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Hospital staff miss danger signs in deteriorating patients


More than one in five nurses lack confidence in their colleagues’ ability to spot a deteriorating patient.

Twenty-two per cent of respondents to Nursing Times’s online survey said they were not confident that the staff on their ward who carry out observations were able to identify significant changes in a patient that might indicate their condition was worsening.

More than one third - 35% - said patient observations had got worse over the last year, with the majority saying that was due to staffing levels.

More than half knew of at least one incident in the past month where a patient’s condition had got worse because staff had failed to notice deterioration.

The most commonly cited reasons for these incidents were a lack of staff, inexperienced employees and staff being “too busy”.

The use of technology was also flagged as a cause of worsening standards in observations with more than half of respondents saying digital observation technology made nurses less likely to be able to identify signs of deterioration by themselves.

The survey also suggested that in 17% of wards, few or none of the staff responsible for using patient observation technology had been trained to use it.

Heart of England Foundation Trust corporate nurse at Jo Richmond said the use of technology could distract from the basics of nursing.

She told Nursing Times: “My biggest concern is that it doesn’t tell you if the pulse is irregular or has poor volume, or if the patient’s skin is clammy.”

To ensure observations are thorough, the National Patient Safety Agency has recommended that every trust should have a deterioration recognition group. However, only a quarter of respondents knew about such a group at their trust.

Ms Richmond said her trust had a multidisciplinary group, which set small targets to improve patient safety based on audits of nurses’ observations.

“The important thing is we have got intelligence on the ground to tell us whether our charts are being filled in and observations being done,” she said.

Medway Foundation Trust director of nursing Jacqueline McKenna said her trust was seeing a “turning point” in improving its observations thanks to its deterioration recognition group. She said: “It’s about having good policy, training and education and constant audit.”

Nursing Times ran a similar survey in October 2009. Then, 9% of respondents said they were not confident staff on their ward could carry out observations with competence, compared with 22% this month. However, our anonymous surveying method means that comparisons are not reliable.


Readers' comments (21)

  • I think this study was a little flawed. For the question would you have confidence in your colleagues’ ability to spot a deteriorating patient, there was no real leeway to answer it other than yes or no.

    For example, if that colleague was a staff Nurse, then I would have every confidence in the world that they could do so, if that colleague was a HCA, I would not. There was no distinction between the two in the study, which I think should have been an important part of it since many wards leave HCAs to do the obs.

    You don't need a 'deterioration recognition group' for crying out loud! You just need enough TRAINED Staff Nurses to be able to do the obs, interpret the data and act accordingly! It isn't rocket science!

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  • sorry mike! that hca are the watch full eye?
    and many times thay have been at the right place at the right time and saved lifes.
    but trained staff dont get it right! and yes it isn't rocket science and to blame it on staffing levels. hca know the signs, that why we have to tell you because we dont get paid enough to think in your eyes!

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  • what dose it take to give a patient a drink regular,or get the doctor to write up fluids, or fill in a fluid balance, you now what thay say 'if it isn't documented it didn't happen' 'god help you if you went to wouldn't have a hells chance?
    but i arn't payed enough to no that i am only a h c a?

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  • I replied to this survey & I agree it didn't give much wiggle room in the responses.
    I am a SHCA/ Student Nurse and I hate to say it but I do not feel that all HCA's are equipped with the knowledge to recognise deteriorating patients, that is not to say that I am wholly confident in the abilities of some of the Staff Nurses I have worked with either!
    I do hope that 'Mike's' comment was not meant to imply that all HCA's are not able to recognise the deteriorating patient, as there are many excellent HCA's out there with more years experience than many qualified nurses. It is my experience that HCA's are taking on more of a nurse role and provide most of the hands on care including observations and it is a shared responsibilty between employee & employer to ensure that the knowledge and skills are obtained by clinical staff to ensure that patients are safe.

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  • HCAs have a duty to observe and report detiorating patients and such observations are commonsense that would be used in the home as well.These observiations are an essential part of working in a nursing team. However, these observations are a useful addition to, and not a substitute for the skills and experience of a trained nurse.

    As for policing the nursing staff to make sure that they are carrying out their observations correctly, this is ludicrous, and what is the point of using trained staff in the first place - and who is going to pay for these extra policing duties.

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  • You are absolutely right Mike.

    Registered nurses are the ones with knowledge and expertise.

    HCA's by there very title are assistants to the registered nurse and will never have our level of knowledge.
    One only has to look at the probable outcome of M. Staffs hosp. enquiry, to see where penny pinching from idiot management leading to a 40/60 ratio of qualified staff has led DIRECTLY... to patients deaths.

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  • Anonymous | 25-Jan-2011 7:36 am and Anonymous | 25-Jan-2011 7:48 am, your responses pretty much make my argument for me don't they?

    Anonymous | 25-Jan-2011 2:18 pm, (god I am sick of these anonymous'), please let me clarify. Yes I know there are a lot of excellent HCA's out there, but that does not mean they are able to perform clinical tasks. They simply are NOT trained. I am not saying HCA's are not capable of training (although some certainly are), it is just that they have not done the training and should not be doing clinical tasks. Many, like yourself (and myself before you) I may add are doing their training at the same time as working as a HCA and that is slightly different; but can I ask would you as a student Nurse undertake a procedure you had not been trained in? I hope your answer is no, in which case what is the difference for HCA's performing clinical tasks? The fact remains that HCA's no matter how long their time served or how experienced they are, are in no way a replacement for trained staff. Clinical studies have actually proven this, where higher numbers of HCA's have been employed in place of trained Staff Nurses, clinical care HAS fallen, it is as simple as that.

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  • one very big thing to consider when talking about hospital staff missing signs of deterioration, is that in these times of cutbacks and short staffing, there just isn't enough staff to be able to always spot them, and take action before it is too late. The bad news is that it will get worse as the trusts belts get tighter. Don't get ill!!

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  • Anonymous | 25-Jan-2011 11:09 pm, exactly my point!

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  • then mike stop slagging h c a's of and do your job? i know you will have a prize coment to that ever hear of team work

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