A Survey of Nurses' Beliefs About the Medical Emergency Team System in a Canadian Tertiary Hospital

2009 ◽  
Vol 19 (1) ◽  
pp. 74-83 ◽  
Author(s):  
S. M. Bagshaw ◽  
E. E. Mondor ◽  
C. Scouten ◽  
C. Montgomery ◽  
L. Slater-MacLean ◽  
...  
Keyword(s):  
Medical Emergency Team ◽  
Tertiary Hospital ◽  
Medical Emergency ◽  
Emergency Team

Doctors’ attitudes regarding not for resuscitation orders

2017 ◽  
Vol 41 (6) ◽  
pp. 680 ◽  
Author(s):  
Gaya Sritharan ◽  
Amber C. Mills ◽  
Michele R. Levinson ◽  
Anthea L. Gellie
Keyword(s):  
Decision Making ◽  
Palliative Care ◽  
Cardiopulmonary Resuscitation ◽  
Medical Emergency Team ◽  
Tertiary Hospital ◽  
Medical Emergency ◽  
Resuscitation Orders ◽  
Goals Of Care ◽  
Emergency Team ◽  
Training Materials

Objectives The aims of the present study were to investigate doctors’ attitudes regarding the discussion and writing of not for resuscitation (NFR) orders and to identify potential barriers to the completion of these orders. Methods A questionnaire-based convenience study was undertaken at a tertiary hospital. Likert scales and open-ended questions were directed to issues surrounding the discussion, timing, understanding and writing of NFR orders, including legal and personal considerations. Results Doctors thought the presence of an NFR order both should and does alter care delivered by nursing staff, particularly delivery of pain relief, nursing observations and contacting the medical emergency team. Eighty-five per cent of doctors believed they needed somebody else’s consent to write an NFR order (seeking of consent is not a requirement in most Australian jurisdictions). Conclusion There are complex barriers to the writing and implementation of NFR orders, including doctors’ knowledge around the need for consent when cardiopulmonary resuscitation is likely to be futile or excessively burdensome. Doctors also believed that NFR orders result in changes to goals-of-care, suggesting a confounding of NFR orders with palliative care. Furthermore, doctors are willing to write NFR orders where there is clear medical indication and the patient is imminently dying, but are otherwise reliant on patients and family to initiate discussion. What is known about the topic? Hospitalised elderly patients, in the absence of an NFR order, are known to have poor survival and outcomes following resuscitation. Further, Australian data on the prevalence of NFR forms show that only a minority of older in-patients have a written NFR order in their history. In Australian hospitals, NFR orders are completed by doctors. What does this paper add? To our knowledge, the present study is the first in Australia to qualitatively analyse doctors’ reasons to writing NFR orders. The open-text nature of this questioning has been important in eliciting doctors’ responses without hypothesis guessing bias. Further, we add to the literature on the breadth of considerations doctors may encounter with regard to NFR orders. What are the implications for practitioners? The findings indicate the issues impeding decision making around cardiopulmonary resuscitation relate to poor knowledge of the law, particularly around the issue of consent and confounding NFR orders with provision of palliative care. Such barriers to the completion of NFR orders expose elderly in-patients to futile and burdensome resuscitation events. The findings suggest consideration be given to education and training materials to inform doctors about jurisdictional law regarding resuscitation documentation, support decision making around cardiopulmonary resuscitation and promote goals-of-care discussions on admission.

Comparison of policies for recognising and responding to clinical deterioration across five Victorian health services

2018 ◽  
Vol 42 (4) ◽  
pp. 412 ◽  
Author(s):  
Julie Considine ◽  
Anastasia F. Hutchison ◽  
Helen Rawson ◽  
Alison M. Hutchinson ◽  
Tracey Bucknall ◽  
...  
Keyword(s):  
Patient Safety ◽  
Health Services ◽  
Medical Emergency Team ◽  
National Standards ◽  
Clinical Deterioration ◽  
Medical Emergency ◽  
Emergency Team ◽  
Subacute Care ◽  
Guidance Documents ◽  
Activation Criteria

Objectives The aim of the present study was to describe and compare organisational guidance documents related to recognising and responding to clinical deterioration across five health services in Victoria, Australia. Methods Guidance documents were obtained from five health services, comprising 13 acute care hospitals, eight subacute care hospitals and approximately 5500 beds. Analysis was guided by a specific policy analysis framework and a priori themes. Results In all, 22 guidance documents and five graphic observation and response charts were reviewed. Variation was observed in terminology, content and recommendations between the health services. Most health services’ definitions of physiological observations fulfilled national standards in terms of minimum parameters and frequency of assessment. All health services had three-tier rapid response systems (RRS) in place at both acute and subacute care sites, consisting of activation criteria and an expected response. RRS activation criteria varied between sites, with all sites requiring modifications to RRS activation criteria to be made by medical staff. All sites had processes for patient and family escalation of care. Conclusions Current guidance documents related to the frequency of observations and escalation of care omit the vital role of nurses in these processes. Inconsistencies between health services may lead to confusion in a mobile workforce and may reduce system dependability. What is known about the topic? Recognising and responding to clinical deterioration is a major patient safety priority. To comply with national standards, health services must have systems in place for recognising and responding to clinical deterioration. What does this paper add? There is some variability in terminology, definitions and specifications of physiological observations and medical emergency team (MET) activation criteria between health services. Although nurses are largely responsible for physiological observations and escalation of care, they have little authority to direct frequency of observations and triggers for care escalation or tailor assessment to individual patient needs. Failure to identify nurses’ role in policy is concerning and contrary to the evidence regarding nurses and MET activations in practice. What are the implications for practitioners? Inconsistencies in recommendations regarding physiological observations and escalation of care criteria may create patient safety issues when students and staff work across organisations or move from one organisation to another. The validity of other parameters, such as appearance, pain, skin colour and cognition, warrant further consideration as early indicators of deterioration that may be used by nurses to identify clinical deterioration earlier. A better understanding of the relationship between the sensitivity, specificity and frequency of monitoring of particular physiological observations and patient outcomes is needed to improve the predictive validity for identification of clinical deterioration.

Features of an Intensive Care based Medical Emergency Team nurse training program in a University Teaching Hospital

2016 ◽  
Vol 29 (1) ◽  
pp. 46-49 ◽  
Author(s):  
Michelle Topple ◽  
Brooke Ryan ◽  
Richard McKay ◽  
Damien Blythe ◽  
John Rogan ◽  
...  
Keyword(s):  
Intensive Care ◽  
Training Program ◽  
Teaching Hospital ◽  
Medical Emergency Team ◽  
University Teaching ◽  
Medical Emergency ◽  
Nurse Training ◽  
Emergency Team

scholarly journals Timing and Location of Medical Emergency Team Activation Is Associated with Seriousness of Outcome: An Observational Study in a Tertiary Care Hospital

PLoS ONE ◽  
2016 ◽  
Vol 11 (12) ◽  
pp. e0168729 ◽  
Author(s):  
Takeo Kurita ◽  
Taka-aki Nakada ◽  
Rui Kawaguchi ◽  
Koichiro Shinozaki ◽  
Ryuzo Abe ◽  
...  
Keyword(s):  
Observational Study ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Medical Emergency Team ◽  
Medical Emergency ◽  
Care Hospital ◽  
Emergency Team

scholarly journals The association between abnormal vital sign groups and undesirable patient outcomes

2018 ◽  
Vol 25 (3) ◽  
pp. 137-145
Author(s):  
Marina Lee ◽  
David McD Taylor ◽  
Antony Ugoni
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Patient Outcomes ◽  
Vital Sign ◽  
Odds Ratio ◽  
Medical Emergency Team ◽  
Vital Signs ◽  
Medical Emergency ◽  
Emergency Team ◽  
Abnormal Vital Sign

Introduction: To determine the association between both abnormal individual vital signs and abnormal vital sign groups in the emergency department, and undesirable patient outcomes: hospital admission, medical emergency team calls and death. Method: We undertook a prospective cohort study in a tertiary referral emergency department (February–May 2015). Vital signs were collected prospectively in the emergency department and undesirable outcomes from the medical records. The primary outcomes were undesirable outcomes for individual vital signs (multivariate logistic regression) and vital sign groups (univariate analyses). Results: Data from 1438 patients were analysed. Admission was associated with tachycardia, tachypnoea, fever, ≥1 abnormal vital sign on admission to the emergency department, ≥1 abnormal vital sign at any time in the emergency department, a persistently abnormal vital sign, and vital signs consistent with both sepsis (tachycardia/hypotension/abnormal temperature) and pneumonia (tachypnoea/fever) (p < 0.05). Medical emergency team calls were associated with tachycardia, tachypnoea, ≥1 abnormal vital sign on admission (odds ratio: 2.3, 95% confidence interval: 1.4–3.8), ≥2 abnormal vital signs at any time (odds ratio: 2.4, 95% confidence interval: 1.2–4.7), and a persistently abnormal vital sign (odds ratio: 2.7, 95% confidence interval: 1.6–4.6). Death was associated with Glasgow Coma Score ≤13 (odds ratio: 6.3, 95% confidence interval: 2.5–16.0), ≥1 abnormal vital sign on admission (odds ratio: 2.6, 95% confidence interval: 1.2–5.6), ≥2 abnormal vital signs at any time (odds ratio: 6.4, 95% confidence interval: 1.4–29.5), a persistently abnormal vital sign (odds ratio: 4.3, 95% confidence interval: 2.0–9.0), and vital signs consistent with pneumonia (odds ratio: 5.3, 95% confidence interval: 1.9–14.8). Conclusion: Abnormal vital sign groups are generally superior to individual vital signs in predicting undesirable outcomes. They could inform best practice management, emergency department disposition, and communication with the patient and family.

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