Recognising patients at risk of deterioration and dying on general medicine wards: a nurse-led point prevalence study | AJAN - The Australian Journal of Advanced Nursing Home Archives Vol. 40 No. 1 (2023): December 2022 – February 2023 Case Studies Main Article Content

David JT Marco
Thomas Whelan
Tamsin Bryan
Jennifer L Weil

Keywords

Deterioration; dying; general medicine; palliative care; supportive care

Abstract

Objective: To trial the Supportive and Palliative Care Indicators Tool (SPICT) as a nurse-led initiative to describe the supportive and palliative care needs of patients in the acute general medical ward. Patient deaths within the subsequent 12 months were identified. Background: National standards specify recognition of patients at risk of deterioration and dying as essential to ensure high quality and safe end-of-life care. However, the timely recognition of these patients in acute medical wards is often complex and inherently uncertain. Method: A point prevalence study assessed the supportive and palliative care needs of patients admitted to the general medical wards of a major public tertiary hospital in a single day. A nurse-led team used the SPICT and the Surprise Question to assess patients. Patient deaths were identified one year following assessment. Results: Most admitted patients (n = 40, 93%) exhibited at least one advanced disease and two indicators of general deterioration on assessment. Of these patients, 40% died within one year. Only one patient was referred to the hospital-based palliative care service at the time of assessment. Conclusion: The SPICT identified a high prevalence of supportive and palliative care needs among general medicine inpatients. The use of the SPICT as a nurse-led initiative provides an opportunity to identify patients at risk of deteriorating and dying while also recognising areas of unmet need. Implications for research, policy, and practice: The SPICT can be effectively administered by nursing teams to assist with the identification of patients who may be at risk of deteriorating and dying so that appropriate end-of-life care decisions can be considered. Further work is needed to develop supportive measures to assist home teams in the identification and response to patients at risk of deterioration and dying in acute hospitals.

What is already known about the topic?

Accreditation standards specify that hospitals are required to promptly recognise patients at high risk of deteriorating or dying within 12 months.
The timely recognition of these patients is often complex and inherently uncertain in the acute medical setting.
The Supportive and Palliative Care Indicators Tool (SPICT) can help multidisciplinary teams identify patients who may be at risk of deteriorating and dying in all care settings.

What this paper adds

This snapshot study revealed >90% of patients admitted to our general medical wards presented with advanced disease and indicators of deterioration. Forty percent of these patients died within 12 months following their admission.
The SPICT can be effectively administered by nursing teams to assist in the recognition of these vulnerable patients so that appropriate end-of-life care decisions can be considered.
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How to Cite

1.

Marco DJ, Whelan T, Bryan T, Weil JL. Recognising patients at risk of deterioration and dying on general medicine wards: a nurse-led point prevalence study. Aust J Adv Nurs [Internet]. 2023 Mar. 1 [cited 2023 Mar. 1];40(1). Available from: https://www.ajan.com.au/index.php/AJAN/article/view/960

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