Introduction
In the pursuit of preserving the safety and welfare of patients, it is invariably the responsibility of caregivers to execute their caretaking duties with utmost diligence. During instances when both doctors and families are unattainable, the responsibility falls on nurses enacting heightened concentration to monitor and assist those under their care. Evidence-based clinical practices are some of the innovations that help nurses gain the confidence of their clients (Alatawi et al., 2020). “Failure to rescue” is a topic that has been of concern to most researchers in the field of healthcare practice. The topic aims to inform nurses how to help patients regain their deteriorating health. This essay aims to evaluate and apply current evidence-based clinical research to enhance the quality and standard of complex nursing care and interventions while maintaining patient safety. Also, display reflective, evidence-based clinical practice in nursing following the Nursing and Midwifery Board of Australia (NMBA) competency standards for complex care nursing. This paper will also discuss how to monitor and manage deteriorating patients who have had “failure to rescue” (FTR) in an acute healthcare setting, as well as what clinical tactics to use to stop FTR and ensure the patient’s safety.”
Definition of the Concept of “Failure to Rescue”
The term failure to Rescue has commonly been used by health practitioners, especially nurses and doctors. Even though there is a substantial definition, most researchers have tried to explain the term using the simplest ways possible. According to Hall et al. (2020), failure to rescue is when the medical attention to patients admitted to the hospital is delayed. According to him, failure to rescue can lead to the patient’s death if not worsening their health conditions. Hall et al. (2020) also considered the safety of patients and healthcare quality metric and defined FTR as mortality due to complications. Failure is simply the inability to prevent the death of a patient who develops complications while admitted to the hospital (Portuondo et al., 2020). Hall and other researchers have identified and clarified that there is a need to establish evidence-based practices that ensure a reduced mortality rate in hospitals.
Adverse Events and Incidences in the Australian Acute Healthcare Environment
Adverse events refer to unintentional but sometimes dangerous incidences where a patient admitted to the hospital is harmed due to various occurrences in line with care, medications, and devices. Australia has one of the strongest health systems in the world, but there are significant regional differences in the manner that healthcare is currently provided there. Adverse events lead to failure to rescue (FTR), and these are defined as incidents in which a person getting medical care suffers harm or death. According to the Quality in Australian Health Care Study, 16% of hospital patients suffered adverse events while they were in the hospital being admitted, and almost 50% of these were avoidable and preventable. Adverse Events are Hospital Acquired Complications (HAC) that can potentially cause harm, suffering, and death to patients. Here are some samples of complications calculated using public hospitals in Australia only. Every year, there are around 61,862 healthcare-associated infections (HAI), 4,249 instances of venous thromboembolism (VTE), 2,840 pressure injuries at stages 3 and 4, also 8,054 surgical issues requiring to come back to the operating theatre, 5,352 cases of 3rd to 4th-degree perineal tears following childbirth, 13,444 medication errors, and 12,018 respiratory problems happens in Australia (Australian Commission on Safety and Quality in Health Care, 2019). All of these complications may lead to FTR and the probable death of a patient.
The Consequences of Failure to Rescue
To the Patients
The consequences of failure to rescue patients can be very adverse. Most of the patients affected by the failure to rescue are the ones that were initially operated on and, therefore, not in a position to support themselves fully. Hence the patients would be struggling to keep up with some body pains. In some cases, the failure to rescue worsens the situation by causing death to the patient (Khan et al., 2019). Patient mortality occurs when the Failure to Rescue delays further. This kind of effect can be so devastating.
Failure to rescue can also lead to permanent disability for the patient. Disability refers to the inability to perform normal activities that one used to do. Disability also has a devastating effect on patients because it keeps reminding them of what happened. In the cases where the nurse is the cause of the disability, the patients might need some time before they forgive them.
Failure to rescue can also lead to the effects of stress and depression on the patient. Patients who suffer due to the failure to rescue need to be taken through counseling so they can easily accept what happened.
Patient’s Family
Whenever a caregiver and a relative take their loved ones to the hospital, they hope that they have their patients recover fully. It can be devastating when they encounter any other form of danger due to the failure to rescue. The loss of a family member to death can even be worse. The grief of a loved one is the natural emotional response to the loss of a family patient (Abe et al., 2020). The process of informing the family about the unexpected loss of a loved one causes the healthcare team can be stressful. Most of the effects of the death of a family member include intense sadness, sometimes feelings of shock and numbness, and even denial and anger.
Whenever patients have to deal with a permanent disability, they need people to help them every time. Most of the caregivers are their family members, and during the entire process, they struggle with stress and denial (Khan et al., 2019). Family members take time to accept that their patients would have been helped only if the effects of failure to rescue could have been avoided.
The family members suffer from financial constraints and psychological strains whenever the nurses fail to provide sufficient services to their clients. Most family members end up sacrificing all they have for the well-being of their loved ones (Hardmeier et al., 2020).
Patients who do not receive sufficient medical treatment post the rescue process might end up suffering from mental illnesses, which means that the family members would have to go the extra mile to ensure that their loved one feels safe and have a sense of belonging (Abe et al., 2020). During the process, family members may suffer emotionally and psychologically.
The Health Care System
The truth is that the healthcare system suffers from the consequences of Failure to Rescue. Possible effects include worsening the client’s health conditions. The inability of elderly or dementia patients to properly express themselves due to pain or confusion can exacerbate their condition, as Hossain et al. (2019) noted, thereby increasing the likelihood of future injury and necessitating further medical intervention to prevent any worsening of their situation.
The Nursing Strategies
One of the strategies involves the healthcare system or hospital implementing a Patient Monitoring System (PMS) like using a Novel Wearable Remote Patient Monitoring (RPM) Device; the second is to have the patient and family members involved that have concerns about the current condition that can potentially worsen.
The ability to monitor patients frequently is highly affected because of differences in clinical conclusions among individual nurses, poor communication, and a lack of experience. For nurses to easily detect the worsening in a patient’s physical, mental, or cognitive status. Utilizing a system makes sure that the proper parameters are monitored for each patient at the proper frequency (number of times per day) and for the proper period (number of days or weeks). This is for changes to be tracked over time; consistent documentation of recorded vital signs and other observed markers is crucial (Australian Commission on Safety and Quality in Health Care, 2019a).
EWS systems used in the timely identification of patients that need critical care in hospitals would be of considerable medical benefit in clinical practice. Frequent and automated vital sign collection for longer periods of time using remote patient monitoring (RPM) platforms with data transmission into algorithm-based computerized systems will probably be able to detect early changes and alerts of various risks than your traditional spot-check vital sign measurements, which are performed over a short period of time and may miss slight changes in parameters (Itelman et al., 2022). Immediately after being captured, the data were instantly sent to a cloud-based online platform repository. Multiple parameters, including the heart rate, respiratory rate, blood pressure, oxygen saturation, cardiac output, stroke volume, cardiac index, vascular resistance, mean arterial pressure (MAP), pulse pressure, temperature, and single-channel electrocardiograms, were recorded every 5 minutes. Regular RPM in patients allows for the early detection of physiological changes that may have therapeutic significance in care. A crucial decision-support tool for early medical action, the incorporation of an EWS system may be beneficial in terms of clinical awareness (Itelman et al., 2022).
Frequent remote patient monitoring provides the ability to detect deterioration in hospitalized patients early, utilizing both aggregated signal-based ratings and algorithm-based prediction. The second strategy is known as patient and family-activated escalation systems.
(PFAESs). PFAES systems refer to the act of reducing the effects of adverse effects by empowering consumers to escalate treatment when they have concerns. PFAES pathways are roughly classified into two types: indirect protocols, which include the activation of either a team or an individual to assess the patient and determine whether the Rapid Response Team (RRT) is necessary, and direct protocols, in which the RRT responds to calls made by the patient or family. Numerous PFAES models with varying labels and activation mechanisms have been implemented in Australia. These are Call and Respond Early in WA, Recognise, Engage, Act, Call, and Help are on the Way (REACH) in New South Wales, and Ryan’s Rule (RR) in Queensland.
RR is a technique for indirect escalation that allows patients and/or family members to escalate treatment when they are concerned, triggering an independent professional assessment of the patient. RR has been implemented in over 160 establishments and 16 hospitals and health services throughout Queensland. The individual making the call (hence referred to as the activator) will first discuss their concerns with the treatment team before escalating issues to the nurse in charge of the shift. If the activator believes their concerns have not been addressed, they can call an outside number and request an independent clinical evaluation. This clinical review is carried out by a senior medical officer or nurse who is not part of the present treatment team (Dwyer et al., 2019).
Individuals who used Ryan’s Rule were pleased and appreciated the process. It provides reassurance by empowering individuals to speak up and request a clinical review.
Conclusion
Evidence-based clinical practices are some of the innovations that help nurses gain the confidence of their clients. “Failure to rescue” is a topic that has been of concern to most researchers in the field of healthcare practice. The topic aims to inform nurses how to help patients regain their deteriorating health. Adverse events are always related to medication misuse, medical devices or vaccines, and infections from other patients. Sometimes, adverse events can also result from the patient falling from the bed or while walking due to body weakness and other struggles. There are various challenges that nurses and other health practitioners face during the practice of their profession. Two nursing strategies mentioned in the paper were the Novel Wearable Remote Patient Monitoring (RPM) Device and the Patient and Family Escalated Activation System (FPAES) involving the patient, family, and the health care system to prevent further death of patients from FTR. Nurses endanger their professions when their patients suffer due to delayed Rescue. Whenever a caregiver and a relative take their loved ones to the hospital, they hope that they have their patients recover fully. It can be devastating when they encounter any other danger due to the failure to rescue. The loss of a family member to death can even be worse.
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