{"id":493,"date":"2014-02-03T16:43:55","date_gmt":"2014-02-03T16:43:55","guid":{"rendered":"https:\/\/blogs.bmj.com\/ebn\/?p=493"},"modified":"2014-02-04T14:41:13","modified_gmt":"2014-02-04T14:41:13","slug":"ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/","title":{"rendered":"EBN Journal Chat – Managing patient deterioriation – 05\/02\/14, 8-9pm"},"content":{"rendered":"

Deterioration in acutely unwell patients can occur rapidly and have detrimental\u00a0effects, therefore it is important to observe, identify and act to improve patient\u00a0outcomes. In observing the patient you would be expected to monitor and record the\u00a0following, blood pressure, heart rate, respiration with oxygen saturation, temperature,\u00a0urine output, fluid intake (accurate fluid balance) and blood glucose level. Ideally\u00a0do a Glasgow Comma Scale, it is often a sign of deterioration. If deterioration is mismanaged it can lead to poorer patient outcomes (Baudouin and Evans 2002). To\u00a0aid identifying patients at risk of deterioration nurses can use the Modified Early\u00a0Warning Score (MEWS) (Subbe, Kruger, Gemmel 2001) based on physiological\u00a0parameters, which are taken when recording patient observations. The observations\u00a0taken are incorporated in this scoring system. An aggregated score is then calculated\u00a0from all parameters, if the identified threshold score is reached, an escalation pathway\u00a0is activated. The escalation pathway outlines actions required for timely review\u00a0ensuring appropriate interventions for patients. This often includes informing the\u00a0doctor and contacting the outreach nurses.<\/p>\n

This Twitter chat aims to discuss the following:<\/p>\n

\n
    \n
  1. How do you identify a deteriorating patient<\/li>\n
  2. Why are observations important<\/li>\n
  3. What actions can be taken to improve outcome<\/li>\n
  4. How can outreach nurses assist ward nurses\u00a0<\/span><\/li>\n
  5. Your experiences of caring for a deteriorating patient<\/span><\/span><\/li>\n<\/ol>\n\n\n\n\n\n\n\n\n
    Score<\/td>\n3<\/td>\n2<\/td>\n1<\/td>\n0<\/td>\n1<\/td>\n2<\/td>\n3<\/td>\n<\/tr>\n
    Systolic BP<\/td>\n<45%<\/td>\n30%<\/td>\n15% down<\/td>\nNormal for patient<\/td>\n15% up<\/td>\n30%<\/td>\n>45%<\/td>\n<\/tr>\n
    Heart rate (BPM)<\/td>\n\u2014<\/td>\n<40<\/td>\n41-50<\/td>\n51-100<\/td>\n101-110<\/td>\n111-129<\/td>\n>130<\/td>\n<\/tr>\n
    Respiratory rate (RPM)<\/td>\n\u2014<\/td>\n<9<\/td>\n\u2014<\/td>\n9-14<\/td>\n15-20<\/td>\n21-29<\/td>\n>30<\/td>\n<\/tr>\n
    Temperature (\u00b0C)<\/td>\n\u2014<\/td>\n<35<\/td>\n\u2014<\/td>\n35.0-38.4<\/td>\n\u2014<\/td>\n>38.5<\/td>\n\u2014<\/td>\n<\/tr>\n
    AVPU<\/a><\/td>\n\u2014<\/td>\n\u2014<\/td>\n\u2014<\/td>\nA<\/td>\nV<\/td>\nP<\/td>\nU<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

    Example of a MEWS score system<\/em><\/p>\n

    References<\/strong><\/p>\n

    Baudouin S, Evans T 2002 Improving outcomes for severely ill medical\u00a0patients Clin Med. Mar-Apr; 2(2):92-4<\/p>\n

    Buykx P, Kinsman L, Cooper S, et al. 2011 FIRST2ACT: educating nurses to identify patient deterioration – a theory-based model for best practice simulation education. Nurse\u00a0Educ Today. (7):687-93.<\/p>\n

    Subbe C.P., Kruger M., Gemmel L. – “Validation of a modified Early Warning\u00a0Score in medical admissions.” Quarterly Journal of Medicine 2001; 94;\u00a0521-6<\/p>\n","protected":false},"excerpt":{"rendered":"

    Deterioration in acutely unwell patients can occur rapidly and have detrimental\u00a0effects, therefore it is important to observe, identify and act to improve patient\u00a0outcomes. In observing the patient you would be expected to monitor and record the\u00a0following, blood pressure, heart rate, respiration with oxygen saturation, temperature,\u00a0urine output, fluid intake (accurate fluid balance) and blood glucose level. […]<\/p>\n

    Read More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3606],"tags":[],"class_list":["post-493","post","type-post","status-publish","format-standard","hentry","category-ebn-journal-chat-ebnjc"],"yoast_head":"\nEBN Journal Chat - Managing patient deterioriation - 05\/02\/14, 8-9pm - Evidence-Based Nursing blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"EBN Journal Chat - Managing patient deterioriation - 05\/02\/14, 8-9pm - Evidence-Based Nursing blog\" \/>\n<meta property=\"og:description\" content=\"Deterioration in acutely unwell patients can occur rapidly and have detrimental\u00a0effects, therefore it is important to observe, identify and act to improve patient\u00a0outcomes. In observing the patient you would be expected to monitor and record the\u00a0following, blood pressure, heart rate, respiration with oxygen saturation, temperature,\u00a0urine output, fluid intake (accurate fluid balance) and blood glucose level. [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/\" \/>\n<meta property=\"og:site_name\" content=\"Evidence-Based Nursing blog\" \/>\n<meta property=\"article:published_time\" content=\"2014-02-03T16:43:55+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2014-02-04T14:41:13+00:00\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2014\\\/02\\\/03\\\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2014\\\/02\\\/03\\\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"EBN Journal Chat – Managing patient deterioriation – 05\\\/02\\\/14, 8-9pm\",\"datePublished\":\"2014-02-03T16:43:55+00:00\",\"dateModified\":\"2014-02-04T14:41:13+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2014\\\/02\\\/03\\\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\\\/\"},\"wordCount\":335,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/#organization\"},\"articleSection\":[\"EBN Twitter Chat #ebnjc\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2014\\\/02\\\/03\\\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2014\\\/02\\\/03\\\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2014\\\/02\\\/03\\\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\\\/\",\"name\":\"EBN Journal Chat - Managing patient deterioriation - 05\\\/02\\\/14, 8-9pm - Evidence-Based Nursing blog\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/#website\"},\"datePublished\":\"2014-02-03T16:43:55+00:00\",\"dateModified\":\"2014-02-04T14:41:13+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2014\\\/02\\\/03\\\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2014\\\/02\\\/03\\\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/2014\\\/02\\\/03\\\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"EBN Journal Chat – Managing patient deterioriation – 05\\\/02\\\/14, 8-9pm\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/\",\"name\":\"Evidence-Based Nursing blog\",\"description\":\"Analysis and discussion of developments in Evidence-Based Nursing.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/#organization\",\"name\":\"Evidence-Based Nursing blog\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/files\\\/2018\\\/04\\\/blog-logo-ebn.png\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/files\\\/2018\\\/04\\\/blog-logo-ebn.png\",\"width\":289,\"height\":34,\"caption\":\"Evidence-Based Nursing blog\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/#\\\/schema\\\/logo\\\/image\\\/\"}},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/ebn\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"EBN Journal Chat - Managing patient deterioriation - 05\/02\/14, 8-9pm - Evidence-Based Nursing blog","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/","og_locale":"en_US","og_type":"article","og_title":"EBN Journal Chat - Managing patient deterioriation - 05\/02\/14, 8-9pm - Evidence-Based Nursing blog","og_description":"Deterioration in acutely unwell patients can occur rapidly and have detrimental\u00a0effects, therefore it is important to observe, identify and act to improve patient\u00a0outcomes. In observing the patient you would be expected to monitor and record the\u00a0following, blood pressure, heart rate, respiration with oxygen saturation, temperature,\u00a0urine output, fluid intake (accurate fluid balance) and blood glucose level. [...]Read More...","og_url":"https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/","og_site_name":"Evidence-Based Nursing blog","article_published_time":"2014-02-03T16:43:55+00:00","article_modified_time":"2014-02-04T14:41:13+00:00","author":"BMJ","twitter_card":"summary_large_image","twitter_misc":{"Written by":"BMJ","Est. reading time":"2 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/ebn\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"EBN Journal Chat – Managing patient deterioriation – 05\/02\/14, 8-9pm","datePublished":"2014-02-03T16:43:55+00:00","dateModified":"2014-02-04T14:41:13+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/"},"wordCount":335,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/ebn\/#organization"},"articleSection":["EBN Twitter Chat #ebnjc"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/","url":"https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/","name":"EBN Journal Chat - Managing patient deterioriation - 05\/02\/14, 8-9pm - Evidence-Based Nursing blog","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/ebn\/#website"},"datePublished":"2014-02-03T16:43:55+00:00","dateModified":"2014-02-04T14:41:13+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/"]}]},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/ebn\/2014\/02\/03\/ebn-journal-chat-managing-patient-deterioriation-050214-8-9pm\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/ebn\/"},{"@type":"ListItem","position":2,"name":"EBN Journal Chat – Managing patient deterioriation – 05\/02\/14, 8-9pm"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/ebn\/#website","url":"https:\/\/blogs.bmj.com\/ebn\/","name":"Evidence-Based Nursing blog","description":"Analysis and discussion of developments in Evidence-Based Nursing.","publisher":{"@id":"https:\/\/blogs.bmj.com\/ebn\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/ebn\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/ebn\/#organization","name":"Evidence-Based Nursing blog","url":"https:\/\/blogs.bmj.com\/ebn\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/ebn\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/ebn\/files\/2018\/04\/blog-logo-ebn.png","contentUrl":"https:\/\/blogs.bmj.com\/ebn\/files\/2018\/04\/blog-logo-ebn.png","width":289,"height":34,"caption":"Evidence-Based Nursing blog"},"image":{"@id":"https:\/\/blogs.bmj.com\/ebn\/#\/schema\/logo\/image\/"}},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/ebn\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/ebn\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/posts\/493","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/comments?post=493"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/posts\/493\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/media?parent=493"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/categories?post=493"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/ebn\/wp-json\/wp\/v2\/tags?post=493"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}