Recognising and Responding to the Deteriorating Patient


Serious adverse events, such as unexpected death, intensive care admission and cardiac arrest, are often preceded by observable physiological, clinical abnormalities and deterioration. Other serious events, such as suicide and aggression, are also often preceded by observed or reported changes in a person’s behaviour or mood that can indicate deterioration in their mental state.

Early identification of deterioration may improve outcomes and decrease interventions required to stabilise patients whose condition deteriorates in a health service organisation.

The warning signs of clinical deterioration are not always identified or responded to appropriately. The organisational and workforce factors that contribute to a failure to recognise and respond to a deteriorating patient are complex and overlapping (Australian Commission on Quality and Safety in Health Care, 2017)


You are required to further explore the trauma case study.

You will be provided with an ISBAR handover and a National Observation Chart (NOC) for Joanna Cleese. (These documents will be attached)

Using the provided information and current academic literature please provide a response to the following three questions


Please answer the following questions as instructed

• Question 1 (750 words)

The condition of your patient Joanna Cleese described in the ISBAR handover, appears to be changing. (Please refer to the attached documentation)

Using the information that you have identified from the NOC and the ISBAR case study handover:

1. Discuss the possible causes of Joanna’s changing condition, supporting your response with contemporary literature and the associated significant cues, signs and symptoms listed in the case study.

2. Explain what possible further deterioration could occur for this patient, with a detailed evidenced -based response.

(Please support your justification and rationales with quality peer-reviewed literature).

• Question 2 (750 words)

There are many tools that can be utilised when assessing a patient. When assessing a deteriorating patient accurate assessment is essential. Compare and contrast the following methods of patient assessment and their appropriate applications for the deteriorating patient.

1. Primary (ABCDE)

2. Head to toe assessment

(Please support your discussion with evidenced based literature).

• Question 3 (500 words)

A change in a patient’s heart rate, blood pressure, temperature and respiratory rate can all be an indication of clinical deterioration. It has been suggested that a changing respiratory rate is the earliest indication of clinical deterioration and yet it is often not measured correctly, or not measured at all. Using evidence-based literature to support your arguments:

1. Discuss why a changing respiratory rate is an important indicator of clinical deterioration.

2. Explain how the respiratory rate can be measured reliably and accurately.

**Discussions are to be supported with relevant and contemporary literature. **References: Reference list and appendices are excluded from the word count. **References to be no older than ten years

**10% word limit allowed.

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