Clinical Deterioration - Identify, Assess, Prevent Seminar
2 Day Seminar for Nurses
There is a significant potential for patients across any clinical setting to rapidly become unwell. Recent system changes have been rolled out to encourage better management of clinical deterioration. However, your ability to recognise and respond to changes in a patient’s condition early is a high priority if acute illness is to be averted. Attend this two-day seminar to gain knowledge that will help you to feel more confident that your essential assessment skills and early nursing management can detect early cues and prevent poor patient outcomes. Learn about:
- The power of assessment when your patient is deteriorating
- How to recognise sepsis early
- Warning signs of acute kidney injury
- How to recognise acute respiratory failure including basic CXR interpretation
- Tips for recognising common arrhythmias and electrolyte imbalances
- How to perform a basic interpretation of arterial blood gases
- The power of communication when things don’t go to plan…
Need for Program
Growing numbers of high acuity patients are increasingly being cared for across a wide range of clinical settings, not just in acute care units such as intensive care units. The more acutely unwell a person is, the greater the risk of poor patient outcomes, including increased morbidity and mortality. Nurses are essential to the prevention, early detection, and management of the developing problems that can increase morbidity and mortality. The ability to recognise and interpret clinical cues and then implement appropriate, evidence-based interventions in a timely manner has a significant positive impact on patient outcomes. Therefore, nurses must continually increase their knowledge to ensure they are sufficiently educated to care for patients at risk of deterioration and prevent them from becoming acutely unwell.
Purpose of Program
This seminar enables nurses working in general areas to feel more confident in their knowledge and ability to assess and manage patients whose clinical condition is deteriorating.
Your Learning Outcomes
- Relate pathophysiological principles that occur in acutely ill patients in order to prioritise assessment in a patient who is deteriorating
- Correlate clinical assessment findings with pathophysiological processes occurring across a range of body systems
- Apply a range of appropriate and timely evidence-based nursing interventions for a person who is acutely ill and whose condition is deteriorating
- Recognise and respond to early signs of sepsis by implementing evidence-based interventions and thereby improve patient outcomes
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8:30am - Registration and Refreshments
Welcome and Introduction to Program
What Happens to a Person During an Acute Illness?
Acute illness can trigger an array of psychological and physiological responses that have the potential to be either beneficial or harmful. Whilst nurses need to focus their attention on what physiological changes may be occurring, we often forget that beneath this is a person! This brief introductory session considers what happens to not just the body but a person's mind and wellbeing during illness and the nursing implications for this.
Essential Physical Assessment Skills
Nurses are essential in the early detection of clinical triggers that may suggest a patient is deteriorating or has already become acutely unwell. Appropriate and timely assessment is known to reduce morbidity and mortality, thus improving patient outcomes. This session reviews important assessment considerations, including:
- Why we assess our patients
- Vitally important “vital signs” – why some clinical cues are neglected
- Overview of Australian Commission on Safety and Quality Health Care Standard 9
- Top tips for quick recognition of acute deterioration
- Assessing consciousness
- Assessing perfusion
10:30am - Morning Tea
Shifting the pH – Acid-Base Balance
A deviation from acid-base balance homeostasis can severely affect any organ in the human body. In this interactive and practical session, you will develop a better understanding of this complex topic. It includes:
- The importance and physiology of acid-base balance
- Arterial blood gas analysis
- Case studies for practice interpretation and management options
Asleep or Unconscious? Assessing Neurological Deterioration
The ability to recognise subtle changes in a person’s neurological state will enable you to detect signs of deterioration early. The purpose of this session is to take you through the basics of a neurological assessment, including a simplified approach to using the Glasgow Coma Scale (GCS). Topics covered include:
- What is a GCS include and what does this tell you?
- What else, other than a person’s GCS, should be assessed, e.g. limb strength?
- What are the common signs and symptoms associated with neurological decline and what may they indicate?
- How do you document and report changes?
1:00pm - Lunch and Networking
ST What? Identifying Important ECG Changes
There are certain ECG changes that may be present in the context of Acute Coronary Syndromes (ACS) that must be correctly identified and reported urgently. This session will use case studies to take a look at some of these important changes, helping you to immediately gain confidence and apply this knowledge to your clinical practice. It includes:
- What ECG changes may indicate a person is experiencing or has experienced chest pain?
- How do you identify ECG changes relating to myocardial ischaemia, injury, or infarction and what might this mean?
3:00pm - Afternoon Tea
Chest Pain – What do I Need to Do?
Acute illness, can originate from or eventually compromise cardiovascular function. Chest pain may be an early indicator of this. So if your patient reports that they have chest pain, what would you do next? How would you assess this individual? Would you be confident in knowing the cause? Would you be able to act on this potential cause of acute illness to prevent a downward spiral of events? This session will leave you feeling much more confident that you can answer these questions. It includes:
- The different types of chest pain and which are life-threatening
- How to assess and differentiate dangerous cardiac pain from other chest pains
- What to do when your patient reports they have chest pain
- Useful update on the pharmacological and non-pharmacological management of chest pain
4:15pm - Close of Day One of Seminar
9:00am - Commencement of Day Two
Recognising Respiratory Failure
The respiratory system is often thought of as a difficult system to assess. However, the importance of assessment cannot be underestimated, particularly as problems associated with the respiratory system often result in acute deterioration and may be the cause of a patient becoming acutely unwell. This session will review key anatomical and physiological principles to guide your assessment of respiratory failure. It includes:
- The difference between ventilation and oxygenation, and why it matters
- Respiratory pathophysiology – type I respiratory failure versus type II respiratory failure
- The indications for the use of non-invasive ventilation (NIV)
- Practical strategies to assist with the introduction and management of NIV
Fluid and Electrolyte Balance
Failure to recognise and appropriately treat fluid and electrolyte imbalances can have fatal consequences. Knowledge and understanding of normal physiological processes is essential for accurate patient assessment. This session will refresh your knowledge and assist you to get up-to-speed of the different types of fluids and their uses. Topics include:
- What are the normal physiological processes of fluid balance?
- What is hypovolaemic shock? How would you recognise it and what might the causes be?
- What intravenous fluids should be used and when?
- How do you recognise electrolyte disturbances early?
- How can you identify important/life-threatening ECG changes on the rhythm strip?
10:30am - Morning Tea
Acute Kidney Injury – More than Just Low Urine Output
Acute onset of kidney injury ranges from mild impairment of function through to acute kidney failure. The incidence increases significantly with progressive severity of the underlying cause. Topics include:
- A brief look at the role of the kidneys
- The potential causes and classifications of acute kidney injury
- Recognising renal dysfunction and the key to preventing acute renal failure
- The management principles of acute renal failure
- A look at renal replacement therapies - basic explanation
Recognising Rapid Cardiovascular Deterioration
Pulmonary embolism, tension pneumothorax, and/or pericardial tamponade, are potentially dangerous cardiac conditions that require alert and responsive care. Your cardiac assessment skills are vital if you are to recognise these states early to ensure appropriate management occurs and rapid deterioration is prevented. In this session, you will review the following considerations for these three common cardiac causes of clinical deterioration:
- The patients considered most at risk
- Pathophysiology related to clinical presentation
- Identification and outline of early management
- Goals of treatment
1:00pm - Lunch and Networking
Sepsis and the Significance of Early Recognition
Did you know that sepsis is one of the leading causes of death globally? Preventing mortality related to sepsis begins with early detection and timely interventions. This session uses case scenarios to explain the pathophysiological mechanisms by which sepsis develops. It will look at how you can detect the early warning signs of sepsis. Finally, it will assist you to understand the evidence-based management of this potentially fatal condition across a range of clinical settings. It includes:
- What is the definition of sepsis?
- What is the relationship between infection and sepsis?
- Early recognition – what are the clinical signs? E.g. an increasing SOFA score
- Why is timely intervention so important?
- In a suspected or a known case of sepsis, what are the main nursing management priorities across a range of clinical settings?
3:00pm - Afternoon Tea and Coffee
When Things Don’t go to Plan…
While the purpose of clinical assessment is to prevent deterioration and recognise acute illness early, it is inevitable that some patients will become significantly unwell. This final session of the seminar will examine some of the key communication challenges that can occur when these sticky situations arise. Take away some key practical skills to help you manage your own stress during these situations.
4:00pm - Close of Seminar and Evaluations