No Such Thing as a Well Patient
-
Upload
jesse-spurr -
Category
Health & Medicine
-
view
168 -
download
2
Transcript of No Such Thing as a Well Patient
![Page 1: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/1.jpg)
Simple
solution for
complex
problem or
complex
solution for a
simple
problem
NO SUCH THING AS A
WELL PATIENT
Jesse Spurr
![Page 2: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/2.jpg)
“The more elaborate his labyrinths,
the further from the Sun his face.”
Mikhail Naimy, The Book of Mirdad: The Strange Story of a Monastery
Which Was Once Called the Ark
COMPLEX SYSTEM
![Page 3: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/3.jpg)
THE GOOD OLD DAYS?
![Page 4: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/4.jpg)
THE BAD NEW DAYS?
![Page 5: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/5.jpg)
“People want to know how much you
care before they care how much you
know."
James F. Hind (Author)
PATIENT-CENTERED CARE
![Page 6: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/6.jpg)
THE REASON WE HAVE A JOB
![Page 7: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/7.jpg)
THE REASON WE HAVE A JOB
![Page 8: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/8.jpg)
THE REASON WE HAVE A JOB
![Page 9: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/9.jpg)
THE REASON WE HAVE A JOB
![Page 10: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/10.jpg)
THE REASON WE HAVE A JOB
![Page 11: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/11.jpg)
The patient is the one essential component of the healthcare system.
The system has become, to a degree, self serving.
New ideas in health are frequently met with skepticism.
CAN WE WRITE SOME GLOBAL TRUTHS?
![Page 12: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/12.jpg)
WHAT MAKES A GOOD IDEA?
![Page 13: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/13.jpg)
We appoint an expert. We invest money.
That expert researches the theories of
other experts. The expert designs a plan
based on the other experts’ theories. The
plan goes to a board of more experts.
These experts attempt to pre-empt what
will go wrong with the plan. The plan,
after months to years of expert
development, is ready for implementation.
THE GOD COMPLEX
![Page 14: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/14.jpg)
How can we remove complexity
from our system?
IS THERE ANOTHER WAY?
![Page 15: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/15.jpg)
We have some ideas. They seem like
they would make sense. Let’s try
them, evaluate them using a
systematic process and keep the bits
that work and throw out the bits that
don’t.
TRIAL AND ERROR
![Page 16: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/16.jpg)
MEET NEW IDEAS WITH OPTIMISM
How about we try to catch
something bad happening to our
patients before it’s too late?
![Page 17: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/17.jpg)
….there were some researchers that
managed to look at some data in just the
right way that suggested, that maybe,
there was a way to predict if someone in
hospital was going to become critically ill
before it actually happened…
ONCE UPON A TIME…..
![Page 18: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/18.jpg)
There is suf ficient evidence that the fol lowing have arguably become accepted truths:
• Serious physiological abnormalities often precede cardiac arrest, unanticipated ICU admission or death – 6 to 8hrs earlier.
• Limiting human error can prevent serious adverse events.
• A significant number of deaths in acute hospital settings are preventable.
• Nurses have a professional responsibility to understand the significance of patient observations.
THE ISSUES
![Page 19: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/19.jpg)
Vital signs are often neglected.
THE SCARIEST TREND
![Page 20: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/20.jpg)
Feiselmann et al in 1993 found evidence that RR>27
breaths/min was the most prevalent predictor of cardiac arrest.
Subbe et al 2003 suggested that, in unstable patients, relative
changes in RR were much greater than changes in heart rate or
blood pressure.
Cretikos et al 2007 evidenced that just over half all general
ward patients who suffered serious adverse events (arrest or
ICU admission) had a RR>24 breaths/min and could have been
predicted as high risk up to 24hrs earlier with 95% confidence.
RESPIRATORY RATE – THE NEGLECTED
SIGN
![Page 21: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/21.jpg)
SO WHAT?
There is no such thing as a well patient….
![Page 22: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/22.jpg)
Kyriacos and colleagues 2011
- Literature review of vital signs monitoring with early warning systems (EWS).
No robust data to validate EWS
Paucity of data to evaluate, guide implementation and clinically test
EWS.
LET MY DATA SET CHANGE YOUR
MINDSET?
![Page 23: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/23.jpg)
SO, WE’RE IMPLEMENTING THIS?
![Page 24: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/24.jpg)
Moment for thought
Why are we doing this?
INSANITY OR REVOLUTION?
![Page 25: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/25.jpg)
TALKING ABOUT EVIDENCE
![Page 26: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/26.jpg)
I take less umbrage in being labeled
ignorant, than being accused as
negligent.
WHAT HAPPENS IF WE DON’T DO
SOMETHING?
![Page 27: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/27.jpg)
Making mistakes in the right
direction.
http://www.youtube.com/watch?v=KR_mCvb-KyY - 3mins
WHAT IF THIS DOESN’T WORK?
![Page 28: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/28.jpg)
1. Are we prepared to fail?
2. Can we survive a failure?
3. How do we spot a failure and fix it -early?
ARE WE WILLING TO FAIL?
![Page 29: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/29.jpg)
Afferent Limb
Efferent Limb
WHAT IS A DETERIORATING RESPONSE
SYSTEM?
![Page 30: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/30.jpg)
SENSING AND FEELING; ACTIVATING AND
RESPONDING
![Page 31: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/31.jpg)
Afferent Evidence based track and trigger obs form
Escalation protocols
Efferent MET
Yet to see….
SO, WHERE ARE YOU AT?
![Page 32: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/32.jpg)
Patient and family escalation.
Automated technologies – pathology, alarms, software.
A new focus in clinical education.
Improvements in end of life care.
More research.
ICU sans frontiers.
WHAT’S ON THE HORIZON?
![Page 33: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/33.jpg)
It takes a strong person and an even stronger system to admit
that they are wrong…
Let’s meet new ideas with optimism, but hold them
accountable.
Recognising the deteriorating patient is patient -centred care.
SO REMEMBER
![Page 34: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/34.jpg)
Fools ignore complexity. Pragmatists
suffer it. Some can avoid it. Geniuses
remove it.
Alan Perlis (American computer science pioneer)
COMPLEXITY
![Page 35: No Such Thing as a Well Patient](https://reader033.fdocuments.in/reader033/viewer/2022042701/55a74c231a28ab6b248b4847/html5/thumbnails/35.jpg)
Questions
THANK YOU