Publication
Title
In-hospital mortality after serious adverse events on medical and surgical nursing units : a mixed methods study
Author
Abstract
Aims and objectives.  To investigate the circumstances of nursing care eight hours before serious adverse events (=SAEs) on medical and surgical nursing units with subsequent in-hospital mortality in order to identify the extent to which these SAEs were potentially preventable. Background.  The prevention of SAE s in acute care is coming under increasing scrutiny, while the role nursing care plays in the prevention of acute critical deterioration of patients is unclear. Methods.  Retrospective review of patient records of 63 SAEs in a Belgian teaching hospital where death was the final outcome following a cardiac arrest team call or unplanned ICU admission from an acute care unit. Data from chart reviews were combined with data regarding working conditions on the nursing unit at the time of the events and experts opinions regarding the preventability of the outcomes. Finally, a pilot survey of staff nurses about their experiences with deteriorating patients and knowledge of vital signs and call criteria was conducted independently of the chart abstractions and case reviews. Results.  Experts were almost five times more likely to designate a case as potentially preventable when a cardiac arrest team call was the terminal event and were 40% less likely to designate a case as potentially preventable when more observations were documented in patient records. Survey results revealed that nurses were often unaware that their patients were deteriorating before the crisis. Nurses also reported threshold levels for concern for abnormal vital signs that suggested they would call for assistance relatively late in clinical crises. Conclusion.  Renewed attention to accurate recording, documentation and interpretation of vital signs in hospital nursing practice appears needed. Relevance to clinical practice.  Timely detection of deteriorating patients to assist staff to improve their outcomes appears to be jeopardised by a number of practices and factors and merits deeper study.
Language
English
Source (journal)
Journal of clinical nursing. - Oxford
Publication
Oxford : 2013
ISSN
0962-1067
DOI
10.1111/J.1365-2702.2012.04154.X
Volume/pages
22 :15-16 (2013) , p. 2308-2317
ISI
000321332100023
Full text (Publisher's DOI)
Full text (publisher's version - intranet only)
UAntwerpen
Faculty/Department
Research group
Publication type
Subject
Affiliation
Publications with a UAntwerp address
External links
Web of Science
Record
Identifier
Creation 30.07.2012
Last edited 09.10.2023
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