IntroductionIt is common for patients undergoing treatment to develop complications that may lead to adverse outcomes, including death. Although some cases are unpreventable, others are as a result of poor care delivery and management of patient. Even when early signs are visible, some caregivers fail to identify or manage patients who are likely to experience adverse outcomes or become critically ill. Such occurrences should be of concern to policy makers and managers of health institutions. This paper examines a case study of a patient who developed complication during his treatment and highlights issues related to care provision in acute care environments.
It proposes how the caregivers should have been aware of early warning signs, suggests the appropriate clinical actions and communications to the health care team, and applies the five rights of clinical reasoning to the case scenario as well as explains how the patient’s adverse outcome could have been averted. Early and late warning signsTime is often a critical aspect when treating patients in acute settings. The time taken to identify and act on the right signs of a medical condition often dictates the success of the treatment of a patient.
A number of authors are in agreement that nursing professionals attending to patients should be able to capture warning signs and act on them early enough to avert complications (Banning, 2008; Clarke, 2004; Hoffman, Aitken, & Duffield, 2009; Levett-Jones, et al. 2010). Note that the cost of capturing cues late is high and may lead to unpleasant outcomes, including death. Detecting signs late is often linked to poor clinical reasoning skills. It is known that some nurses often fail to recognize patients in need of urgent attention, and/or fail to take timely action.
Hoffman, Aitken, & Duffield (2009) have concurred that ‘novice’ nurses often do not collect reasonably adequate cues on time to evaluate a patient’s condition. Yet, being able to make appropriate decisions regarding treatment of a patient is hinged on timely availability of a wide array of cues (Hoffman, Aitken, & Duffield, 2009; Levett-Jones, et al. 2010). The ability to detect early warning signs is dependent on a number of factors. Clarke (2004) has pointed out staffing as one factor that affects nurses’ ability to make early identification of complication.
The level of nursing experience and education also matters when identifying early signs for potential complication. Levett-Jones, et al. (2010) have emphasized that education enhances the clinical reasoning ability of nurses to become competent in managing patients at high risk of developing medical complications. Therefore, a nurse assessing a patient’s condition should have proper educational background and wide experience in nursing practice. The nurse should also collect adequate cues before making decision regarding a patient. Failure to rescueNurses’ inability to identify worsening condition of patients and failure to take action are likely to result in unpleasant outcomes.
These outcomes include death, which Clarke (2004) and Levett-Jones, et al. (2010) have termed the “failure to rescue. ” It is worth to note that failure to rescue is associated with complications acquired through the treatment process. A number of factors contribute to the failure to rescue. One main factor is nurses’ poor clinical reasoning skills. As Levett-Jones, et al. (2010) notes, clinical reasoning involves judging a patient’s condition and deciding the course of action.
Clarke (2004) summarizes the causes of unpleasant outcome as the failure to correctly diagnose a condition and give proper care. Inapt handling of complications also leads to failure to rescue (Levett-Jones, et al. , 2010). If a nurse fails to make correct judgement and/or does not take appropriate action, it is likely for the patient to develop severe complications or even die. The ability to make appropriate judgements and decisions is correlated to education and experience. Levett-Jones, et al. (2010) notes that nurses with proper education and extensive experience in acute care rarely commits errors.
However, some other factors such as organizational attributes, staffing, remuneration and working conditions may determine the outcome of a patient’s treatment. Clarke (2004) has highlighted that the variations in the number of staffs and the working conditions among various health institutions are empirically linked to patient outcomes and nurses’ performance. The percentage of mortality among patients who experience medical complications during treatment has been linked to availability of resource in the health institution and by to staff involved in their care Clarke, 2010; Levett-Jones, et al. , 2010).
In addition, Clarke (2010) has noted that higher staffing levels are associated with lower unpleasant outcomes, or failure to rescue.