Abstract
Nurses have the knowledge and skills to recognize and intervene when the condition of patients on medical or surgical units deteriorates. Despite this, deterioration is sometimes missed resulting in unexpected ICU admissions. This study explored the nursing process factors associated with unexpected ICU admissions. A chart audit was undertaken in a large urban hospital and data were collected measuring nursing assessment (vital signs), communication and documentation. Results showed that the most common reason for an unexpected ICU admission was respiratory distress. At the same time, respiratory rate was the least documented vital sign. Communication, documentation and recognition of patient deterioration play a key role in intervening and preventing unexpected ICU admissions. Attention to adequate staffing levels as well as implementation of clinical tools may assist nurses to more readily address patient deterioration and prevent unexpected ICU admissions.
Highlights
People are hospitalized for a variety of reasons such as to receive specialized medical testing, to receive expert care in the stabilization of a medical condition, to recover from surgery and more
Not all patients are in a critical state, requiring them to be in the intensive care unit (ICU)
This study focused on processes within the nurses’ domain that are related to unexpected ICU admissions
Summary
People are hospitalized for a variety of reasons such as to receive specialized medical testing, to receive expert care in the stabilization of a medical condition, to recover from surgery and more. Called Post Intensive Care Syndrome, these issues may last for a year or more following a critical illness (Elliott et al 2014, Bradford & Grassi 2009) and some patients may never recover (Harvey 2012, Bradford & Grassi 2009). Anticipation and prevention of adverse events are critical components of patient safety and central to the role of the nurse within the hospital system (Mok et al 2015, Boyle 2004). Recognition and correction of physiological abnormalities can aid in the prevention of the deterioration of patients (Mok et al 2015, Considine 2005) and avoidance of unplanned ICU admissions. Deaths have resulted in part from lack of observation, documentation, and recognition of deterioration as well as a lack of communication between health care providers (Mapp et al 2013)
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