Nurses often contribute significantly to ensuring patient safety while in a clinical setting, but their role is not clearly understood by these individual nurses and the health care system.  The lack of recognition of the roles of patients is the result of the barriers that make nurses not to intervene diligently to patients who are at risk. Lack of understanding and recognition is the result of the moral distress among the nurses and adverse outcomes in patients. The kind of view that the healthcare system provides to the nurses and also the view of the individual nurses on their roles can be a reality to nurses as they become inept in their roles. Sometimes the nurses are in a position of identifying a condition in a patient that requires an emergency response, but they are unable to elicit a response from the medical staff. Nurses can also examine a patent diligently but fail to find a complication with the patient and all the same fails to call for the attention of the medical staff.  The nurses are not able in such a situation to call for a response from the medical staff since they are not able to recognize the level of risk to the patient.  Such incidences when a patient is not able to call for an emergency response from the medical staff since they don’t understand the level of risk on the patient is referred to as “failure to rescue.” The main causes of failure to rescue are always identified as “failure to recognize” and “failure to respond.” Patients have been reported to suffer increased length of hospital stay, adverse outcomes, death or cardiac arrests. The paper aims to describe the experience of nurses in the response for patients at risk and the outcome such experiences have on patient safety.

Definition

“Failure to Rescue” is the delayed or inadequate response to clinical deterioration in hospitalized patients resulting in risk in patient safety.

The incidence of adverse events

Failure to rescue is a challenge that is also experienced among the Australian nurses, and there are several incidences when the actions of nurses’ failure to rescue resulted in acute health complications and death in hospital patients.  Sometimes patients are at risk and need a response from the medical staff, but the nurse fails to respond.  The nursing staff can recognize the risk in a patient, but the nurse is unable to elicit a relevant response from a doctor. The problem of failure to respond is also common among the doctors especially when they fail to respond to calls from nurses to assist in terms of review and to issue appropriate treatment. It is coherent that if a response could have occurred within the right time, the patient’s outcome could have been altered and this is what we call an incidence of “failure to respond.”

Patients incidences of recovery have been prolonged since a medical doctor did not respond to an emergency and most patients have been discharged with severe cardiac impairment. Another incidence that is reported is when a nursing staff examines and diligently provides a result of the deteriorating condition of the patient, but they don’t request for a review from the medical staff. The nurse was not able to recognize the level of risk that the patient could be exposed to as a result of the deteriorating clinical condition. In such an incidence the patient suffers a health complication up to a point where minimal efforts from the doctor can rescue the situation. Such an occurrence is termed as “failure to recognize” which is associated with the lack of understanding of the role for the patient. For example in one of the significant Australian hospitals, a senior woman was admitted to the hospital with a fractured neck of the femur (NOF). The surgery was postponed, but in the process, the patient started developing severe conditions such as increased heart rate, high blood pressure and decreased urine output which was recorded by the nurse and recognized as deteriorating the health of the patient.  In the report filed by nurses, they indicated that the patient condition was severe but at no one particular point did the nurse attempt to contact the medical doctor to review the condition. The following morning the patient was diagnosed and found with a myocardial infarction which could not allow for surgery hence the surgery waand the patient died the next morning.

Another incidence reported was ineffective communication where a nurse reported a poor clinical condition of a patient by using the term “going off” which the doctor misinterpreted. The nurse wanted to inform the doctor about the deteriorating condition while the doctor interpreted this as the patient becoming increasingly agitated. The doctor hence ordered inappropriate treatment that was only meant to reduce the patient’s agitation but not the deteriorating condition which was experienced by the patient. The misinterpretation resulted in a delay in administering appropriate treatment, and subsequently, the incidence is termed as “failure to communicate.”

Failure to elevate is an incidence that occurs when a nurse raises a concern about the futility of a recommended surgery by a doctor, but the doctor fails to address the issue and goes ahead with the operation. The nurses are expected to elevate the situation by reporting the case to anyone else with relevant qualification and can advise the doctor. Most nurses feel that they cannot raise their concerns and keep silent resulting in severe outcome experienced by the patient who is taken through a wrong surgical process. Nurses can also fail to challenge the decision by a doctor which poses a threat to the safety of a patient. Nurses sometimes are aware of the length of stay that a patient should have in a hospital, but sometimes doctors make mistakes, and the nurse do not have the confidence to challenge such a decision. Another incident reported in a private hospital in Australia was a situation where an acutely unwell patient is not escorted to the medical imaging department. The clinical nurse was supposed to accompany the patient but was ignorant of her responsibilities and allowed the patient to walk to the department all alone.  During the process of transfer the condition of the patient started deteriorating and since there was no one to respond, the situation remarkably deteriorated, and the patient developed other health complications.  The incidence is termed as “failure to escort.”

Consequences of “Failure to Rescue”

There are associated consequences with incidences when the deteriorating conditions in a patient cannot be altered accordingly by providing relevant treatment. The consequences can impact the patient, the family of the patient and the healthcare system adversely. Patients who have had experiences of “failure to rescue” have always developed severe health complications such as acute cardiac failure and other chronic diseases.  A patient can be admitted into a healthcare system with a slight health complication but due to the mistake that a nurse or a doctor does and fails to respond accordingly, results into the development of more severe health conditions. There are reports of death from patients who are recovering from surgery and are provided with painkillers. The doctor fails to respond until late when the patient condition is severe. The delay results in death due to the inability of the surgery process to be conducted on the patient.  Patients stay for more extended periods in the hospital due to the development of more severe conditions as a result of the failure to alter the deteriorating conditions in the patient is also common among hospitals. Incidences of failure to rescue have impoverished certain patient’s families who spent a lot of money to pay hospital bills since a doctor ordered for unnecessary longer hospital stays than the recommended time. The reputation of a healthcare system is tarnished when inappropriate action is taken to rescue the life of a patient or when the hospital fails to bring an action to alter the patients deteriorating condition. A disconnect is created between a medical doctor and the nursing staff due to lack of relevant communication or response required to alter the risk in a patient. A disconnect results to reduce the performance of the healthcare staff which is associated with low-quality patients’ care.

Potential barriers for nurses “failure to rescue.”

The first potential barrier is the failure to recognize a deteriorating condition in a patient. When a certified clinical nurse is not in a position to obtain the right results on the risk that the patients are undergoing, the nurse is not likely to understand the outcome. Such nurses have always failed to elicit the information to the clinical doctor since they are not aware of the risk that the patient will be exposed to. Treatment is not provided to the patient at the right time, and the patient suffers even more complications.

The second barrier is the lack of proper communication between a nurse and the medical staff. Sometimes nurses use inappropriate language which can be misinterpreted by a doctor. A misinterpretation of a term by a doctor can result in administering the wrong medication for the patient. There are always medical terms that must be used appropriately so that the doctor can understand the condition of a patient and when a nurse is not able to relay the correct information, the patient’s life may be placed in jeopardy.

Overcoming the potential barriers

Appropriate education among clinical nurses to understand the severe outcomes of a clinical condition is required in a healthcare system. The nursing staff should be aware of the deteriorating conditions in a patient and should also be taught how to issues an appropriate response. The hospital setting can enhance proper nurses’ sensitivity through coming up with the right training programs that can inform the nurses on the adequate measures to be taken during an emergency.

Maintaining close contact with the patient through regular examinations to understand a change in the condition of the patient can reduce instances of failure to recognize the severity of a health condition. The nurse becomes sufficiently equipped with the information to provide to the medical doctor in case the patient’s condition deteriorates. Nurses should maintain clear records and indicate the type of response that is required when unexpected change occurs in the patient’s condition.

Nursing strategies to prevent nurses from failing to rescue

Inter-professional practice

Inter-professional Practice (IPP) is a collaborative process which takes place when healthcare providers work comprehensively with other professionals, patients, and family of the patient. When nurses can work collaboratively, they can seek common goals together with the doctors to analyze and address the health challenges that arise.  The nurses will be able to make better use of their knowledge and skills to improve on patients care through increased recognition and response to deteriorating healthcare conditions. Multiple nurses from different backgrounds increase the efficiency of patients care and hence the nurses will respond effectively to emergencies.

Increased funding for research in patient safety

Increasing research in patient safety equips the nurses with adequate knowledge to provide sufficient care to the patients. Through research, nurses can investigate some of the barriers that challenge their skills in rescuing patients. After identifying the gaps, the nurses can determine the best patients care practice which can be used to alter the challenges.

Conclusion

In conclusion, “failure to rescue” is a situation that is experienced when nurses are not able to request for treatment to alter the deteriorating conditions in patients. The nurse experiences that are associated with the “failure to rescue” encompasses failure to recognize, inability to respond, failure to communicate and failure to elevate. The incidences show the experiences that nurses have had while providing care for their patients. When nurses are not able to recognize a complication with their patient, they are not able to examine the level of risk that the patient can be exposed to hence failing to request a review from the medical staff. When a nurse does not call for an emergency response from the doctors, the health condition of the patient might deteriorate and results in death or severe health conditions. Therefore, inter-personal professional practice and increased funding in research is the remedy towards improved efforts of nurses to rescue their patients.

 
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