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Module Title:Practice Learning Experience 1
Module Code:NURS08034
Cohort:September 2011
Assignment Title:Reflective Account
Assignment Date: 12/07/2013
Word Count:1,656

Introduction
This essay will demonstrate the aim of the Scottish Patient Safety Programme (SPSP, 2008) in relation to early intervention in a deteriorating patient, through reflective practice. Using Gibb’s (1988) reflective model the writer will analyse and appraise a personal experience on placement whilst demonstrating the skills and knowledge based theory (Jasper, M., 2013), in accordance with SPSPs’ guidelines; monitoring of Early Warning Scoring (EWS) system and the use of the SBAR (Situation-Background-Assessment-Recommendations) tool and safety briefings in relation to patient safety. The six step account consists of: a description of events, how I felt, evaluation, analysis, conclusion and action plan for future practice. Due to the (Data Protection, 1998) Act, the patient will be referred to as Mr Smith.

Description
Whilst monitoring patients on an acute medical ward using the EWS system, on a busy Friday morning, I came across Mr Smith who was complaining of abdominal pain. I noticed his skin colour was extremely pale and he was agitated. I proceeded to check his vital signs. His Blood pressure (Bp) determined he was hypotensive (low blood pressure) 79/49 and he was tachycardic (increased heart rate) 123 beats per minute (Bpm). His temperature, respiratory rate and oxygen saturations were within normal range. I documented his vital signs and on checking the EWS score (4), this triggered me to alert the nurse in charge and medics on the ward, in accordance with SPSPs driver diagram on what action should follow.

Feelings
I felt relieved to have had the observational skills and knowledge which gave me an understanding that Mr Smith was deteriorating. Having guidance and protocols such as EWS driver diagram gave me the confidence and support required to take the relevant action. Mr Smith was examined by medical staff within ten minutes of me alerting them and appropriate action taken. At this point it was realised by a clinician who checked his medical notes, that Mr Smith had had a previous incidence of a gastrointestinal (GI) Haemorrhage (bleed) but this information had not been passed on during the handover report which I felt was vital in this case and could have been detrimental to his outcome.

Evaluation/Analysis
GI haemorrhages account for 7% of deaths in Scotland (SIGN, 2008). SPSP together with HIS developed a toolkit; The Hospital Standardised Mortality Rate (HSMR) to link the study of mortality rates and healthcare improvement in Scotland; the aim being to reduce mortality rates and adverse harm, including near misses to patients in acute wards, (HIS, 2011).

Strategies such as SBAR and EWS are promoted by SPSP and Health Improvement Scotland (HIS) to identify any potential risks to patients and allow for early intervention. Communication between staff regarding patient’s condition including relevant past medical history is important if patients are to receive specific care and treatment required. The SBAR tool was adopted from the US Navy and the aviation industry by Dr M Leonard (2000). It was adapted for the healthcare setting, to allow all practitioners to communicate concerns and risk to patients’. (NHS, Institute for Innovation and Improvement, 2013). EWS was developed to measure patient’s physiological level of illness and identify clinical deterioration using a scoring system. This is calculated by totalling abnormalities of vital signs which are below or above normal parameters. Scoring, triggers nurses to take appropriate action and referrals to clinicians, (Odell. M., 2010). However it has been suggested there is scope for error using EWS if scoring is not carried out properly and factors such as knowing the patient and pattern;...
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