Archives
Admission and Discharge Practices: High Dependency Unit audit outcome
Alan Tulloch
Lecturer, School of Nursing and Midwifery, Curtin University of Technology; Nurse Research Consultant, Curtin University, Joondalup Health Campus, WA
Chris How
Clinical Nurse Manager, Cassia Ward, Joondalup Health Campus, Perth WA
Marjorie Brent
Clinical Nurse Consultant, Cassia Ward, Joondalup Health Campus, Perth WA
Rose Chapman
Director of Clinical and Nursing Practice, School of Nursing and Midwifery, Curtin University of Technology; Nurse Research Consultant ED, Curtin University, Joondalup Health Campus, Perth WA
Brendon Burns
Clinical Nurse Manager, Critical Care and Renal Units, Joondalup Health Campus, Perth WA
Su-Mei Pomery
Clinical Nurse, Emergency Department, Joondalup Health Campus, Perth WA
Abstract
This paper presents the findings of a retrospective audit of admission and discharge practices of a nurse led High Dependency Unit (Nurse Specials Unit) in Perth, Western Australia.
The aim of the study was:
-
to review the effectiveness of the inclusion and exclusion guidelines for patients admitted to the Nurse Special Unit (NSU);
-
to identify characteristics of admitted patients; and
-
to determine the level of adherence to admission protocols for documentation of patient condition, plan of care, medical and Clinical Nurse Consultant review.
The sample comprised all patients admitted to the NSU from September 2004 – March 2005, excluding those (50) in the pilot study (n=154).
This audit revealed patients were primarily elderly and admitted for close nursing supervision. Inclusion and exclusion criterion were adhered to, however documentation of patient data, in relation to current status and plan of care, was poorly completed and frequently absent during intra hospital transfer. This lack of clear documentation poses a significant risk to the patient. Further research is required to determine strategies that result in appropriate and useful transfer documentation. In addition, the content of transfer data that permits continuity of care needs to be determined.
Keywords
nurse, high dependency unit, audit, documentation, transfer summary, nurse specials unit
References
Australian Council for Safety and Quality in Health Care (2005) Clinical handover and patient safety, accessed at http://www.safetyandquality.org/clinhovrlitrev.pdf on 1 July 2006.
Ball C (2005) Ensuring a successful discharge from intensive care. Intensive and Critical Care Nursing 21(1): 1-4.
Ball C, Kirkby M and Williams S (2003) Effect of the critical care outreach team on patient survival to discharge from hospital and readmission to critical care: non-randomised population study. British Medical Journal 327: 1014-7.
Barlow R (2001) The surgical high dependency unit. Nursing Progress 10: 19-20.
Boots R and Lipman J (2002) High dependency units; Issues to consider in their planning. Anaesthesia and Intensive Care 30(3): 348-354.
Clarke T (1996) A quality review of high-dependency patient care. Australian Critical Care 9(3): 96-101.
Coombs M and Dillon A (2002) Crossing boundaries, re-defining care: the role of the critical care outreach team. Journal of Clinical Nursing II(3): 387-393.
Cuthbertson BH and Webster NR (1999) The role of the intensive care unit in the management of the critically ill surgical patient. Journal of the Royal College of Surgeons of Edinburgh 44(5): 294-300.
Daffurn K (1998) Roles of acute care nurse practitioners, physician assistants, and resident physicians in acute care settings. American Journal of Critical Care 7(4): 253-255.
Dunn S and Schmitz K (2005) Nurse's perception of patients' requirements for nursing resources. Australian Journal of Advanced Nursing 22(3): 33-41.
Garrard C and Young D (1998) Suboptimal care of patients before admission to intensive care is caused by failure to appreciate or apply the ABCs of life support. British Medical Journal 316(7148): 1841-1843.
Goldhill DR, Worthington L, Mulcahy A, Tarling M and Sumner A (1999) The patient-at-risk team: identifying and managing seriously ill ward patients. Anaesthesia 54(9): 853-860.
Hall-Smith J, Ball C and Coakley J (1997) Follow up services and the development of a clinical nurse specialist in intensive care. Intensive and Critical Care Nursing 13: 243-248.
Health Department of Victoria (2002) Review of intensive care in Victoria: Intensive Care Management Issues, Phase 1 Report.
Hillman K, Parr M, Flabouris A, Bishop G and Stewart A (2001) Redefining in-hospital resuscitation: the concept of the medical emergency team. Resuscitation 48(2): 105-110.
Joint Commission on
Accreditation of Healthcare Organizations (2006) Joint Commission 2006
National patient safety goals, accessed at
http://www.jointcommission.org/NR/rdonlyres/883E2035-F862-4698-8379-
2A5B3C959ACB/0/06_NPSG_ome_grid.pdf
on 1 June 2006.
Joint Faculty of Intensive Care Medicine (2002) Recommendations for high dependency units seeking accredited training in intensive care.
Knight G (2003) Nurse-led discharge from high dependency unit. Nursing in Critical Care 8(2): 56-60.
Pappachan JV, Millar BW, Barrett DJ and Smith GB (1999) Analysis of intensive care populations to select possible candidates for high dependency care. Journal of Accident and Emergency Medicine 16: 13-17.
Patterson E, Roth E, Woods D, Chow R and Gomes OG (2004) Handoff strategies in settings with high consequences for failure: lessons for health care operations. International Journal for Quality in Health Care 16: 125-132.
Place B and Graham S (2000) Non-invasive vital organ assessment. Nursing Times Plus 96: 6-9
Sharpley JT and Holden JC (2004) Introducing an early warning scoring system in a district general hospital. Nurs Crit Care 9(3): 98-103.
Smith G (2000) To MET or not to MET - that is the question. Care of the Critically Ill 16: 198-199.
Subbe CP, Kruger M, Rutherford P and Gemmel L (2001) Validation of a modified early warning score in medical admissions. Quarterly Journal of Medicine 94: 521-526.
McArthur-Rouse F (2001) Critical care outreach services and early warning scoring systems: a review of the literature. Journal of Advanced Nursing 36(5): 696-704.
McQuillan P, Pilkington S, Allan A, Taylor B, Short A, Morgan G, Nielson M, Barrett D and Smith G (1998) Confidential inquiry into the quality of care before admission to intensive care. British Medical Journal 316: 1853-1858.
Thurgood G (1995) Verbal handover reports: what skills are needed? British Journal of Nursing 4(12): 720-722.
Turner M, McFarlane H and Krukowski Z (1998) Prospective study of high dependency care requirements and provision, JR Coll Surg Edinb. 44: 19-23
USA Department of Defense (2006) Department of Defense patient safety program healthcare communications toolkit, accessed at http://www.usuhs.mil/cerps/documents/Handoff_Toolkit.pdf on 1 June 2006.
Weinstock M (2005) Transitioning care. Hospitals and Health Networks 79(6): 27-28.
Whittaker J and Ball C (2000) Discharge from intensive care: a view from the ward. Intensive Critical Care Nursing 16: 135-43.
Wright MM, Stenhouse CW and Morgan RJ (2000) Early detection of patients at risk. Anaesthesia 55(4): 391-392.
eContent Home