Recognition of deterioration: activities handout
Activity 1
Either watch the Recognition of Deterioration section of the Milestones film or read the case study George below and discuss:
1. Based on what you saw and what you heard, were there any signs that the patient was deteriorating or dying?
2. What did they do and what didn’t they do?
3. What do you think got the attention of other colleagues? What specific action or information was helpful?
4. What are the management options?
5. Do the members of the multi-professional team agree?
6. Who else needs to be consulted (e.g. reversible cause?)
7. Why is it important to agree?
8. Could this person be in the last hours or days of life?
9. Could this person benefit from palliative care?
10. Can you recall a recent situation when a patient was dying?
Recognition of deterioration: activities handout
Activity 1: Alternative case example – George
George Matthews was admitted to the hospital 2 weeks ago from a nursing home for the Elderly Mentally Infirm having had a fractured right neck of femur which was pinned the day after admission and a week ago he was transferred to your unit for rehabilitation. He has not done well, only standing up once a day when the physios get him out of bed and spending most of his time dozing in bed, eating very little and only drinking when prompted by staff or his wife.
Three days ago, he became chesty and has deteriorated despite having had iv co-amoxiclav and clarithromycin for three days. He is now semi-conscious, febrile and restless but not appearing very breathless, unable to take fluids safely.
His current medication:
· Bendrofluazide 2.5mg od orally
· Ramipril 5mg od orally
· Codeine phosphate 15mg 1 or 2 orally qds prn
He has a legal advanced decision to refuse treatment from a couple of years ago when his dementing illness started, stipulating DNAR and no artificial feeding.
1. Were there any signs that the patient was deteriorating or dying?
2. What did they do and what didn’t they do?
3. What do you think got the attention of other colleagues? What specific action or information was helpful?
4. What are the management options?
5. Do the members of the multi-professional team agree? Why is it important to agree?
6. Who else needs to be consulted (e.g. reversible cause?)
7. Could this person be in the last hours or days of life?
8. Could this person benefit from palliative care?
9. Can you recall a recent situation when a patient was dying?