Physical deterioration in an acute mental health unit: A quantitative retrospective analysis of medical emergencies

Abstract

Nursing management of physical deterioration of patients within acute mental health settings is observed, recorded, and actively managed with the use of standardized Adult Deterioration Detection System (ADDS) charts. Patient deterioration may require the urgent assistance of a hospital rapid response or Medical Emergency Team. A five-and-a-half-year (2011-2016) audit of hospital-wide Medical Emergency Team attendances was conducted in an acute mental health unit of a single large 250 bed regional hospital in Victoria, Australia. Data were extracted from the hospitals' quality and patient safety program, RISKMan, and entered into a statistical data program for analysis. A total of 140 patient records were analysed, and the 'Worried' category (34%, n = 47) was the principle reason for a Medical Emergency Team call in a mental health ward, followed by hypotension (23%, n = 31) and a low Glasgow Coma Score (16%, n = 22). Upon further investigation of the 'Worried' category, the most common conditions recorded were an altered conscious state (22%, n = 9), low oxygen saturation (20%, n = 8), or chest pain (17%, n = 7). Activation of Medical Emergency Team calls predominantly occurred in the daylight morning hours (6am-12md). When data were compared to the general hospital patients, the context of the physiological deterioration of the mental health patients was strikingly similar. Further research is recommended to ascertain the extent and frequency with which staff working in mental health units are performing vital signs monitoring as an essential component of detection of early signs of physiological deterioration.

Clarity, confidence and complexity: Learning from mental health nurses' experiences of events involving physiological deterioration of consumers in acute inpatient mental health settings

“…Identification of acute changes in the physiological status of consumers is known to precede more complex physiological instability, with early identification providing opportunities to prevent and ameliorate further problems (Porter et al, 2018). While there has been a much welcome increase in evidence from studies of nurses' experience and knowledge of physical deterioration in recent years, studies have highlighted shortfalls in related confidence and knowledge (Bressington et al, 2014;Dickens, Ramjan, Endrawes, May Barlow, & Everett, 2019;Flood, Gull, Thomas, Gordon, & Cleary, 2014).…”

“…Contact with consumers during mental health-related presentations offers opportunities for nurses to impact positively on consumers' physical health (Robson & Haddad, 2012). Further, nurses are the most likely "first responders" to acute physiological deterioration (APD) in mental health units (Porter, Cant, Missen, Raymond, & Churchill, 2018). The combined mental state acuity and the emerging recognition of the increased risk of physical health acuity in this group has placed nurses in particular in a challenging position where they are required to have high levels of confidence and skills across both domains (Ehrlich et al, 2014;Happell, Wilson, Platania-Phung, & Stanton, 2016b).…”

Evaluation of an immersive simulation programme for mental health clinicians to address aggression, violence, and clinical deterioration

“…2015; Porter et al . 2018). Further compounding emergency intervention is when agitation, aggression and violence are also present, sometimes masking the underlying clinical issue (Craze et al .…”

“…Porter et al . (2018) undertook a retrospective medical record review in an acute mental health setting of patients who required MET intervention. Of the 140 records analysed, the most frequent reason for a MET call was being ‘worried’ about a patient's condition (e.g.…”

“…altered conscious state, low oxygen saturation or chest pain; n = 47; 34%) followed by hypotension ( n = 31; 23%) or low Glasgow Coma Scale scores ( n = 22; 16%; Porter et al . 2018).…”