Ástand og vöktun sjúklinga fyrir óvænta innlögn á gjörgæsludeild

Abstract

Aims and objectives. The purpose of this study was to explore and describe the condition and nursing observation of patients prior to emergency admission to intensive care units. The aim of this study was to promote nursing observation and collaboration between general wards and the intensive care units at Landspitali - University Teaching Hospital in Iceland. Methods. The study was retrospective and descriptive. Data was collected from medical records of patients who presented as emergency admissions to the intensive care units at Landspitali University hospital, between October 1st 2006 and December 31st 2006. Results. Data was collected from 132 patients, representing 87% participation of all emergency ICU admissions (152) during the three month period. Almost half (49%) of the admissions came from general wards. Seven patients (5%) were readmitted to the ICU within 48 hours. Respiratory failure was the primary reason for admission, followed by sepsis. Respiratory rate is a good indicator for patients clinical condition prior to their ICU admission, but was at the same time the least documented vital observation in this study. Respiratory rate was documented for nine (14%) patients of 65 patients from general wards prior to ICU admission. The accuracy of the Modified Early Warning Score (MEWS) relies on documentation of physiological parameters, and can be used to assess the need for intervention from the Medical Emergency Team. Lack of patient data from the general wards in this study diminished the effectiveness of this risk assessment tool. Conclusion. There is a need to promote nursing education and awareness regarding the importance of recording vital observations in patients. This particularly applies to documentation of respiratory rate, as this study has shown that respiratory failure is the primary cause of emergency in-patient admission to intensive care. One part in prompting nursing observation is to implement Modified Early Warning Score (MEWS) to regular practice on general wards. Another, is the implementation of a Medical Emergency Team service as a strategy to improve patient care.