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Nurses' recognition and response to clinical deterioration in the cardiac catheterisation laboratory
journal contribution
posted on 2019-09-01, 00:00 authored by Kevin White, Julie ConsidineJulie Considine, Judy CurreyJudy CurreyBACKGROUND: Patients presenting to the cardiac catheter laboratory for treatment of unstable acute coronary syndromes (ACS) experience a mismatch in myocardial oxygen supply and demand, causing vital sign abnormalities prior to neurological, cardiac and respiratory deterioration. Delays in detecting clinical deterioration and escalating care increases risk of adverse events, unplanned intensive care (ICU) admission, cardiac arrest, and in-hospital mortality. OBJECTIVES: The objective of the study was to explore how nurses in the cardiac catheter laboratory (CCL) recognise and respond to clinical deterioration in patients with unstable ACS undergoing primary percutaneous coronary intervention (PCI). METHODS: A prospective exploratory descriptive design was used with 30 participants completing 10 written clinical scenarios. Participants scored their level of concern for each physiological cue and then then ranked their preferred immediate response based on the deterioration identified. RESULTS: Hypotension and the presence of pain were the physiological cues of highest concern. The most common responses to clinical deterioration were to increase vital sign assessment to 5-minutely intervals, administer pain relief or provide reassurance. Despite the presence of clinical deterioration fulfilling organisational escalation of care criteria, calling cardiac arrest or rapid response team (RRT) were not commonly selected responses. CONCLUSION: Nurses most commonly use hypotension and the presence of pain to recognise clinical deterioration in patients presenting to the CCL with an unstable ACS. Once clinical deterioration is identified, interventional cardiac nurses delay the escalation of care to the RRT or cardiac arrest team, preferring to implement local nurse initiated interventions.
History
Journal
Australian critical careVolume
32Issue
5Pagination
355 - 360Publisher
ElsevierLocation
Amsterdam, The NetherlandsPublisher DOI
ISSN
1036-7314Language
engPublication classification
C1 Refereed article in a scholarly journalCopyright notice
2018, Australian College of Critical Care NursesUsage metrics
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No categories selectedKeywords
Acute coronary syndromeCardiac nursingNursingPatient safetyPercutaneous coronary interventionScience & TechnologyLife Sciences & BiomedicineCritical Care MedicineGeneral & Internal MedicineACUTE MYOCARDIAL-INFARCTIONPRIMARY ANGIOPLASTYSYSTEM 1MANAGEMENTDISPOSITIONPREDICTIONGUIDELINESAUSTRALIAMORTALITYACCURACY
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