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Acutely Ill Patients in Hospital

Recognition of and Response to Acute Illness in Adults in Hospital

NICE Clinical Guidelines, No. 50

Centre for Clinical Practice at NICE (UK).

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Patients who are admitted to hospital believe that they are entering a place of safety, where they, and their families and carers, have a right to believe that they will receive the best possible care. They feel confident that, should their condition deteriorate, they are in the best place for prompt and effective treatment.

Yet there is evidence to the contrary. Patients who are, or become, acutely unwell in hospital may receive suboptimal care. This may be because their deterioration is not recognised, or because – despite indications of clinical deterioration – it is not appreciated, or not acted upon sufficiently rapidly. Communication and documentation are often poor, experience might be lacking and provision of critical care expertise, including admission to critical care areas, delayed.

We have endeavoured to produce practical guidance with recommendations for the measurement and recording of a set of physiological observations, linked to a ‘track and trigger’ system (see section 2.1.1). We have emphasised the importance of a full clinical assessment, and of tailoring the written monitoring and management plans to the individual patient’s clinical circumstances. Throughout the document we have emphasised the importance of training; by ensuring that routine measurements are accurately taken and recorded by staff that understand their clinical relevance, and by linking these observations to a graded track and trigger system, care can be escalated appropriately. The foundations for patient safety are laid through doing and recording simple measurements well and having agreed response strategies in place.

NICE clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the NHS in England and Wales

This guidance represents the view of the Institute, which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. The guidance does not, however, override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer and informed by the summary of product characteristics of any drugs they are considering.

Copyright © 2007, National Institute for Health and Clinical Excellence.

All rights reserved. This material may be freely reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the express written permission of the Institute.

PMID: 21204323

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