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Patient perceptions of deterioration and patient and family activated escalation systems-a qualitative study

Guinane, Jessica, Hutchinson, Alison M and Bucknall, Tracey K 2018, Patient perceptions of deterioration and patient and family activated escalation systems-a qualitative study, Journal of clinical nursing, vol. 27, no. 7-8, pp. 1621-1631, doi: 10.1111/jocn.14202.

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Title Patient perceptions of deterioration and patient and family activated escalation systems-a qualitative study
Author(s) Guinane, Jessica
Hutchinson, Alison MORCID iD for Hutchinson, Alison M orcid.org/0000-0001-5065-2726
Bucknall, Tracey KORCID iD for Bucknall, Tracey K orcid.org/0000-0001-9089-3583
Journal name Journal of clinical nursing
Volume number 27
Issue number 7-8
Start page 1621
End page 1631
Total pages 11
Publisher Wiley-Blackwell Publishing
Place of publication Chichester, Eng.
Publication date 2018-04
ISSN 0962-1067
1365-2702
Keyword(s) clinical decision-making
communication
deterioration
nursing
patient and family escalation
patient participation
rapid response systems
Summary Aims and objectives
To investigate the experiences of patients who received a medical emergency team review following a period of clinical deterioration and their views about the potential use of a patient and family activated escalation system.

Background
Delay or failure by health professionals to respond to clinical deterioration remains a patient safety concern. Patients may sometimes identify subtle cues of early deterioration prior to changes in vital signs. In response to health professional and system failures, patient and family activated escalation systems have been mandated and implemented in Australia. However, little research has evaluated their effectiveness nor taken patients’ perspectives into account.

Design
Qualitative exploratory descriptive design was used.

Methods

Purposive sampling was used. Semistructured interviews were undertaken in 2014 with 33 patients who required medical emergency team intervention. Data were collected from one private and one public hospital in Melbourne, Victoria, Australia. The framework method was used to analyse the data.

Results
All patients stated that it was the clinician who detected and responded to deterioration. Private patient participants were unaware of the medical emergency team system, and felt escalating care was not their responsibility. These patients reported being too sick to communicate prior to and during medical emergency team review and did not favour a patient and family activated escalation system. Public patients were well informed about the medical emergency team system yet expressed concerns around overriding clinicians if activating a patient and family activated escalation system.

Conclusion
Patient participation during a period of deterioration is restricted by their clinical condition and limited medical knowledge. Patients felt comfortable to communicate concerns to clinicians but felt they would not activate the patient and family activated escalation system. This behoves clinicians to actively listen and respond to patient concerns.
Language eng
DOI 10.1111/jocn.14202
Field of Research 1110 Nursing
1701 Psychology
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2017, The Authors
Free to Read? Yes
Use Rights Creative Commons Attribution non-commercial licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30108793

Document type: Journal Article
Collections: Centre for Quality and Patient Safety
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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.