Maintaining The Safety Of A Patient

2.7 Monitoring physiological measurements it´s important to make sure the individual health status and also necessary after surgery, as patients in intensive care units require continuous monitoring, and sometimes have medications that requires physical measurements taken. These are measurements we take to ensure that they are functioning in the way they are supposed to. When we carry out physiological measurements, such as measuring temperature, pulse and respiration, we are monitoring for signs of abnormality. Then be able to draw conclusions about the health status of the individual and any treatments they may

Lack of enough trained staff in conscious sedation available at the time of the procedure

The role of the nurse anesthetist gradually developed as the demand increased for individuals who were highly and meticulously trained in anesthesia administration in an era where knowledge of germs, antisepsis and surgical interventions was emerging. During the 1800s, medical students were often responsible in the administration of anesthesia under the direct supervision of surgeons but the increased mortality rates in intraoperative patients suggested the need to reevaluate who would provide anesthesia. As a result of negative patient outcomes, surgeons turned to nurses, who served to be an adequate and reliable replacement. This trend proved to be catalytic in the movement of the nurse anesthetist.

While there was a policy in place for conscious sedation, even good policies rely on the vigilance of staff to adhere to them. Often times, working conditions allow for distractions, and even the best of practitioners, with the best of intentions, make errors. There were several areas presented in this scenario that require examination and improvement.

Vital observations were carried out efficiently, they were recorded every 15 minutes and a cardiac monitor was attached to continuously monitor for any deterioration. As a student nurse I assisted by recording vital observations using NEWS and assessing consciousness by using the Glasgow coma scale to ensure there were no signs of brain trauma (Le Roux, Levine and Kofke, 2013). In line with the NMC, my mentor supervised and countersigned my observations (NMC, 2011b). I promoted good patient safety as deterioration would be recognised early and appropriate care provided. Throughout the treatment process I witnessed and provided person centred care. Nursing and medical staff continuously checked patient comfort and obtained consent for treatment being provided.

This Anaesthetic case study would describes and discussed the scenario of a patient through the anaesthetic role of their surgical procedure. It will include and discuss the anaesthetic safety procedures equipment and drug interventions used to ensure this particular patients maximum safety and comfort before and during the procedure. The case study will include pre and peri-operative assessment in order to describe the involvement contribution of various specialties in the holistic care of the critical care patient. This assignment will focus only on the anaesthetics side of the procedure but will also highlight the importance of the triad of anaesthesia and discuss the administration, maintenance and reversal of

Additionally, the care environment developed a hazard when the patient population increased both in number and acuity with the admission of the acute respiratory distress patient and increasing patient load in the lobby without note of available back up staff being called in. Examples of errors from the flow chart comparison might include failure to assess and monitor when Nurse J initiates blood pressure and SpO2 measurements, fails to initiate ECG with respiration monitoring, fails to administer supplemental O2, and leaves the room without apparently noting the baseline of the patient2. Furthermore, there appears to be an error in the lack of communication collaboration between the RN and LPN regarding Mr. B’s post procedure status and monitoring needs, and there is a failure to rescue when the LPN notes the low SpO2 value, fails to respond, and instead re-initiates another blood pressure reading without noting the results. As Mr. B’s condition deteriorates and a code is called, an ACLS error is observed in the timeline when the patient is noted first to have absent pulse and respirations and that a monitor is next applied and the patient and displays ventricular fibrillation. Chest compressions appear to not have been the first action in this scenario, nor is end tidal CO2 monitoring noted as initiated to monitor the quality of compressions. These are examples of hazards and errors in the care of Mr. B and in an actual RCA the level of detail would likely turn up

On reflection I realise that the incident which happened to Mrs D could have been avoided and prevented if proper communication and multidisciplinary team work had been implemented (Mellanby, Podmore and McNarry, 2014; DOH, 2012; NMC, 2015). The outcome of an airway crisis can be influenced by the anaesthetic nurse as the anaesthetist does not work in isolation and therefore discussion of the potential alternatives should difficulty arise is vital (Mellanby, Podmore and McNarry, 2014). As with all aspects of healthcare, structured communication within the team is central to preparing for critical incidents (DOH, 2012). Furthermore, in this situation it is possible that the anaesthetic nurse was not experienced or confident enough to deal with

(History of Nurse Anesthesia Practice. 2010, May), (Koch, E., Downey, P., Kelly, J. W., & Wilson, W. 2001).

Clinicians recognize risk factors assess, better diagnose and manage patients and reduce mortality rates. (Trenary, 2007)Describes how Banner Health Care System uses a system called eICU where patients are cared for by intensivists, experienced critical care nurses and health unit secretaries working from a remote location on the campus of Banner Desert Medical Centre. From this location care clinicians can see and hear six different units in five different hospitals .Their aim is to increase this added support to all ICU patients within their Banner Health Care System across the seven states in twenty different facilities. .Using the eICU system the ICU rooms are fitted with a camera, microphone and a speaker .The camera is activated when initiated by the bedside team when there is an alert received from the eICU system .There is no recording availability so the system is HIPAA compliant .This system adds an additional support to the nurse patient ration at bedside. A similar system is used in the Ob department to support the nurses and help to reduce complications during childbirth

The National Safety and Quality Health (NSQHS) standards ultimately were established to protect the public from harm and to develop and enhance the quality of care delivered by health care organisations (NSQHS 2012). These standards are used as a guideline to aid health care organisations to support the quality improvement programs using the NSQHS framework to ensure patient safety and quality care is being delivered. Standard 9 of the NSQHS specifically addresses the recognition and response to clinical deterioration in acute health care with the aim of early recognition of patient deterioration and suitable action is taken.

sedation have continuous BP, ECG, & Pox monitoring done. Nurse J. who was trained in the

This paper briefly touches on a case study by a nursing assistant student who is assisting with an anesthesiologist that she is shadowing. The student was asked to monitor vitals during a knee surgery. The patient was given Halothane and the surgery began. After two hours in surgery, the patient, who was a young athletic female named Sharon Riley, began to show signs of distress. This patient’s temperature elevated to 105 °F and pulse began to rise up to 120 bpm, and her blood pressure began to drop down to 60/56 mmHg. This triggers the monitors alarm because normal vitals for this patient were a temperature of 98.6 °F, 75 bpm pulse and blood pressure of 105/60 mmHg. This causes the doctors to react quickly and begin to assess what is wrong

John was a 76 year old gentleman returning to an orthopaedic ward following a total hip replacement under general anaesthetic. The agreed care plan was to regularly monitor John’s vital signs over the next several hours in accordance with local hospital resuscitation trust policy (2012) and the National Institute

Learning about the potential complications of epidural reinforced my knowledge in being able to choose the right anaesthetic monitoring equipment. Knowing that Spinal and epidural anaesthesia can cause unpredictable and profound arterial hypotension necessitate the use of adequate monitoring like the; Pulse oximetry, ECG and Blood pressure cuff. This knowledge will help me to be able to select appropriate monitoring devices during epidural catheter insertion. Also it goes without saying that an epidural must be performed in a work area that is equipped for airway management and resuscitation.