Emergency Department nursing shift leaders’ perceptions of their role in responding to escalation of care for patient clinical deterioration

Mrs Vanessa Leonard-Roberts1,2, Professor Julie Considine2,3, Professor Judy Currey2

1Northern Health, Epping, Australia, 2Deakin University , Geelong, Australia, 3Centre for Quality and Patient Safety, Eastern Health Partnership, Box Hill, Australia

Background: Clinical leadership is fundamental to patient safety and is vital to an effective response to patient clinical deterioration. The Emergency Department (ED) Nursing Shift Leader is a key leadership role, however to date there have been no studies exploring the management of clinical deterioration from the perspective of the ED Nursing Shift Leader. The aim of this study was to explore ED Nursing Shift Leaders’ perceptions of their role in responding to episodes of escalation of care for patient clinical deterioration.

Methods: A prospective exploratory descriptive design was used to address the study aims. The study was conducted in an urban district ED in Melbourne, Australia. Participants were recruited from the senior emergency nurses at the study site that fulfilled the role of being in charge of the ED. In-depth semi-structured interviews were conducted between December 2015 and March 2016.

Results. Two major themes and four subthemes were identified from the interviews. The first major theme of Clinical Risk Management comprised sub-themes of Clinical Skills and Confidence. The second major theme of Resource Management comprised sub-themes of Human Resource Management and Logistical Resource Management.

Conclusions: Strong collaboration, logistical management and expert clinical skills were all identified as fundamental to the Nursing Shift Leaders capacity to respond to escalations of care for clinical deterioration within in a complex team environment such as the ED.

Implications: The ED Nursing Shift Leader role is complex and challenging. Investment in this frontline leadership role has the potential to benefit the team, the organisation and the profession and ultimately improve patient outcomes.


Biography:

Vanessa Leonard-Roberts was born in Africa and worked for many years in South Africa as an intermediate life support paramedic. During periods of civil unrest Vanessa volunteered for the South African Red Cross Society, often working in areas of extreme conditions and political unrest. Vanessa spent 5 years with the National Sea Rescue Institute where she worked as a crew medic training new crew members in basic life support and maritime emergency care. In 2008 Vanessa immigrated to Australia and subsequently completed a Bachelor of Nursing Degree followed by a Diploma in Emergency Nursing. Vanessa is currently a Master of Nursing candidate through Deakin University and works as a Clinical Support Nurse at Northern Health, Victoria.

Optimizing the emergency to ward handover process

Ms Shannon Bakon1, Tracey Millichamp2

1Queensland University Of Technology, Caboolture, Australia, 2Queensland Health, Australia

The effective handover of patient health data from the emergency to other hospital units is integral for the continuity of patient care. Yet no handover process has been identified as superior to others within this context and within the regional hospital in which this study was based the emergency to ward handover was identified as an area of concern. The broad aim of this study was to improve the handover process and handover consistency by developing a handover form that provides direction on the appropriate health data to be communicated. This study employed mixed methods to develop an emergency to ward patient handover form that could also be used as a prompt for emergency nurses to improve the handover of key patient information. This form was developed by incorporating research from various international and domestic handover forms, adapting them to the local context, and using multiple phases of feedback. The feedback was sourced from all levels of emergency nursing and ward staff, hospital executives, researchers from the local university and consumer groups. Versions of the form were updated after the receipt of feedback from each of the key stakeholders. The multiple levels of feedback allowed the successful development of a form that is currently being trialled. The feedback processes promoted ownership and a sense of involvement and collaboration within the hospital. Initial results from the implementation of the form will be discussed.


Biography:

Shannon Bakon has completed her Masters in Applied Science (Res) from the School of Nursing at Queensland University of Technology. She is a unit coordinator within the undergraduate curriculum and has published various papers in reputable peer reviewed journals while working on the ground at her local emergency department.

Emergency Department nursing shift leaders’ responses to episodes of escalation of care for clinical deterioration

Mrs Vanessa Leonard-Roberts1,2, Professor Julie Considine2,3, Professor Judy Currey2

1Northern Health, Epping, Australia, 2Deakin University, Geelong, Australia, 3Eastern Health Partnership, Box Hill, Australia

Background: Recognising and responding to clinical deterioration is a national patient safety priority. The aim of this study was to determine the frequency, nature, and response of ED Nursing Shift Leaders to episodes of escalation of care for patient clinical deterioration.

Methods: A prospective exploratory descriptive design was used to address the study aims. The study was conducted in an urban district ED in Melbourne, Australia. Participants were recruited from the senior emergency nurses at the study site that fulfilled the role of being in charge of the ED. Study data were collected between October and December 2015 across a variety of shifts.

Results: This study had three major findings. First, escalation of care for patients who are clinically deteriorating to the Nursing Shift Leaders is a common occurrence. A total of 37 episodes of escalation of care for clinical deterioration were observed across a variety of shifts, equating to 1.02 episodes of escalation of care per hour. Second, Nursing Shift Leaders rely on advanced clinical emergency nursing skills to recognise, prioritise and respond to escalation of care for a clinically deteriorating patient. Finally, the Nursing Shift Leaders’ role in responding to escalation of care for clinical deterioration is multifaceted.

Conclusions: The Nursing Shift Leader role is crucial in identifying, responding to and managing escalation of care for patient clinical deterioration and has a direct impact on patient outcomes.

Implications: The Nursing Shift Leader role is complex and requires a high level of management and clinical acumen. Opportunities to maintain these skills should be provided on an ongoing basis.


Biography:

Vanessa Leonard-Roberts was born in Africa and worked for many years in South Africa as an intermediate life support paramedic. During periods of civil unrest Vanessa volunteered for the South African Red Cross Society, often working in areas of extreme conditions and political unrest. Vanessa spent 5 years with the National Sea Rescue Institute where she worked as a crew medic training new crew members in basic life support and maritime emergency care. In 2008 Vanessa immigrated to Australia and subsequently completed a Bachelor of Nursing Degree followed by a Diploma in Emergency Nursing. Vanessa is currently a Master of Nursing candidate through Deakin University and works as a Clinical Support Nurse at Northern Health, Victoria.

It’s the ED I have a patient to handover: The development of the ED to ward clinical handover tool

Mrs Naomi Clark1, Mrs Kate Ruperto2, Ms  Janet  White3

1Wollongong Hospital Emergency Department, Wollongong , Australia; 2Illawarra Shoalhaven Local Health District, Wollongong, Australia; 3IMSD (SESLHD, ISLHD, SCHN- Randwick), Wollongong, Australia

Clinical handover is defined as “the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or a group of patients, to another person or professional group on a temporary or permanent basis” ¹.  However clinical handover from the ED to the ward nurse has been met with the challenges of inconsistency between staff, competing needs of the handover and the documentation of this in the electronic medical record.

A failure to meet the MoH Clinical Handover- Standard Key Principles PD2009_060 criteria for the handover process led to development of an ED to Ward Clinical Handover tool.  The handover tool was developed utilising the ISBAR framework whilst meeting the needs of the ED, ward and key standards of the handover process.

The tool was trialed in paper form on a medical and cardiac ward, two surgical wards and paediatric ward over a month. This allowed for testing of the framework and content. Feedback from ED and ward nursing staff allowed this tool to be reviewed and developed for four emergency departments across our local health district for utilisation in the electronic medical record.

The development of an electronic handover form has required a multi stakeholder approach across the district. The challenges included the development of the IT format, the agreed handover process, additional infrastructure, the health district structure and education. However the benefit of a documented handover between clinicians, which is time stamped with an electronic signature meets the requirements of the clinical handover policy thus promoting best practice. We envision the implementation of the electronic tool with further testing resulting in a reduction of clinical incidences relating to clinical handover.

  1. Australian Commission of Safety and Quality in Healthcare, 2012, National Safety and Quality Health Service (NSQHS) Standards Standard 6; Clinical Handover, p.6.

Biography:

Naomi Clark has been working in the emergency department environment for 12 years and held both clinical and management roles. She has completed post graduate degrees in emergency nursing and healthcare management. As a Nurse Unit Manager (Grade 2) Naomi has key interests in quality improvement initiatives, the implementation of National Safety and Quality Health Service (NSQHS) Standards in the emergency department and the professional development of the emergency nurse.