The Acute Illness Course

1. The Acute Illness Course Joanne Garside and Stephen Prescott Senior Lecturers Department of Adult and Children’s Nursing School of Human and Health Sciences

2. Background • Changes In health care provision. • Critical Care environments. • McQuillan et al 1998. • Literature review. • Personal.

3. Kause, Smith, Prytherch et al (2004) • International, multi centre, prospective, observational study. • UK, Australia and New Zealand. • Over 3 days in October 2000. • Studied the incidence of antecedents. • 638 Primary events. • 308 death • 141 cardiac arrests • 189 unplanned ICU admissions

4. Kause, Smith, Prytherch et al (2004, p280) ‘Several patients studied had exhibited antecedents that were recorded continuously for periods of up to 24 hours prior to a primary event.’

5. DH and Modernisation Agency (2003) ‘Patients at-risk, deteriorating, or recovering from critical illness are not always well managed: sub-standard care is seen in failures to optimise essential functions – airway, breathing and circulation, oxygen therapy, fluid balance, and monitoring.’

6. DH and Modernisation Agency (2003) ‘Organisational problems, inadequate supervision, failure to seek advice and poor communication compound the situation, but significant deficits in fundamental skills and knowledge are also major factors.’ ‘Current education does not properly equip healthcare providers to care for critically ill patients, particularly those outside designated critical care departments.’

7. Smith (2005, p27) ‘Often, medical and nursing staff do not possess acute-care knowledge and skills and may lack confidence when dealing with acute-care problems.’

8. Specific areas of concern (Smith, 2005) • Incorrect use of oxygen therapy. • Failure to monitor patients. • Failure to involve experienced senior staff. • Failure to use a systematic approach. • Poor communication. • Lack of teamwork. • Insufficient use of treatment limitation plans.

9. Allen (2004, p34) ‘As their role enables them to be in constant contact with patients, nurses are in a prime position to identify problems at an early stage with the use of a systematic patient assessment. This means appropriate treatment can be identified quickly, potentially saving the patient’s life.’

10. Watson (2006, p34) ‘Recording baseline observations is no longer sufficient. In today's climate of clinical effectiveness and value for money, a greater level of skill is required of nurses. They need a sound knowledge of basic anatomy and physiology to facilitate the interpretation of observations as well as of the pathology and nursing management of common illnesses and injuries.’

11. More recently • National Patient Safety Agency (2007): Safer care for the acutely ill patient: learning from serious incidents. • National Institute for Health and Clinical Excellence (2007): Acutely ill patients in hospital: Recognition of and response to acute illness in adults in hospital.

12. The Acute Illness Course • Aim. • Focus. • Clinical placements within the students’ own clinical areas. • Alternative clinical placements.

13. Modules • 60 Honours level credits. • Professional certificate/BSc (Hons). • Assessment, care and management of an acutely ill patient – 40 credits. • Professional principles underpinning acute clinical practice – 20 credits.

14. ABCDE. Assessment care & management of systematic illness e.g. respiratory, cardiac, GI etc. Peri/cardiac arrest. ABG’s/ECG’s. Critical Thinking. Ethical & Legal dilemmas. Accountability. Communication. Timetable

15. Teaching & Learning Methods • Lecture. • Problem based discussions. • Seminars. • Simulation.

16. Simulation • Can take many forms. • Variety of manikins. • Problem Based Learning. • Promotes team working.

17. A Different teaching strategy • Often viewed as a different teaching strategy. • Not just a stage between theory and practice. • Offers an opportunity for theory to be delivered through practice. • ‘What I read I forget, what I see I remember, what I do I understand’. • Simulation is about promoting understanding through the doing.

21. Assessments • Portfolio. • Simulated Clinical Scenario. • Choice (Learning Contract).

22. Evaluation • ‘I now feel more confident in care that I provide to my patients. In acute situations I feel more able to stay in control of situations because I am able to understand more about what’s happening.’ • ‘This course has been excellent……It has helped me develop myself personally and professionally. I feel a lot more confident at work and colleagues have praised me.’

23. The future? • Intra-Professional Learning. • Research. • Masters level. • Acute Illness book.

24. Any Questions?

25. References • Allen, K (2004); Recognising and managing adult patients who are critically sick. Nursing Times, Vol. 100, No. 34, pp34-37. • DH and Modernisation Agency (2003); The National Outreach Report. London. NHS Modernisation Agency. • Kause, J; Smith, G; Prytherch, D; Parr, M; Flabouris, A and Hillman, K for the Intensive Care Society (UK) & Australian and New Zealand Intensive Care Society Clinical Trials Group ACADEMIA Study investigators (2004); A comparision of Antecedents to Cardiac Arrest, Deaths and Emergency Intensive Care Admissions in Australia and New Zealand, and the United Kingdom – the ACADEMIA study. Resuscitation, Vol. 62, pp275-282.

26. References (2) • McQuillan, P. et al (1998); Confidential inquiry into quality of care before admission to intensive care. BMJ, Vol. 316, 20 June 1998, pp1853-1858. • National Institute for Health and Clinical Excellence (2007): Acutely ill patients in hospital: Recognition of and response to acute illness in adults in hospital. London. National Institute for Health and Clinical Excellence. • National Patient Safety Agency (2007): Safer care for the acutely ill patient: learning from serious incidents. London. The National Patient Safety Agency.

27. References (3) • Smith, G (2005); Prevention of in-hospital cardiac arrest and decisions about cardiopulmonary resuscitation. IN Handley, A.J (Ed) (2005); Resuscitation Guidelines 2005. London. Resuscitation Council (UK). • Watson, D (2006); The impact of accurate patient assessment on the quality of care. Nursing Times, Vol. 102, No. 6, 07 February 2006, pp34-37.