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Dr Lindy King, Senior Lecturer in Nursing, Flinders University delivered this presentation at the 2013 Managing the Deteriorating Patient conference. The management of patients in clinical deterioration has become a chief concern for Australian hospitals, with a patient’s potential for deterioration existing in every hospital ward and health service across the country. This annual event focusses on improving education for staff caring for these patients, and improving the policies and protocols in place to maintain patient safety. For more information, please visit the event website: www.healthcareconferences.com.au/deterioratingpatients
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Senior Nurses perspectives
on caring for the deteriorating
patient through utilisation of
the MET call system
Dr Lindy King
September 2013
Presentation Overview
Drawing on senior nurses perspectives of:
• Recognising when patient deterioration warrants
a MET call
- Enablers and barriers to nurses effective
use of the MET call system
- Difficulties met by less experienced nurses
in deciding when to call a MET
Recognising when patient
deterioration warrants a MET
call • Ward nurses are recognised as the most
frequent MET activators during patient care
• Patient outcomes therefore remain dependent in part on ward nurses’ abilities to:
- first identify and respond to signs of
deterioration and
- second, if appropriate, to seek MET
intervention.
Enablers and barriers to nurses
effective use of the MET call
system Analysis of 15 studies-inclusion criteria • Published between 1994 and 2007
• English language
• Primary research article or thesis
• Acute care setting
• Registered nurses experiences
• Complex patient care
• MET calls for deteriorating patient
(Jones, King & Wilson 2009)
Enablers and barriers to nurses
effective use of the MET call
system Five major positive / negative
influencing factors:
1. Nurse education on the MET
2. Nurse expertise
(Jones, King & Wilson 2009)
Enablers and barriers to nurses
effective use of the MET call
system 3. Nurse support by medical and nursing
staff
4. Nurses’ familiarity with, and advocacy
for patients
5. Nurse workload (Jones, King & Wilson 2009)
Difficulties met by less experienced
nurses in deciding when to call a
MET
Analysis of 17 studies-inclusion criteria • Published between 2000 and 2011
• Published in English language
• Primary research article or thesis
• Acute care setting
• Graduate nurses and registered nurses experiences
• Complex patient care
• Deteriorating patient
(Purling & King 2012)
Difficulties met by less
experienced nurses in deciding
when to call a MET
Six major influencing factors emerged:
1. Clinical Support
a) Positive experiences
b) Negative experience
2. Lack of experience
3. Overwhelming workload (Purling & King 2012)
Difficulties met by less
experienced nurses in deciding
when to call a MET
4. Holistic patient assessment
a) Using objective data to support nurse’s
concerns
b) Lack of a holistic approach
c) Graduate’s lack of the total picture
(Purling & King 2012)
Difficulties met by less
experienced nurses in
deciding when to call a MET
5. Past experiences
a) Specific patient
b) Similar patients
c) Rapid response situation
(Purling & King 2012)
Difficulties met by less
experienced nurses in
deciding when to call a MET
6. Lack of available resources
a) Staff resources
b) Insufficient/faulty equipment
(Purling & King 2012)
Has the story changed more
recently?
Structured interviews with 91 medical and
nursing staff to explore cognitive and
sociocultural barriers to activating the
RRS.
Finding: “staff members identified
predominantly sociocultural reasons for failure
to activate the RRS’. (Shearer et al 2012 p 569)
Has the story changed more
recently?
Explanation for non-activation of the RRS
1. Felt situation under control in the ward
setting
2. ICU team already involved but no
ICU bed was available
3. Team involved were experienced in this
type of patient and felt RRS activation
was not required (Shearer et al 2012 p 569)
Has the story changed more
recently?
4. Poor communication / prioritisation by
medical team
5. Additional skills were not required to
manage the patient
6. No further clinical observations has
been taken (Shearer et al 2012 p 569)
Has the story changed more
recently?
7. Altered thresholds for RRS activation
but not documented
8. Thought they were too junior to activate
RRS
(Shearer et al 2012 p 569)
Thoughts on the Road Ahead
to better recognition and response to
the deteriorating patient
Need for:
Interprofessional education
Professional support across disciplines
Relationship building
Policy
Culture change
Consumer involvement
References
• Jones L, King L & Wilson C (2009) Factors that impact on nurses’
effective use of the medical emergency team. Journal of Clinical
Nursing. 18: 3379-3390
• Purling A & King L (2012) A Literature Review: Graduate nurses
preparedness for recognising and responding to the deteriorating
patient. Journal of Clinical Nursing. 21: 3451-3465
• Shearer W, Marshall S, Buist M, Finnigan M, Kitto, S, Hore, T,
Sturgess, T, Wilson S & Ramsay W (2012) What stops hospital clinical
staff from following protocols? An analysis of the incidence and factors
behind the failure of bedside clinical staff to activate the rapid response
system in a multi-campus Australian metropolitan healthcare service.
BMJ Quality & Safety. 21: 569-575
