context of care and the ‘at risk’ patient • Physiology update • ABCDE - Assessment & Intervention • Common patient presentations and management • Clinical decision making • Interpreting results of common investigations • Evidence based practice • Patient management plans • Root cause analysis • Organisational aspects on acuity • Intra-hospital and inter-hospital patient transfer • Assertiveness • Communication • End-of-life decision making • Case study – simulated practice • Study skills and seminars regarding student learning contracts • Tutorial time • Module evaluation The module aims, learning outcomes and syllabus have been informed by the following international research and evidence: • Ball,C. (2003) Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population based study, BMJ. 327(7422):1014- • Barbetti, J.; Lee G. (2008) Medical emergency team: a review of the literature. Nursing in Critical Care. 13 (2) 80-85 • Cioffi J, (2000) Nurses’ experiences of making decisions to call emergency assistance to their patients, Journal of Advanced Nursing, 32(1), pp108-114 • Department of Health, (2000) Comprehensive Critical Care: A Review of Adult Critical Care Services. London: DOH • Department of Health (2001) The nursing contribution to the provision of comprehensive critical care for adults: a strategic programme of action. London: Department of Health. • Massey, D.; Aitken, L.; Chaboyer, W. (2010) Literature review: do rapid response systems reduce the incidence of major adverse events in the deteriorating ward patient? Journal of Clinical Nursing 19 (23-24) 3260-73 • McGloin et al, 1999, Unexpected Deaths and Referrals to Intensive Care of Patients on General Wards. Are Some Cases Potentially Avoidable?, J R Coll Physicians, 33(3): 255-9 • McQuillan P, Pilkington S, Allan A, Taylor B, Short A, Morgan G, Nielson M, Barrett D, Smith G, (1998), Confidential enquiry into quality of care before admission to intensive care, British Medical Journal, 316, 1853-1858 • Naeem, N., Montenegro, H. (2005) Beyond the intensive care unit: A review of interventions aimed at anticipating and preventing in-hospital cardiopulmonary arrest. Resuscitation. 67 (1) 13-23 • National Confidential Enquiry Into Patient Outcome And Death (2005) An acute problem? London: NCEPOD • National Institute for Health and Clinical Excellence (2007) Acutely ill patients in hospital: Recognition of and response to acute illness in adults in hospital London: National Institute for Health and Clinical Excellence
Access to a mentor in practice is required to complete the practice based competencies.
Learning and Teaching
Teaching and learning methods
A range of teaching and learning methods are employed throughout this module in order to cater to the spectrum of learning styles. During the study days the following strategies are used: • Large group lecture/exposition • Large group discussion • Small group discussion • Case study • Small group activities (for example production of a management plan template) • Video presentation • Simulated case study with manikin and high fidelity simulation suite • Small group seminar • Individual tutorial • On-line activities • Module workbook with suggested self-directed learning activities to prepare for subsequent study days Students are also expected to undertake individual learning activities outside of the taught study days. The focus of these activities will be decided by the students however they may receive suggestions for self-directed study topics from the academic staff in relation to taught elements of the module, and the students’ choice of topic for the learning contract. Taught sessions are delivered by various members of academic staff with expertise in the topic areas. Academic staff with joint appointments in practice, or those seconded from practice are invited to contribute to the teaching of the module.
|Preparation for scheduled sessions||10|
|Completion of assessment task||50|
|Work based learning||50|
|Wider reading or practice||50|
|Total study time||250|
Resources & Reading list
Medical emergency team: a review of the literature.. ,13 , pp. 80-85.
Pantazopoulos, I. et al (2012). Factors influencing nurses’ decisions to activate medical emergency teams.
Creed, F.; Spiers, C. (2010). Care of the acutely ill adult: an essential guide for nurses.
Massey, D.; Aitken, L.; Chaboyer, W. (2011). Caring for the seriously ill patient.
A mutli-faceted approach to the physiologically unstable patient. ,19 , pp. e47.
Tait, D. (2012). Acute and critical care in adult nursing.
Nolan, J. et al. (2011). Advanced Life Support.
Literature review: do rapid response systems reduce the incidence of major adverse events in the deteriorating ward patient?. ,19 , pp. 3260-73.
Peate, I.; Dutton, H. (2012). Acute nursing care : recognising and responding to medical emergencies.
Track, trigger and teamwork: communication of deterioration in acute medical and surgical wards.. ,26 , pp. 10 - 7.
Indicators of acute deterioration in adult patients nursed in acute wards: a factorial study. ,20 , pp. 723-32.
Jevon, P. (2012). Monitoring the critically ill patient.
Repeat type: Internal & External