Communication In Healthcare: Failure To Recognize And Respond To Clinical Deterioration And Non-Compliance With Early Warning And Response Tools

Importance of therapeutic communication in healthcare

Communication in healthcare services is considered to be one of the important pillars for providing effective health care to the patient (Faizipour & Perreira, 2013). The communication among the nurses, doctors and other healthcare staff is vital to understand the logic behind planning, implementation, and evaluation of the intervention been given (Patrick, 2017). Communication is a root through which each medical staff involved in the case gets aware about the latest update on the patient’s wellness or clinical deterioration. Once the patient is admitted in the hospital, it is the responsibility of the healthcare provider to provide the best standard care regimen, irrespective of any other reason involved in the case (Kalyandooj et al., 2017). In this essay, Roy Jacob’s case will be analyzed wherein his sudden death caused a severe violation of the care practice standards and practices. There was a significant lack of communication, lack of accountability and extreme case of negligence that violates the nursing codes of practices.

The essay will critically analyze one of the statements “Failure to recognize and respond to clinical deterioration and non-compliance with early warning and response tools is a recognized issue across the health sector, public and private” and provide a detailed insight into the statement highlight the latest evidence available to support the argument.

Jacob Roy is a 48-year-old man belonging to an aboriginal community who died unexpectedly on 31^st August 2017 at Cherbourg Hospital. As reported by the family members, Roy was quite a happy man with a big family and during his death, he was staying in Brisbane to spend time with his grandchildren within the community. He recently visited a funeral and was intoxicated with alcohol that leads to falling and admitted to Cherbourg hospital. During his final presentation, he was given with treatment for pneumonia, and despite certain resuscitation efforts, he was found to be unresponsive and later found dead. With a sudden death of the patient with unknown reason, the case was reported to the police, and later it was found that the patient died because of several reasons such as liver cirrhosis, lipoid anemia, coronary artery disease and the cause of death is probably a cardiac arrest.

Therapeutic communication is one of the key aspects of this case study. It is a process that facilitates a face to face interaction primarily focused on the emotional and physical wellbeing of the patient. Healthcare providers use this communication to provide information and support to the patient. There is a variety of technologies to achieve it. However, the use of these techniques must be perfect and needs proper training to achieve it in clinical settings (Bogner, 2018). Another aspect of clinical care is accountability. It is considered to be the heart of nursing that helps in weaving the wave through in every setting and at all level of the profession. It is also an energizing force within the healthcare organization. The existence of accountability culture in the healthcare organization, healthcare workers, will understand their responsibility and will perform their duties as per the care ethics and standards. The organization that lacks accountability gives excuses when they fail to meet the objectives (Hacker & Walker, 2013). The staff thinks that they are quite close to the desired target and fail to recognize the difference. The presentation of Roy on 3^rd day was quite inappropriate as the nurses fail to recognize the abnormal vital signs and they also didn’t recognize the alternative diagnoses. They also didn’t consider the referral to critical care physician and emergency care unit. Further, the review committee also identified that the care required for Mr. Roy was beyond the scope of resources available that can help in the improvement of his condition (Marik, 2017). 

The role of accountability in nursing

The failure to recognize the clinical deterioration and responding to it swiftly is one of the key issues these days within clinical settings. One of the major factors associated with it is non compliance of the clinical staffs towards effective patient’s monitoring.  The monitoring of patient within the community or general hospital is mostly based on the intermittent monitoring and measurement of vital signs such as temperature, blood pressure, etc by the healthcare staff present in the hospital (Moore,2018). It has been reported that with several hours passes by the measurement, and the deterioration of the patient generally goes unnoticed. Further, the interpretation and integration of the information achieved through the measurements remain very important for the clinical judgment of the patient. In this case, Mr. Jacob’s vital signs measurement might not be taken appropriately, and it may be one of the major reason for her clinical deterioration (Haegdoron et al., 2018). The monitoring of the patient is quite intense in operation care and intensive care units. It is quite likely that the early identification of the clinical deterioration will help in understanding the situation and plan an immediate nursing intervention for the patient. The regular monitoring of the patient is very important as it may help in the identification of complication, which cannot be identified with intermittent monitoring of the patient (McClave et al., 2016). Early identification of Jacob’s case could have tailored appropriate management and therefore help in reduction of the need of high care requirement and reduces the length of stay in the hospital, reduces hospital admission, time and cost and improve the survival chances of the patient. The monitoring of the patient is known to be inappropriate in most of the hospital because of either lack of appropriate equipment, lack of expertise of the clinical staff in clinical data interpretation, high patient to staff ratio etc increasing the load on the staff in monitoring of the patient (Cho et al., 2016).

Another factor that is responsible for unrecognized clinical deterioration and responding to it swiftly is lack of adequate training and knowledge of the clinical staff. Even if they commit some mistake, they try to avoid it and lacks accountability. Serious adversity may occur such as unplanned admission in intensive care unit or cardiac arrest because of under treatment of clinical deterioration or unrecognized vital signs of the patient. It has been reported that about one in 20 patient admitted in the hospital shows the signs of clinical deterioration that are more than enough to warrant the clinical intervention to the patient by the nursing staff (Vincent et al., 2018). Results also suggest that the nurses do not properly identify the warning signs because of lack in accountability and clinical communication between the healthcare staff. The unrecognized clinical deterioration, failing in alternative diagnoses and lack of emergency response to the patient’s condition, delay the response to the intervention leads to increase in the risk of mortality of the patient (Lam & Flabouris, 2017).

Factors contributing to failure to recognize clinical deterioration

Misdiagnosis and failure to perform alternative diagnosis is one more issue that add on to failure to recognize clinical deterioration. The failure of the clinical staff in diagnoses or misdiagnosis of a particular illness becomes the basis of medical malpractice and misconduct of the nursing codes of practice. The misdiagnosis of a patient’s clinical condition is not always malpractice in medical service, and not every error in diagnosis may give rise to a lawsuit. Reports suggest that even very highly qualified and experienced doctors may make a certain error in diagnosis (Bonger, 2018). It should be understood that the case of misdiagnosis is merely a result of delayed treatment, miscommunication, lack of proper medical care and no timely treatment that result in the worsening of the patient’s condition. The cases of misdiagnosis may also involve a false diagnosis, delayed diagnosis, and failure of the clinical staff to recognize the main reason of clinical complications result in aggravation of the condition of the patient. There are scenarios where the doctors fail to recognize one condition and understand the fact that it is important to make an alternative diagnosis to treat the patient in an appropriate manner (Callaghan et al., 2017). The improper diagnosis of Jacob in the hospital may have caused because of a lack of proper facility, reduced time and pressure on the clinical staff that regularly monitor the vital signs and help the physician to make an appropriate diagnosis, etc. The unusual illnesses are difficult to get diagnosed such as in the case of Jacob. It was diagnosed that he had pneumonia; however, after the autopsy; it was found that he was suffering from liver cirrhosis and was a long term abuser of alcohol. He died because of cardiac arrest, and it must have been recognized using the regular monitoring of the vital signs such as pulse rate and blood pressure etc. The nurses must have performed ECG test as well or must have kept a regular monitor of the cardiac function. For instance, in Jacob’s case, he was admitted to the hospital after consuming alcohol and the doctor failed to make a correlation between his current health condition and his past medical history. Jacob was having cardiovascular issues and that must be the major reason of his sudden death by myocardial infarction. The hospital staff must have referred Jacob to a more experienced doctor or could have send him to the emergency unit in another hospital for a proper diagnosis and treatment 

Conclusion 

Improved monitoring of the patient on the low acuity ward is highly needed to reduce the rate of failure to rescue. It is not always possible to regularly monitor the patient in a general ward, but the general body of medical care is now demanding the need of a proper tool for regularly monitoring the vital signs of the patient so that a differential and alternative diagnosis can be made appropriately (Bruin, 2018).  

References 

Bogner, M. S. (2018). Human error in medicine. CRC Press.

Bruin, Y. (2018). Recording and interpretation of vital signs in a private hospital in KwaZulu-Natal.

Callaghan, A., Kinsman, L., Cooper, S., & Radomski, N. (2017). The factors that influence junior doctors’ capacity to recognize, respond and manage patient deterioration in an acute ward setting: an integrative review. Australian Critical Care, 30(4), 197-209.

Cho, E., Lee, N. J., Kim, E. Y., Kim, S., Lee, K., Park, K. O., & Sung, Y. H. (2016). Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: a cross-sectional study. International journal of nursing studies, 60, 263-271.

Hacker, K., &Walker, D. K. (2013). Achieving population health in accountable care organizations. American journal of public health, 103(7), 1163-1167.

Kalayanarooj, S., Rothman, A. L., & Srikiatkhachorn, A. (2017). Case management of dengue: lessons learned. The Journal of infectious diseases, 215(suppl_2), S79-S88.

Lam, S., & Flabouris, A. (2017). Medical Trainees and Patient Safety. In Textbook of Rapid Response Systems (pp. 45-52). Springer, Cham.

Marik, P. E. (2015). Understanding the Vital Signs: BP, HR, RR, TEMP, SaO 2… and SV. In Evidence-based critical care(pp. 169-196). Springer, Cham.

McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., … & Gervasio, J. M. (2016). Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). Journal of Parenteral and Enteral Nutrition, 40(2), 159-211.

Moore, T. (2016). Observations and monitoring. Clinical Skills for Nursing Practice, 161.

Patrick, R. A. (2017). TeamSTEPPS Training and Vital Signs Chart to Improve Situational Monitoring for Clinical Deterioration.

Vincent, J. L., Einav, S., Pearse, R., Jaber, S., Kranke, P., Overdyk, F. J., … & Hoeft, A. (2018). Improving detection of patient deterioration in the general hospital ward environment. European journal of anaesthesiology, 35(5), 325.