Recently, I’ve been thinking about risk scores, and whether they work or not.
An example comes to mind of a trust where high risk scores are called PAR (patient at risk) scores. Basically the higher the number, the worse the patient’s condition is. You would give a higher score for high or low respirations, pulse, and systolic blood pressure and so on.
On this particular occasion the patient was in severe pain.
The patient had had quite extensive surgery and there was a fear that they were suffering from some severe complications. The nurse administered morphine but this had little to no effect on alleviating the patient’s pain.
While the trust has its own measuring system for pain for which the patient was obviously scoring quite high, the actual PAR was quite low and this is where the difficulty arose.
The nurse contacted the outreach team who are a highly skilled team of nurses based in the critical care unit to come and assess the patient. Following that assessment the outreach nurse agreed that the patient needed to be reviewed quickly.
House officers were called, senior house officers were bleeped and the team tried desperately to contact the registrar. A recurring theme came up that because the patient wasn’t scoring high on the risk score, and as such it was difficult for the nurses on the ward to convey the severity of the patient’s condition.
Eventually, a registrar came and assess the patient and agreed with the nurse that the patient did need some intervention.
The patient was taken to theatre where a full investigation could begin. If I’m honest, I’m not sure what the moral of the story should be but it does make me wonder whether the current approach is really working?
As students we are hopefully being taught to develop our intuition and it is certainly something that will develop over time.
My only concern is that with all of these systems, pathways and scales we could be distilling nursing intuition into a numerical scale.
What do you think? Do you think risk scores undermine a nurse’s intuition?