The Queensland Adult Deterioration Detection System (QADDS) – improving compliance to recognise deteriorating patients in an Emergency Department.

Muireann Wynne1, Joanne Farrell2,

1 Queensland Health, Emergency Department, Logan Hospital, Meadowbrook, QLD, 4131.  muireann.wynne@health.qld.gov.au.
2 Queensland Health, Emergency Department, Logan Hospital, Meadowbrook, QLD, 4131. jo.farrell@health.qld.gov.au.

Abnormalities in physiological observations are known predecessors to adverse patient events such as respiratory and cardiac arrest. Evidence suggests that many of these abnormalities and deteriorations go unreported (Mitchell Scott et al, 2015). Structured processes for recognising and responding to deteriorating emergency department (ED) patients are varied around Australia. The Queensland Adult Deterioration Detection System (QADDS) was implemented at Logan hospital emergency department (LH ED) in 2013, consistent with state wide guidelines. The QADDS tool provides nurses with a framework in which to record observations and with a prescribed escalation process to follow in the event of patient deterioration. In October 2014, the LH ED moved to a new building which led to a threefold increase in nursing staff with a dilution of specialist emergency nursing knowledge and skill mix.

Routine audits of 20 QADDS charts were carried out in LH ED in May 2015.

  • 50% of charts had observations recorded at acceptable frequency.
  • 0% of patients with a numerical score of 4-5 in the first instance had appropriate escalation or an acceptable frequency of observations.
  • 0% of patients with a numerical score of 8 or greater had appropriate escalation or observation frequency recorded.
  • 25% of patients who warranted an emergency response in the last instance had one initiated immediately.

A nursing staff survey was carried out post initial audit results to gain further insight into facilitators and barriers experienced by staff. A qualitative approach was undertaken using a paper based survey tool. A number of barriers experienced by nursing staff when attempting to escalate deteriorating patients were identified.

Further audits in 2016 displayed some improvement in compliance to the QADDS tool.

  • 60% of charts had observations recorded at acceptable frequency.
  • 50% of patients with a numerical score of 4-5 in the first instance were escalated appropriately but 0% of these had an acceptable frequency of observations.
  • 0% of patients with a numerical score of 8 or greater had appropriate escalation or observation frequency recorded.
  • 100% of patients who warranted an emergency response in the last instance had one initiated immediately.

A QADDS quality improvement project was commenced as a priority based on the results. A focus group was formed to address the recommendations of the nursing staff survey. An expression of interest was advertised and self-nominated QADDS champions were formed to be a part of the project. A set of values and role expectations for the QADDS champions were devised using a patient safety model.

The project is ongoing and post project implementation audit results are expected by the end of September 2016.

Reference

Scott, B.M., Considine, J., Botti, M. Unreported clinical deterioration in emergency department patients: A point prevalence study. Australasian Emergency Nursing Journal 2015; 18: 33-41

Biography

Muireann Wynne.
I have worked in emergency nursing for almost my whole career. I started my nursing career in Ireland in and moved to Australia 4 years ago. I have completed a post graduate and masters in emergency nursing. I currently work as a clinical nurse consultant in Logan hospital emergency department and have a background in clinical teaching and education. My area’s of interest are in nursing education and patient safety.

Joanne Farrell.
Jo has worked in many areas in her nursing career, mainly in emergency nursing. She started her career in the UK and has worked in Western Australia for a number of years before moving to Brisbane. Jo has completed her post grad and masters in emergency nursing. She has a background in nursing management and she works as a clinical nurse consultant in Logan hospital emergency department currently. Jo’s area’s of interest are in resuscitation and disaster management.