May 11, 2021

Improving critical care

Standard 8 – Recognising and Responding to Acute Deterioration aims to ensure that a person’s acute deterioration is recognised promptly and appropriate action is taken. Acute deterioration includes physiological changes, as well as acute changes in cognition and mental state.

Elise Sutton, Clinical Deterioration and Resuscitation Coordinator, is one of the leads on the Standard 8 Committee and works on numerous Standard 8-related projects, as well as on the education around this Standard.

“Some of the projects implemented include the ‘Allergy and Anaphylaxis’ project, where we identified there was no allergy and anaphylaxis procedure, so we developed an online learning module and a face to face component. We also gave authority to nurses to initiate adrenaline in the event of anaphylaxis, if they have done this learning package,” she explained.

Another project Elise is proud of is moving pre-METs to Medtasker.

“Prior to this, pre-METs were activated by dialing 444 which went through the switchboard. The switch gets around 3,000 calls in codes every month, and half of those were pre-METs. We have moved pre-METs to Medtasker and that has been going for a month now,” Elise said.

“Some of the really good things about this change is that we can actually track the reasons why the pre-METs are being called, while previously we had no information on that. Now, we know that one third of those calls are blood sugar related and we can now identify where the calls are coming from and what is the reason. For example, if we notice our surgical wards are having a lot of pre-METs for blood sugar, we can target our education towards that area,” she explained.

Previously, with pagers, the team wasn’t able to see if the pre-MET message was getting through. Now, with Medtasker, the team can see if the message has been delivered.

“It could happen that the pager has gone flat or missing and we wouldn’t know that pager was not staffed. Now, if you try to activate a pre-MET and there is no one logged on, we can see straight away and escalate. Rather than having a 30 minute delay due to no response, now we can escalate to a MET call if needed. Ultimately, this is reducing the delay in time to treatment,” Elise explained.

Another organisation-wide initiative and a key improvement was working with the Standard 4 Committee to standardise all the medication in resus trolleys, so all the critical care areas have a standardised layout of the medication in the trolleys, and the same was implemented in general wards.

“Education is another key improvement. We found ways to utilise virtual resources and adjust our sessions, via Microsoft Teams and LMS. We now have a Clinical Deterioration and Resuscitation Learning Hub, so there is one centralised location with all the resources around resuscitation,” Elise said.

Over the last 12 months, a new fleet of defibrillators was rolled out across the health service, standardising these devices across Northern Health.

“Previously, we had several brands. Now, they are standardised and meet the Australian Resuscitation Council guidelines, as they have the ability to escalate joules to 360 if required. The Northern Health Foundation donated money to purchase the new fleet of defibrillators,” Elise said.

Featured image: Elise Sutton with the new green trolley and new defibrillator