First Respond to Unresponsive Patients

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General Definition of Statement

Above all else, the greatest responsibility of a doctor or nurse is to save the life of his or her patient. As a consequence, it is imperative for hospitals and clinics to do everything within their powers to ensure that health care experts perform their duties to a high degree of excellence. Strict rules and regulations should be put in place to guide the work done by health care professionals. While the hospital management is tasked with making sure that health care providers act responsibly, it is equally important for doctors and nurses to be men and women of integrity. To avoid confusion, it is advisable for hospitals and clinics to have standard guidelines to direct rescuers.

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The first guidelines for basic life support (BLS) were developed in 1966 by the American Heart Association (AHA). The original guidelines have over the years undergone several updates. According to Field et al. (2010), BLS presents the starting point for saving a patient’s life. Generally, BLS involves instant recognition of cardiac arrest and subsequent activation of the emergency response process. To effectively deal with cardiopulmonary resuscitation (CPR) and Emergency Cardiovascular Care (ECC), the American Heart Association recommends some best practice guidelines (Field et al., 2010). To start with, rescuers must identify cardiac arrest at the earliest opportunity possible. Typically, this is done by checking a patient’s breathing system and whether he or she is responsive. The rescuers should then examine the patients for any compressions which should be minimized. Finally, rescuers are advised to minimize pulse checks which can be very difficult to notice at this point.

Introduction

Responding to unresponsive patients often poses serious challenges for health care experts. In order to realize the most favorable outcome, it is imperative to have a well designed intervention strategy. Although different clinical settings may require different approaches, having a carefully designed strategy for intervention provides a good starting point. Generally, the underlying principles are the same for different settings.

For most medical institutions, a standard procedure is put in place to guide health care professionals on what to do when dealing with unresponsive patients. According to Goede et al. (2014), the absence of a step by step sequence to deal with patients suffering from acute conditions is responsible for many deaths. Having a properly designed strategy is thus very critical for great results to be realized. It is essential to document activities undertaken at every stage of the intervention in order to ensure that a reference point exists in the event that something goes wrong at a particular stage. Arguably, lack of relevant information on the severity of a patient’s condition leaves health care experts with no baseline point to refer to. The ability of healthcare experts to understand the nature of a patient’s condition is very important and can help to restore the state of an unresponsive patient. It makes it possible for nurses and doctors to access the correct information and provide the right treatment.

Generally, having proper guidelines to be followed when handling patients with severe medical conditions ensures that a comprehensive approach is taken to treat patients and that optimal results are obtained (Handelsman et al., 2011). Such a guideline helps doctors and nurses to move beyond a simple focus during the treatment process. To realize the best outcome therefore, it is imperative to focus on having a comprehensive care and practical intervention strategy in an elaborate and easy to understand format (Handelsman et al., 2011). Ostensibly, it is equally important to have comprehensive treatment goals for patients who are not responsive. Without a doubt, such goals make it possible for the response team to work effectively besides knowing whether or not they are doing the right thing.

In their study, El-Orbany and Connolly (2010) talked about rapid sequence induction and intubation (RSII). In general, RSII is designed to simplify the process of attending to patients with severe conditions. The key objective of the RSII technique is to lessen the total amount of time between loss of protective airway reflexes and tracheal intubation with a cuffed endotracheal tube (El-Orbany & Connolly, 2010). Considering that the airway is usually unprotected during this period, it is regarded as the most vital stage where complications can easily occur. The components of RSII include the administration of oxygen and avoidance of positive pressure ventilation before tracheal intubation with a cuffed endotracheal tube. Although RSII has been widely adopted and recommended for use is in different places as a useful strategy of administering anesthesia to patients, there is confusion on how best this should be carried out. Apparently, the approach taken differs from one hospital to another.

Evidently, lack of baseline data is an obvious indication of a poor intervention strategy which can subject patients to serious consequences. It is advisable for doctors and nurses to rely on a well designed plan in order to realize set goals. Among other things, this paper looks at the most effective sequence to first respond to unresponsive patients for optimal patient outcomes.

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Responding to Unresponsive Patients for Optimal Patient Outcomes

This section looks at what is known as well as what is not known as far as responding to unresponsive patients is concerned. In general, unless a patient is completely unresponsive, it is always advisable to make use of an induction drug to eliminate a patient’s awareness (El-Orbany & Connolly, 2010). This initial step is very critical in ensuring that the patient feels less pain for the entire period of treatment. Arguably, the induction drug used should have a very fast effect on a patient so as to realize a rapid loss of consciousness before embarking on a clinical procedure. In addition, the induction drug should help in the achievement of other subsidiary goals. It is, however, important to note that rapid administration of the induction drug may have some negative effects on the patient. For this reason, it is prudent for members of a response team to cautiously handle the induction procedure. To a large extent, it is the patient’s condition that dictates the choice of induction medicine to be used.

Drawing from a study by Birnbaum (2014), it is advisable for physicians to take an oath and commit themselves to doing what is right when responding to unresponsive patients. For better results to be realized, however, it is imperative for all employees to demonstrate a similar level of commitment when called upon to be part of a team dealing with unresponsive cases. In addition, licensing and regulatory concerns must be fully addressed. Where licenses have expired, it is important to have them renewed at the right time. Individual medical practitioners must also be required to renew any important credentials in order to permit them to offer their services. To be on the safe side, medical institutions must request for employment references from individuals seeking to be employed and any cases of patient safety violations must be dealt with accordingly. Medical institutions should also make every effort to prevent, detect, and respond to cases of drug diversion. Stakeholders must see to it that all drugs are used for the right purpose. As pointed out by Birnbaum (2014), all health care experts must be licensed by relevant institutions in order to guarantee the safety of patients. Arguably, failure to do so can subject patients to serious problems. In general, lack of seriousness as far as licensing is concerned creates gaps in the health care sector that can easily put the life of patients at risk.

According to Phipps (2013), the ability of health care professionals to demonstrate acts of kindness and compassion toward patients are important factors that are mainly used by patients to gauge the quality of care provided by health care experts. For this reason, health care experts must focus on delivering beyond their technical expertise. While it is important to be technically equipped, taking care of a patient goes beyond technical expertise. Consequently, health care experts should be fully equipped with people management skills. Health care experts should also be exposed to emergency medical training in order to equip them with what is needed when taking care of patients during emergencies. However, medical institutions must ensure that health care professionals who are good at handling emergencies get an opportunity to empower their colleagues. Having inexperienced medical practitioners to work alongside experienced medical practitioners makes it possible for medical institutions to increase their ability to deal with emergency situations. As further alleged by Phipps (2013), it is essential to have a standardized training to be used when preparing health care experts to respond to emergencies situations. Another critical suggestion is to ensure that reliable audits are carried out in all hospitals to check the quality of services offered. Generally, audits are meant to detect any anomalies or inconsistencies encountered when dealing with unresponsive patients. Such audits must be taken seriously and experienced individuals should be hired to conduct the audits. Furthermore, audits should be carried out by an independent team in order to produce reliable results and eliminate any possibilities of covering up mistakes or omissions during service delivery. Despite the fact that most doctors understand the importance of auditing as a critical requirement in clinical governance, the audits must lead to relevant actions if they are to make a difference in the medical sector.

Modern accident and emergency departments have made attempts to determine different aspects of patient care that lead to the best results regarding patient safety and outcomes (Phipps, 2013). Apparently, some of these have led to the development of clinical and administrative guidelines that govern various aspects of the service from the time a patient can wait to be seen by an appropriate health care expert to the time he or she can wait to be transferred from one unit to another. Unfortunately, some of these guidelines have resulted in more confusion rather than improved service delivery. To some extent, the guidelines were simply used to create an impression that all was going well while practically, no improvement to service delivery for patients could be detected. Instead of focusing on making figures appear appealing to stakeholders and the general public, medical institutions should work toward ensuring that patients receive quality services. As pointed out by Mpogiatzidis (2013), policies that are meant to improve safety and clinical treatment efficiency cannot be achieved without the involvement of clinical managers and other stakeholders at every stage of planning and development. Many authors are in agreement that the involvement of clinical managers is very critical for designing effective emergency response strategies.

Recently, the International Federation for Emergency Medicine held a conference aimed at developing a standard document containing indicators of best practice for ensuring quality and safety when offering emergency services (Ducharme, 2013). Efforts to have a standard document that can be used by all medical practitioners across the world are, however, hindered by the different approaches used by different hospitals. In addition, the evidence available is not credible enough and cannot be used to formulate a standard document that is acceptable to all stakeholders. Ducharme (2013) further claimed that having a properly designed intervention plan for use when attending to unresponsive patients makes it possible for hospitals to cut down on the total cost of service delivery. An elaborate intervention strategy also lessens the amount of time taken by medical practitioners to deal with emergency situations. Apparently, experiences by patients are quite helpful when formulating an intervention strategy (Shale, 2013). Among other things, patient experiences provide first hand information that is necessary for designing strategies that will succeed. Consequently, their experiences should not be neglected.

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As noted by Molyneux and Dube (2013), the overall quality of health care provided by hospitals can be affected by a number of factors including insufficient professional resource, limited funding, poor organization of care, poor governance, and a low level of expectation among patients. There is thus an increased need to monitor service delivery, distribute guidelines for best practices, strengthen audit procedures, and solicit feedback from patients. According to Strobl and Madhok (2012), the involvement of private medical practitioners also presents challenges that must be handled very carefully. Arguably, the services offered by private medical practitioners must be subjected to serious scrutiny.

Conclusion of Literature Review

From the information gathered through literature review, a number of things stand out as far as dealing with unresponsive patients is concerned. While there is a common agreement that health care experts must have an elaborate intervention strategy, variations exist since different countries employ different approaches. Evidently, numerous efforts have been made by various stakeholders to have a standard document that can provide guidelines for all medical practitioners regardless of where they are located. Unfortunately, such efforts have been hindered by various factors. Key among these factors is the lack of relevant evidence that can be used to provide credible information.

A review of literature also points to the fact that the involvement of different stakeholders is very vital if success is to be realized. As has been explained, experience by different patients provide rich information that help to design useful intervention strategies. It is thus imperative to incorporate any feedback that comes from patients. Issues of governance must also be considered. Ostensibly, poor governance is the cause of most failed interventions. It is thus essential to thoroughly monitor all the activities undertaken when attending to unresponsive patients. As pointed out, the interventions must always be subjected to a very thorough audit process to identify any anomalies that may affect outcomes. However, it is important to note that while audits are good and can help to improve interventions by medical practitioners during emergency situations, they must be accompanied by serious follow up activities to ensure effectiveness and better results.

As explained, the quality of service delivery to patients may be hindered by various factors. First, hospitals are affected by the low number of medical professionals available to offer critical services during emergencies. Financial challenges have also interfered with efforts to provide quality services to unresponsive patients. In some places it is poor organization of health care that has hindered effective service delivery to deserving patients. Other critical factors include poor governance and a low level of expectation by patients. As a consequence, it is imperative to provide health care experts with strict guidelines to control their behavior and general approach to patient issues. Besides distributing guidelines that clearly stipulate best practices, service delivery must be monitored strictly. As has been noted, it is important to strengthen audit procedures and to ensure that audit activities help to meet the intended objectives. Considering that the number of private practitioners getting involved with emergency cases has been growing over the years, it is necessary to ensure that their services are strictly monitored. Undoubtedly, monitoring what is done by private practitioners helps to make them accountable for their actions.

Based on the literature reviewed, it is clear that no widely accepted standard for dealing with unresponsive patients exist. Apparently, this is linked to the fact that different countries tend to adopt different strategies when handling medical emergencies. A review of literature also indicates that private health care institutions have largely been isolated by policy formulators. There is therefore need to research and come up with a design that will help to iron out notable differences and provide a standard document that can be used by all medical practitioners. In addition, stakeholders must look for ways of incorporating private health care practitioners. Certainly, improved collaboration will yield better results for all.

Potential Research Question and Performance Improvement

From available literature, it is obvious that stakeholders must do everything possible to establish why different countries apply different standards while attending to unresponsive patients. By answering this important question, it will be possible to understand the source of the problem and to come up with a strategy that can be applied uniformly in all places. As earlier explained, there are a number of things that should be done to improve performance. First, it is essential to involve all managers of health care facilities and to seek their input when designing an intervention strategy. It may also be helpful to involve patients as much as possible. Arguably, the feedback received from patients can be used to take note of important concerns raised by patients and what should be done to makes things better. Improvement can also be realized through strict monitoring of the activities of medical practitioners. Auditing of intervention processes is also very critical in order to determine whether patients are receiving the right quality of health care. To achieve the intended results, any existing gaps should be dealt with efficiently. Research also indicates that equipping health care experts with people management skills is very critical. While being technically ready is important, the absence of people management skills can lead to failure. Seemingly, most patients place so much value on how they are handled by doctors and nurses and may thus pay little attention to a medical practitioner’s level of expertise. Medical institutions should thus make every effort to organize trainings for health care experts on how to manage people.

References

Birnbaum, D. (2014). North American Perspective: First Do No More Harm. Clinical Governance: An International Journal, 17(19), 17 – 20.

Ducharme, J. (2013). North American Perspectives Best Practices in Emergency Medicine: What We Have to Consider if We Wish to Get it Right. Clinical Governance: An International Journal, 18(4), 315 – 324.

El-Orbany, M. & Connolly, L. A. (2010). Rapid Sequence Induction and Intubation: Current Controversy. International Anesthesia Research Society, 110(5), 1318 – 1325.

Field, J. M., Hazinski, M. F., Sayre, M. R., Chameides, L., Schexnayder, S. M., Hemphill, R., Samson, R. A., Kattwinkel, J., Berg, R. A., Bhanji, F., Cave, D. M., Jauch, E. C., Kudenchuk, P. J., Neumar, R. W., Peberdy, M. A., Perlman, J. M., Sinz, E., Travers, A. H., Berg, M. D., Billi, J. E., Eigel, B., Hickey, R. W., Kleinman, M. E., Link, M. S., Morrison, L. J., O’Connor, R. E., Shuster, M., Callaway, C. W., Cucchiara, B., Ferguson, J. D., Rea, T. D. & Hoek, T. L. V. (2010). 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Web.

Goede, V., Cramer, P., Busch, R., Bergmann, M., Stauch, M., Hopfinger, G., Stilgenbauer, S., Dohner, H., Westermann, A., Wendtner, C. M., Eichhorst, B. & Hallek, M. (2014). Interactions between Comorbidity and Treatment of Chronic Lymphocytic Leukemia: Results of German Chronic Lymphocytic Leukemia Study Group Trials. Haematologica, 99(6), 1095 – 1100.

Handelsman, Y., Mechanick, J. I., Blonde, L., Grunberger, G., Bloomgarden, Z. T., Bray, G. A., Dagogo-Jack, S., Davidson, J. A., Daniel, E., Ganda, O., Garber, A. J., Hirsch, I. B., Horton, E. S., Ismail-Beigi, F., Jellinger, P. S., Jones, K. L., Jovanovic, L., Lebovitz, H., Levy, P., Moghissi, E. S., Orzeck, E. A., Vinik, A. I. & Wyne, K. L. (2011). American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Developing a Diabetes Mellitus Comprehensive Care Plan. American Association of Clinical Endocrinologists, 17(2), 1 – 53.

Molyneux, E. M. & Dube, Q. (2013). Promoting Quality Emergency Care in a Resource-Constrained Setting. Clinical Governance: An International Journal 18(4), 300 – 314.

Mpogiatzidis, P. (2013). Prescribing Behavior on a Clinical Department Leadership Level in Public Hospitals. Clinical Governance: An International Journal, 18(4), 332 – 349.

Phipps, F. M. (2013). CGIJ Review. Clinical Governance: An International Journal, 18(4), 350 – 354.

Shale, S. (2013). Patient Experience as an Indicator of Clinical Quality in Emergency Care. Clinical Governance: An International Journal, 18(4), 285 – 292.

Strobl, J. & Madhok, R. (2012). Commissioning for Quality: Experience in an English Primary Care Trust. Clinical Governance: An International Journal, 17(4), 277 –286.

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NursingBird. (2022, April 26). First Respond to Unresponsive Patients. Retrieved from https://nursingbird.com/first-respond-to-unresponsive-patients/

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NursingBird. (2022) 'First Respond to Unresponsive Patients'. 26 April.

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NursingBird. 2022. "First Respond to Unresponsive Patients." April 26, 2022. https://nursingbird.com/first-respond-to-unresponsive-patients/.

1. NursingBird. "First Respond to Unresponsive Patients." April 26, 2022. https://nursingbird.com/first-respond-to-unresponsive-patients/.


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NursingBird. "First Respond to Unresponsive Patients." April 26, 2022. https://nursingbird.com/first-respond-to-unresponsive-patients/.