We Must Get Better at Detecting Patient Deterioration

Editor’s Note: This editorial from the desk of PPAHS’s Executive Director urges clinicians to do better at detecting patient deterioration. Patient monitoring is a combination of the use of technology in the hands of clinicians adequately trained on its use.

By Michael Wong, JD (Founder and Executive Director, Physician-Patient Alliance for Health & Safety)

ECRI Institute recently released its “2019 Top 10 Patient Safety Concerns.” In releasing its top 10 patient safety concerns, ECRI said:

This annual top 10 list helps organizations identify looming patient safety challenges and offers suggestions and resources for addressing them.

One of these 10 patient safety concerns in ECRI’s list is – Detecting Changes in a Patient’s Condition.

Why is this important?

Like a canary in a coal mine to detect carbon monoxide and other toxic gases, which alerted miners of potential dangers, being alerted to a change in a patient’s conditions provides the opportunity for clinicians to intervene.

Source: https://www.smithsonianmag.com/smart-news/story-real-canary-coal-mine-180961570/

Monitoring of patients is probably best known in the operating room where patients are monitored with a variety of monitors – physiologic parameters such as heart rate, blood pressure, oxygenation, and respiratory gas content are observed. However, there are now monitors that provide alerts for many key patient issues – falls, pressure ulcers, sepsis, and respiratory depression are just a handful of patient conditions.

The Physician-Patient Alliance for Health & Safety has advocated for the use of patient monitoring since our inception almost eight years ago. In particular, our position statement “Patients Receiving Opioids Must Be Monitored With Continuous Electronic Monitoring” is a call for all patients receiving opioids to be monitored with pulse oximetry for oxygenation and with capnography for the adequacy of ventilation.

However, the use of technology, while an aid, is not a “silver bullet.” As ECRI’s “2019 Top 10 Patient Safety Concerns reminds us, technology must be combined with skilled clinicians. The  training of and communication between caregivers, as well as listening to patient and family concerns, are also critical:

Technology can alert caregivers to a patient’s changing condition, but it must be used appropriately. Staff must be trained in how to operate the equipment and understand the organization’s policies and their responsibilities for responding to alarms.

Finally, staff must listen to concerns that patients and family members raise. Likewise, be the patient’s advocate.

Clinicians must be open to using technology to help them better care for their patients. However, like a smart phone in the hands of a user who only uses it to make phone calls, technology is only as good as the user – clinicians must also be adequately trained on the equipment.

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