SUPPORT IN PRACTICE
Help to spot deterioration Patient deterioration is not always detected, resulting in avoidable deaths. Monitoring vital signs is key to safe patient care, and to recognising patient deterioration. Increasingly, acutely ill patients are cared for on general hospital wards staffed by fewer qualified nurses. So the routine monitoring and documentation of vital signs has become less of a priority for nurses and the responsibility is often delegated to healthcare assistants. Having been documented, all clinical information, such as a patient’s vital signs, needs to be interpreted in the context of normal values. These need to be known and understood if the information is to be acted on appropriately.
JASMINE CHIN
Robin Lewis argues that the safety of patients in hospital can be improved by using tools to monitor their vital signs
Many hospitals use assessment tools to aid in clinical decision making. These provide a standardised approach to making decisions about a patient’s condition. Clear instructions are
Best interests Richard Griffith on the law and capacity Healthcare assistants must always act in a patient’s best interests. The court is clear that best interests action only arises when a person lacks the capacity to make decisions for themselves. Where this is the case, HCAs have a legal duty to ensure that their care is always in the best interests of the person who lacks capacity. Adults with capacity have the right to make their own decisions about care and treatment, even if their carers consider that decision to be unwise. Recently, a woman with capacity refused a blood transfusion for a bleeding ulcer. Her carers believed her refusal was not in her best interests but accepted it was
her right to refuse treatment; she died some days later. Where a person is assessed as lacking capacity to decide on care and treatment, the Mental Capacity Act 2005 requires that the patient’s best interests be determined before care and treatment can begin. The act and its code of practice require a holistic consideration of a person’s wishes and beliefs and the views of family, friends and carers. HCAs must follow the care plan developed from the determination of best interests and always work with consent, explaining care clearly. HCAs must not act in a discriminatory way, so cannot say that care is not in a person’s best interests because of their age, appearance, behaviour or condition. In one case, a man with renal failure was told he could not undergo dialysis because he had a learning disability.
given for when to inform a nurse or when to increase monitoring. Early warning scoring (EWS) systems are one such tool designed to help detect deterioration. These track signs of deterioration, then trigger a rapid response if needed. Tracking is achieved by measuring and documentating the patient’s vital signs. Accurate and timely measurement of vital signs and the calculation of the EWS are crucial in identifying patients at risk of deterioration. Accurate and complete documentation of the EWS information enables tracking of the often subtle signs of deterioration. If, when the score is calculated, a patient ‘triggers’, this information should be passed promptly to a qualified clinician and the communication documented in the patient’s notes. Any delays in taking action can harm the patient NS Robin Lewis is senior lecturer (research) at Sheffield Hallam University
The court held that this decision was discriminatory and unlawful. Under the act, HCAs who fail to give care according to a care plan based on a patient’s best interests face prosecution for wilful neglect. A nurse and HCA were found guilty when a patient who lacked capacity, and whom they claimed to have helped to bed and to have checked during the night, was found asleep under his undisturbed bed next morning. The way for HCAs to ensure they are working in the best interests of a patient who lacks capacity is to follow the act’s code of practice NS Richard Griffith is lecturer in law at Swansea University Mental Capacity Act – Code of Practice tinyurl.com/MCA05CoP
74 february 18 from :: vol RCNi.com 29 no 25 by :: 2015 STANDARD Downloaded ${individualUser.displayName} on Nov 21, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
Help to spot deterioration Patient deterioration is not always detected, resulting in avoidable deaths. Monitoring vital signs is key to safe patient care, and to recognising patient deterioration. Increasingly, acutely ill patients are cared for on general hospital wards staffed by fewer qualified nurses. So the routine monitoring and documentation of vital signs has become less of a priority for nurses and the responsibility is often delegated to healthcare assistants. Having been documented, all clinical information, such as a patient’s vital signs, needs to be interpreted in the context of normal values. These need to be known and understood if the information is to be acted on appropriately.
JASMINE CHIN
Robin Lewis argues that the safety of patients in hospital can be improved by using tools to monitor their vital signs
Many hospitals use assessment tools to aid in clinical decision making. These provide a standardised approach to making decisions about a patient’s condition. Clear instructions are
Best interests Richard Griffith on the law and capacity Healthcare assistants must always act in a patient’s best interests. The court is clear that best interests action only arises when a person lacks the capacity to make decisions for themselves. Where this is the case, HCAs have a legal duty to ensure that their care is always in the best interests of the person who lacks capacity. Adults with capacity have the right to make their own decisions about care and treatment, even if their carers consider that decision to be unwise. Recently, a woman with capacity refused a blood transfusion for a bleeding ulcer. Her carers believed her refusal was not in her best interests but accepted it was
her right to refuse treatment; she died some days later. Where a person is assessed as lacking capacity to decide on care and treatment, the Mental Capacity Act 2005 requires that the patient’s best interests be determined before care and treatment can begin. The act and its code of practice require a holistic consideration of a person’s wishes and beliefs and the views of family, friends and carers. HCAs must follow the care plan developed from the determination of best interests and always work with consent, explaining care clearly. HCAs must not act in a discriminatory way, so cannot say that care is not in a person’s best interests because of their age, appearance, behaviour or condition. In one case, a man with renal failure was told he could not undergo dialysis because he had a learning disability.
given for when to inform a nurse or when to increase monitoring. Early warning scoring (EWS) systems are one such tool designed to help detect deterioration. These track signs of deterioration, then trigger a rapid response if needed. Tracking is achieved by measuring and documentating the patient’s vital signs. Accurate and timely measurement of vital signs and the calculation of the EWS are crucial in identifying patients at risk of deterioration. Accurate and complete documentation of the EWS information enables tracking of the often subtle signs of deterioration. If, when the score is calculated, a patient ‘triggers’, this information should be passed promptly to a qualified clinician and the communication documented in the patient’s notes. Any delays in taking action can harm the patient NS Robin Lewis is senior lecturer (research) at Sheffield Hallam University
The court held that this decision was discriminatory and unlawful. Under the act, HCAs who fail to give care according to a care plan based on a patient’s best interests face prosecution for wilful neglect. A nurse and HCA were found guilty when a patient who lacked capacity, and whom they claimed to have helped to bed and to have checked during the night, was found asleep under his undisturbed bed next morning. The way for HCAs to ensure they are working in the best interests of a patient who lacks capacity is to follow the act’s code of practice NS Richard Griffith is lecturer in law at Swansea University Mental Capacity Act – Code of Practice tinyurl.com/MCA05CoP
74 february 18 from :: vol RCNi.com 29 no 25 by :: 2015 STANDARD Downloaded ${individualUser.displayName} on Nov 21, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
