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Lyell Brougham NEF Operating Room Services Royal Adelaide Hospital.

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Presentation on theme: "Lyell Brougham NEF Operating Room Services Royal Adelaide Hospital."— Presentation transcript:

1 Lyell Brougham NEF Operating Room Services Royal Adelaide Hospital

2 RECOGNISING the DETERIORATING PATIENT

3 The primary purpose of the recovery room is the critical evaluation of the postoperative patient with the emphasis on the anticipation and prevention of complications. Drain and Shipley 1987 POSTANAESTHETISIA RECOVERY UNIT

4 RECOGNISING the DETERIORATING PATIENT How we educate and how we clinically practice, effects competence!

5 RECOGNISING the DETERIORATING PATIENT 50% of what we know is probably wrong, our problem is which 50%?

6 RECOGNISING the DETERIORATING PATIENT Standard 9: Recognising and responding to the Deteriorating Patient

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9 A = AIRWAY B = BREATHING C = CIRCULATION D = DISABILITY E = EXPOSURE DETERIORATING PATIENT

10 WHAT IS THE ESSENCE OF INFECTION CONTROL? QUESTION

11 WHAT IS THE ESSENCE OF INFECTION CONTROL? A: Transmission Prevention QUESTION

12 WHAT IS THE ESSENCE OF DETERIORATING PATIENT? QUESTION?

13 ASSESSMENT? NURSING the DETERIORATING PATIENT

14 ASSESSMENT? OR ASSESSING? NURSING the DETERIORATING PATIENT

15 ASSESSMENT PLANNING IMPLEMENTATION EVALUATION THE NURSING PROCESS

16 STRUCTURE PROCESS OUTCOME MANAGEMENT MODEL

17 STRUCTURE + PROCESS = OUTCOME MANAGEMENT MODEL

18 STRUCTURE PROCESS OUTCOME EVALUATION MODEL

19 1.ASSESSMENT 2.CURING MEDICAL MODEL 2 Steps

20 1.ASSESSING 2.CLINICAL INTERVENTION PARU NURSING MODEL 2 Steps

21 RECOGNISING the DETERIORATING PATIENT Standard 9: Recognising and responding to the Deteriorating Patient

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24 A = AIRWAY B = BREATHING C = CIRCULATION D = DISABILITY E = EXPOSURE DETERIORATING PATIENT

25 Check for loose dentures, teeth etc Is the airway clear? A = AIRWAY

26 Respiratory rate SpO 2 Observation CXR ABG Auscultation B = BREATHING

27 Heart Rate Rhythm BP 12 lead ECG Capillary Return > 3 seconds Bloods IV Access Fluids Urinary Output Fluid Balance Chart C = CIRCULATION

28 BSL AVPU (Alert, Voice, Pain, Unresponsive) GCS MEDICATION CHART Anything else that doesnt fit into ABC D = DISABILITY

29 Pull back the blankets and look! E = EXPOSURE

30 RECOGNISING the DETERIORATING PATIENT

31 ASSESSMENT OR ASSESSING? NURSING the DETERIORATING PATIENT

32 The primary purpose of the recovery room is the critical evaluation of the postoperative patient with the emphasis on the anticipation and prevention of complications. Drain and Shipley 1987 POSTANAESTHETISIA RECOVERY UNIT

33 You walk into a 6 bed bay. There are 5 patients asleep and one who has had a cardiac arrest! HOW CAN YOU TELL WHICH PATIENT HAS ARRESTED? CLINICAL INTERVENTION QUESTION

34 Monitor the Patient not the machines! ICU Mantra

35 We need to learn to read the patient like a book. WHAT WE NEED TO UNDERSTAND?

36 We need to learn to read the patient like a book. WHAT WE NEED TO UNDERSTAND? EVERYTHING HAS MEANING?

37 1.ASSESSING 2.CLINICAL INTERVENTION PARU NURSING MODEL 2 Steps

38 What is the most valuable vital sign of a deteriorating patient? QUESTION

39 What is the most valuable vital sign in a deteriorating patient? A: STATE OF CONSCIOUSNESS QUESTION

40 State of Consciousness Movement Colour Skin Vital signs OBSERVATIONS

41 Problem: No scales that accurately reflect the SOC! STATE OF CONSCIOUSNESS

42 Awareness – Face, eyes Arms Legs Seizure / TIA MOVEMENT

43 Awareness – Face, eyes Arms Legs Seizure / TIA MOVEMENT

44 The trend is of more value than the number! COLOUR

45 Movement Colour Temperature Moisture (dry – clammy) SKIN

46 Respiratory rate SpO 2 Observation CXR ABG Auscultation OBSERVATIONS

47 83 yrs #NOF 36 hrs from fall Aramine throughout theatre VIGNETTE

48 83 yrs #NOF 36 hrs from fall Aramine throughout theatre VIGNETTE

49 The primary purpose of the recovery room is the critical evaluation of the postoperative patient with the emphasis on the anticipation and prevention of complications. Drain and Shipley 1987 POSTANAESTHETISIA RECOVERY UNIT

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53 The Australian Resuscitation Guidelines, December Thanks also to Kym Mart (NEF SDD) References


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