d1 rapid fire: warly warning systems for better care - t. northway and c. masuda
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Escalation of Patient Care Process:
A Team Approach to Recognition and Support for the Deteriorating Child
Tracie Northway, Cathy Masuda, Kira Cooksley, Caroline Laverock, Denise Hudson, Rita Janke & David Waller
What is the Escalation of Patient Care Process?
The Escalation of Patient Care (EOPC) Process is a comprehensive team approach for identification of
a deteriorating patient and accessing additional health care team
supports for this patient.
Catalyst for Change
•Patient harm related to a system failure resulting in:
–Delayed recognition of deteriorating patient status–Failure to notify most appropriate healthcare team member(s)–Delay in response by most appropriate healthcare team member
Components of the EoPC Process
Practice Makes Perfect
Baby Smith is a 5 month old admitted with respiratory virus. While previously vigorous in her activity, she is now lethargic with a sunken fontanel. Her respirations are 65 per minute and she is “working hard” with nasal flaring. Her SaO2 is 95% on 1 L/min of NP. 2 hours previous she had an SaO2 of 98% on 1L/min of NP. Her cap refill is 4 seconds. She is pale. No wet diapers for 10 hours.
How to Use EoPC Score?
Total score is 7
How to Use EoPC Score?
•Document EoPC score with Vital Signs
•Communication (SBAR) of changes in pt. status to charge nurse & physician
•Documentation of changes by focus and data, action, response
•Increased monitoring •Treatments as per plan
•Responding to page within established time frames
•Requesting SBAR of situation (“SBAR me”)
•Assessment of pt within established time frame
•Seeking supports as required•Documentation of assessment and plan
•If Attending not aware of change in patient status, ensure attending aware (Attending to assess within 1 hour)
Nurse (Direct Care) Physician (CTU/Subspecialty Resident, 1st Responder)
Roles & Responsibilities in EoPC Process
Situation-what is the problem? (5-10 seconds to report)
Background – particular information relevant to problem(10 -15seconds to report)
Assessment – reporter’s ideas as to what problem is (5-10 seconds to report)
Recommendations -what reporter wants done & when? (5-10 seconds to report)
•Request SBAR of situation•Determine resources available•Assess patient•Document assessment in physicians’ progress notes
Charge Nurse Critical Care (MD, RN, RT)
Roles & Responsibilities in EoPC Process
•Request SBAR of situation•Assessing pt•Notifying physician or delegating notification (SBAR)
•Mobilizing Nursing Supports as required
•Seeking Critical Care supports as required
•Support of direct care RN
Results
2009/10 2010/11 2011/120
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Comparison of Critical Patient Safety Events Pre & Post Escalation of Patient Care Process Implementation
Fiscal Year
# o
f C
riti
cal
Pat
ien
t S
afet
y E
ven
t R
evie
ws
71% reduction
86% reduction
Implementation of Escalation of Patient Care Process – March 2010
Results
Challenges: Present & Future
• Orientation of interprofessional team• Continuing education of interprofessional
team• Ways to simplify work:
• combining with sepsis screening• streamline documentation
• Culture shift focused on safety and responsibilities with escalating
