Rising Accuity Levels and an Aging Patient Population Require New Patient Management Strategies on General Care Floors

The demands for improved patient safety on general care floors are increasing, leaving clinicians with patient care challenges that are requiring a re-examination of the way in which care is delivered. Specific challenges include:

• Increased risk of sentinel events resulting from aggressive post-operative pain management, patients with Obstructive Sleep Apnea (OSA), and increased co-morbidity at admission
  
  
• Decrease in nurse-to-patient ratios and larger proportions of higher acuity patients on general care floors are requiring new ways to distribute point-of-care alarms to qualified clinicians
  
  
• Care providers with varying skill sets require patient monitoring and clinician notification systems that are elegantly simple and easy to use

Standard Bodies Are Driving a New Standard of Care

• The continuous monitoring of patient oxygen levels with pulse oximetry...
  
  
• With clinically meaningful alarms sent to appropriate caregivers...
  
  
• Leading to improved patient safety and significant reduction of unobserved sentinel events..
  
  
  

  
  

  2008 Patient Safety Goals
  

• Improve recognition and response to changes in a patient's condition
  






Practice Guidelines for the perioperative management of patients at risk for obstructive sleep apnea (OSA). Post-op patient monitoring as follows:



• Continuous pulse oximetry after discharge from recovery
  
  
• Continuous monitoring in critical-care, step-down, telemetry or hospital ward, or by dedicated trained observer in the room
  
  
• Intermittent pulse oximetry or continous bedside oximetry without adequate nursing observation does NOT provide the same level of safety
  
  
  
  
  

  Safety During Patient-Controlled Analgesia
  
  

• Goal: No patient shall be harmed by opioid-induced ventilatory depression in the postoperative period
  
  
• APSF urges healthcare professionals to give consideration to the potential safety value of continuous monitoring of oxygenation (pulse oximetry) and ventilation in patients receiving PCA or neuraxial opioids in the postoperative period
  
  
• APSF also believes it is critical that any monitoring system be linked to a reliable process to summon a competent healthcare professional to the patient's bedside in a timely manner
  
  
  
  
  

  Establish Rapid Response Teams to bring critical care expertise to the patient bedside (or wherever it is needed). Large Variability in quality of care and the safety of patients in health care today, three main systemic issues contribute to the problem:
  
  

• Failure to plan (includes assessments, treatments, goals)
  
  
• Failure to communicate (patient to staff, staff to staff, staff to physician, etc.)
  
  
• Failure to recognize deteriorating patient condition