Objective:To identify the available published primary research and any relevant policies, guidelines, or protocols regarding how care home staff recognize and respond to an acutely deteriorating resident.Introduction:Older people living in care homes have complex health care needs. Chronic illnesses, comorbidities, frailty, cognitive impairment, and physical dependency can contribute to unpredictable changes in their health status that can lead to residents becoming unwell and acutely deteriorating. Exploring how care home staff recognize and respond to acutely deteriorating health among residents is important to understand whether opportunities exist to minimize these unpredictable changes in health.Inclusion criteria:This scoping review will consider studies that feature the recognition and response to acute deterioration in care home residents. This review will consider qualitative and quantitative primary research. Non-indexed and gray literature such as policies, deterioration tools, and reports from health policy organizations will also be included.Methods:The searches will be conducted using bibliographic databases, university repositories, and non-indexed and gray literature, such as reports by health care and health policy organizations. The studies will be independently selected from the inclusion criteria by two researchers based on their title and abstract. In case of disagreement, a third researcher will be consulted. An adapted version of the JBI data extraction form will be used to extrapolate data from included studies. The results will be presented in tabular form, accompanied by a narrative summary related to the objectives of the scoping review.
Aims In patients with heart failure (HF), hospitalization rates are increasing, particularly for non-HF causes and over half may be avoidable. Self-monitoring of symptoms plays a key part in the early identification of deterioration. Our objective was to develop expert consensus for a core outcome set (COS) of symptoms to be monitored by patients, using validated single-item patient-reported outcome measures (PROMs), focused on the key priority of reducing admissions in HF. Methods and results A rigorous COS development process incorporating systematic review, modified e-Delphi and nominal group technique (NGT) methods. Participants included 24 HF patients, 4 carers, 29 HF nurses, and 9 doctors. In three Delphi and NGT rounds, participants rated potential outcomes on their importance before a HF or a non-HF admission using a 5-point Likert scale. Opinion change between rounds was assessed and a two-thirds threshold was used for outcome selection. Item generation using systematic review identified 100 validated single-item PROMs covering 34 symptoms or signs, relevant to admission for people with HF. De-duplication and formal consensus processes, resulted in a COS comprising eight symptoms and signs; shortness of breath, arm or leg swelling, abdomen bloating, palpitations, weight gain, chest pain, anxiety, and overall health. In the NGT, a numerical rating scale was selected as the optimal approach to symptom monitoring. Conclusion Recognition of a range of HF-specific and general symptoms, alongside comorbidities, is an important consideration for admission prevention. Further work is needed to validate and integrate the COS in routine care with the aim of facilitating faster identification of clinical deterioration.
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