LR29 / Vital signs – an education initiatives for occupational therapists

Type of Patient Safety Practice
Clinical Risk Management Practice (CRMP)
Related practices from PaSQ database
“Best fit” category of the reported practice
There is no specified text here
Patient safety theme the SCP/clinical risk management practice is aimed at
Clinical risk management practice focused on knowledge and skills improvement of occupational therapists to be able to recognise the early warning signs of acute deterioration and understand the significance of vital signs to be able to raise concerns with nursing and medical staff.
Objective of the CRM practice
To reduce in-hospital mortality and morbidity by training ocupational therapists to observe vital signs and to early detect patients’ deterioration in acute hospitals [p.44, 1]
Short description of the CRM practice, including any references for further information
Occupational therapist that have as main duty the patients’ rehabilitation, are trained to recognize the vital signs (airway, breathing, circulation, disability, exposure) They check the following aspects: Breathing rate (depth, skin, cough, peak flow, pulse oximetry saturation). Circulation (pulse, atrial fibrillation, blood pressure, postural hypotension, temperature). Disability (AVPU – alert, responsive to voice, responsive to pain, unresponsive; pupil reaction, pain). MEWT (local MEWS adaptation, Table 1), critical care outreach. They learn how to detect rapid deterioration of patients’ status in order to categorize them into 4 categories. Based on these categories interventions are made in order to reduce morbidity and mortality in acute hospitals. Level 0: Patients whose needs can be met through normal ward care in an acute hospital. Level 1: Patients at risk of their condition deteriorating, or those recentlyrelocated from higher levels of care, whose needs can be met on an acute ward with additional advice and support from the critical care team. Level 2: Patients requiring more detailed observation or intervention including support for a single failing organ system or post-operative care and those ‘stepping down’ from higher levels of care. Level 3: Patients requiring advanced respiratory support alone or basic respiratory support together with support of at least two organs. [4]
Innovator of the SCP, country of origin
Country of origin – UK, East Kent Hospitals University NHS Foundation Trust
Involved health care staff
The involved staff was represented by occupational therapists
Tested in which countries/health care systems, health care context(s) and/or clinical specialty/specialties, including references
Tested in UK [p.44, 1]
Summary of evidence for effectiveness, including references
For the session on vital signs, occupational therapy managers identified two objectives for staff: to be familiar with the equipment, procedures and documentation of baseline observations and be familiar with the normal ranges of baseline observations. The evaluation of the training program was positive, with staff commenting on: An increased understanding of vital signs observations, normal and abnormal results and their effect on occupational therapy sessions. Skill acquisition – the ability to use the equipment to undertake vital sign observations, with two people measuring vital signs within days of the course. An increase in confidence when observing and documenting vital signs pre and post-therapy interventions. Managers identified the following service improvements as a result of the course: alerting ward staff to problems, better communication with other staff, improved patient care and increased confidence in patient management. [p.47, 1]
Summary of evidence for transferability (transferability across health care systems or health care contexts or clinical specialties), including references
Description of the context – Occupational therapists are largely involved with patients who have complex rehabilitation needs, seeking to optimize their independence [p.1-22, 2 ] and assessing their fitness for discharge. Although responsibility for such assessments lies with medical staff, the expanding role of occupational therapists has broadened the limits of their professional accountability [ 3 ]. During patient assessment, occupational therapists have the opportunity to observe for signs of a new complication, or one that has been overlooked. They are also in a position to identify acute deterioration and physiological changes that would make discharge unsuitable. [p.45, 1] Guidance on implementation practice: draft available [p.46, 47, 1] Generalizability: The project was initiated at the request of occupational therapists, but the knowledge and skills are applicable to all staff in clinical practice, and similar initiatives have been developed for other healthcare professionals. Abnormal vital signs usually precede acute deterioration, so enabling staff to record vital signs and understand their significance enhances patient safety. Monitoring and awareness of vital signs by all members of the multidisciplinary team can help to ensure safer patient discharge[p.48, 1] The session was originally requested for staff based at Kent & Canterbury Hospital, but discussions between occupational therapists across sites brought subsequent requests from staff at the William Harvey Hospital in Ashford, Buckland Hospital in Dover and the Queen Elizabeth the Queen Mother Hospital in Margate. The trust’s critical care outreach team believes in delivering education wherever it is needed and possesses laptops, projectors and other equipment to make this possible. Sessions were therefore delivered on each of the four sites, with the local senior occupational therapist taking responsibility for arranging staff attendance. [p.47, 1] Transferability evaluation: results available regarding the level of knowledge and application in practice
Summary of available information on feasibility, including references
Occupational therapists’ main involvement with patients is usually when they have complex rehabilitation needs. Although the expectation at this stage is that patients will continue to progress, acute deterioration can occur. Rehabilitation focuses on promoting independence, but staff focused on preparing patients for rehabilitation into the community might miss early signs of acute deterioration. Patient safety is a high priority of major national organisations, such as the NPSA, as well as individual hospitals. Abnormal vital signs usually precede acute deterioration, so enabling staff to record vital signs and understand their significance enhances patient safety. Monitoring and awareness of vital signs by all members of the multidisciplinary team can help to ensure safer patient discharge. [p.48, 1]
Existing implementation tools, including references
Monitoring and awareness of vital signs by all members of the multidisciplinary team can help to ensure safer patient discharge [p.48, 1]
Potential for/description of patient involvement in the CRM practice, including references
Nothing described
Bibliography (for each reference: author(s), year, title, journal/internet link, page(s))
1. Woodrow P (2010) Vital signs: a nurse-led education initiative for occupational therapists. Nursing Standard. 24, 28, 44-48. Date of acceptance: January 14 2010 2. Creek J (2007) The thinking therapist. In Creek J, Lawson-Porter A (Eds) Contemporary Issues in Occupational Therapy: Reasoning and Reflection. John Wiley & Sons, Chichester, 1-22. 3. Dimond B (2004) Legal Aspects of Occupational Therapy. Second edition. Blackwell Publishing, Oxford. 3. Department of Health (2000) Comprehensive Critical Care: A Review of Adult Critical Care Services. The Stationery Office, London.
Dr. Georgeta Popovici, National School of Public Health and Management, Romania
National School of Public Health and Management, Romania
Any additional information on the CRM (e.g. implementation barriers and drivers)
There is no specified text here