John Welch

Failure to rescue: using rapid response systems to improve care of the deteriorating patient in hospital:

“Failure to rescue” is the inadequate or delayed response to clinical deterioration in hospitalized patients. Rapid response systems are a set of hospital-wide interventions that attempt to reduce failure to rescue by improving patient monitoring on general wards (the afferent component) and the reliability of the response to deterioration by a dedicated Critical Care Outreach Team, Rapid Response Team or Medical Emergency Team (the efferent component). The reliability of such systems depends on the faultless functioning of a “chain of survival” consisting of: (1) high-quality recording of vital signs; (2) the education and mind-set of staff at the bedside to recognize pathological patterns; (3) the reporting of abnormality to the efferent team; (4) a timely and appropriate response by the latter. Repeated feedback loops are crucial for an effective functioning of the chain.

Nursing intensive care skills training: A nurse led, short, structured, and practical training program, developed and tested in a resource-limited setting☆

PURPOSE To assess the impact of a nurse-led, short, structured training program for intensive care unit (ICU) nurses in a resource-limited setting. METHODS A training program using a structured approach to patient assessment and management for ICU nurses was designed and delivered by local nurse tutors in partnership with overseas nurse trainers. The impact of the course was assessed using the following: pre-course and post-course self-assessment, a pre-course and post-course Multiple Choice Questionnaire (MCQ), a post-course Objective Structured Clinical Assessment station, 2 post-course Short Oral Exam (SOE) stations, and post-course feedback questionnaires. RESULTS In total, 117 ICU nurses were trained. Post-MCQ scores were significantly higher when compared with pre-MCQ (P < .0001). More than 95% passed the post-course Objective Structured Clinical Assessment (patient assessment) and SOE 1 (arterial blood gas analysis), whereas 76.9% passed SOE 2 (3-lead electrocardiogram analysis). The course was highly rated by participants, with 98% believing that this was a useful experience. CONCLUSIONS Nursing Intensive Care Skills Training was highly rated by participants and was effective in improving the knowledge of the participants. This sustainable short course model may be adaptable to other resource-limited settings.

Capacity building for critical care training delivery: Development and evaluation of the Network for Improving Critical care Skills Training (NICST) programme in Sri Lanka

OBJECTIVES To deliver and evaluate a short critical care nurse training course whilst simultaneously building local training capacity. RESEARCH METHODOLOGY A multi-modal short course for critical care nursing skills was delivered in seven training blocks, from 06/2013-11/2014. Each training block included a Train the Trainer programme. The project was evaluated using Kirkpatricks Hierarchy of Learning. There was a graded hand over of responsibility for course delivery from overseas to local faculty between 2013 and 2014. SETTING Sri Lanka. MAIN OUTCOME MEASURES Participant learning assessed through pre/post course Multi-Choice Questionnaires. RESULTS A total of 584 nurses and 29 faculty were trained. Participant feedback was consistently positive and each course demonstrated a significant increase (p≤0.0001) in MCQ scores. There was no significant difference MCQ scores (p=0.186) between overseas faculty led and local faculty led courses. CONCLUSIONS In a relatively short period, training with good educational outcomes was delivered to nearly 25% of the critical care nursing population in Sri Lanka whilst simultaneously building a local faculty of trainers. Through use of a structured Train the Trainer programme, course outcomes were maintained following the handover of training responsibility to Sri Lankan faculty. The focus on local capacity building increases the possibility of long term course sustainability.

Capacity building for critical care skills training provision in resource limited settings: the nursing intensive care skills training (nicst) project

The availability of high quality critical care is increasingly recognised as a global health problem [1, 2]. The ability of any health system to scale-up delivery of effective critical care services will be limited by critical care training capacity.

Rapid Response Systems: Education for Ward Staff Caring for At-Risk and Deteriorating Patients

This chapter considers the essential role played by ward staff in the functioning of the rapid response system and the need to ensure that the knowledge, skills and attitudes of medical, nursing and other staff working on general wards are sustained. It presents the evidence that ward staff can improve patient outcomes by intervening early with simple procedures and by ensuring the timely involvement of the rapid response team (RRT), but considers the challenges in training ward staff in the immediate management of acute illness. It outlines many of the current initiatives in acute care education, including the role of the rapid response team in educating ward staff.

RRS Education for Ward Staff

Medical, nursing and other staff working on general wards form the most important component of hospital-wide patient safety systems. In relation to patient deterioration, ward staff roles include the regular monitoring, charting and interpretation of patients’ vital signs and other clinical variables; the identification of “at-risk” and deteriorating patients; the timely administration of simple, first-line treatments; recognizing the need for additional, often more experienced help; and activating the rapid response system (RRS). Without ward staff involvement, the rapid response team (RRT) and Medical Emergency Team (MET) cannot be effective. (In this chapter, when we refer to the response team, we will use RRT to mean RRT, MET, and Critical Care Outreach Team (CCOT) – in other words, any responder team that an institution utilizes). Ward staff also provides important clinical and resource support to RRT members on the team’s arrival. Finally, if a patient remains on the general ward following a visit by the RRT, the ward staff must assume responsibility for the patient’s continuing surveillance and care.