Failure to Rescue and its Relation to deteriorating Patient Health in Acute Care

Answer

Failure to Rescue and its Relation to deteriorating Patient Health in Acute Care

            Nurses should care for the patients, observe and maintain their health and safety at all times. According to the Nurses’ Code of Ethics, patient safety is a multidimensional aspect grounded in legal and ethical imperatives (Kadivar, Manookian, Asghari, Niknafs, Okazi, & Zarvani, 2017). Therefore, nurses should always be ready to safeguard their patient’s safety, especially when dealing with those in acute care environments, to meet their ethical obligations and avoid potential litigation associated with negligence cases. Failure to rescue is one of the concerns that affect patient safety in acute care settings. This paper provides an evaluation of failure to rescue and its relationship to the patient’s declining health within critical care environments.  To achieve this, the paper will define "failure to rescue," discuss the incidence and prevalence rates of adverse events associated with the failure to rescue within the Australian acute care context, and further analyze and evaluate the consequences. Moreover, two nursing strategies focused on preventing nurses from failing to rescue will be addressed in the discussion.

Failure to Rescue Definition

            According to Hall, Lim, and Gale (2020), failure to rescue (FTR) refers to the delay or failure in responding to a hospitalized patient who is experiencing complications from a medical intervention or disease process. FTR is also considered an effective metric for measuring healthcare quality and patient safety (Hall, Lim, & Gale, 2020).  FTR can also be defined as a mortality factor following a process of complications exhibited by a patient. Hall, Lim, and Gale (2020) state that variations exist from one institution to another on the term's primary definition, and no universally agreed-upon description exists for FTR.

Incidence and Prevalence of Adverse Events within an Australian Context

            Adverse events experienced during patient hospitalization and complications after surgery are considered a common occurrence within the healthcare environment. In Australia, approximately 15 to 20% of patients face at least one difficulty after undergoing a surgical procedure (Hall, Lim, & Gale, 2020). Out of this figure, 5% to 7% of the patients died before they were discharged from the acute care environment. Hall, Lim, and Gale (2020) suggest that effective treatment and timely recognition of any ensuing complications can effectively prevent the death of the patient.

            The FTR rates vary across hospitals and patients with varying characteristics, such as age and pre-existing health conditions. Older patients and those with higher pre-operative comorbidities are associated with an increased risk of complications and death after a surgical procedure. Falls and medication errors are considered some of the adverse events, which are also the leading causes of death within acute care settings.

            The instances of patient fall in critical care settings in Australia are also on the rise. Mousa (2017) reports that in 2010, up to 3 million Australians are over the age of 65, which makes up approximately 14% of the region’s population. Older people have a ten times greater likelihood of being admitted to a critical care environment and a further eight times greater chance of dying from a fall than children or younger, healthier people (Mousa, 2017). FTR is one of the critical causes of patient falls in essential Australian environments of care. The limited nurse-to-patient ratios in these facilities make it difficult for them to respond to complications on time, thus increasing the instances of fatality or the development of severe disability.

            According to Peacock et al. (2021), approximately 30,000 patients undergo an emergency laparotomy procedure annually in Australia. Out of these, 20% are carried out for bowel perforation (Peacock et al., 2021). Postoperative experiences following the laparotomy include a 33% mortality rate due to the development of complications. The incidence rates of complications after surgical procedures have been estimated at 24.3% for a period of three years (2013-2016) in hospitals in England and Wales (Peacock et al., 2021). This included 857 deaths out of 3533 patients after complications developed. This value was higher in comparison to the number of deaths of patients within critical care settings who did not record any difficulties, which was estimated at 6% (Peacock et al., 2021). These statistics show that the incidence of FTR in Australia is significantly higher than in other areas such as the UK, which calls for appropriate interventions.

Consequences of Failure to Rescue

For the Patient

            Failure to rescue is associated with several drastic consequences for the patient.  For instance, failure to rescue increases the risk for mortality associated with surgery complications for the patient. According to the study carried out by Kuo, Kaufman, Hoffman, Pascual, Martin, Kelz and Holena (2017), the general hospital mortality rate after a surgical process is directly related to the failure to rescue. Even though FTR can also result in patient complication rates, the correlation between the two factors is weak. A study supports the finding carried out in 2009 (Kuo et al., 2017). This research demonstrated that hospitals, which recorded the lowest overall mortality rates, shared virtually similar rates of major complications among their patients. However, the low mortality rates and the lower number of deaths were because they could effectively "rescue" patients in the event of a complication. Notably, the study reported that the failure-to-rescue rates at low mortality hospitals were estimated at 12.5% compared to 21.4% recorded at the high mortality care institutions (Kuo et al., 2017). This study's findings provide a framework for recognizing and managing major complications in time and have clear implications for strategies focused on reducing surgical mortality rates.

            Increased harm to patients is another challenge associated with failure to rescue. The concept of resilience provides us with insight into the team's ability to recognize changes in the patient's condition quickly and act on them effectively so that the patient’s health is significantly benefitted. When conceptually analyzed through the lens of resilience, failure to rescue can be experienced in any situation where the clinical team members find it challenging to mitigate any preventable harm faced by the patients (Kuo et al., 2017). The failure to identify any complication developed by a patient in an acute care setting poses a risk to the patient’s health because it exposes them to an environment where they can quickly develop fatal or severe complications such as developing a permanent disability.

For the Patient’s Family

            Post-traumatic stress, economic hardship, anger, guilt, and depression can all be experienced by the patient's family due to FTR. FTR can result in a patient’s death or the development of a permanent disability in situations that could have been easily avoided. The knowledge that the timely intervention of health professionals could have prevented the trauma can psychologically affect the patient's family, resulting in emotional trauma, possibly even anger, resentment, guilt, or PTSD. In addition, FTR can cause the patient’s family to lose trust in hospitals and lose faith in their services. They may also become depressed due to the extra financial hardship incurred in caring for a patient whose condition has worsened or developed a permanent disability due to an avoidable complication (Southwick et al., 2016).

Impact on the Health Care System

            FTR also results in negative impacts on the health care system. In cases where the FTR results in drastic patient outcomes, the families and individuals affected will lose trust in the care providers and the care system itself. The patients and their families may come to believe that if only the necessary system changes had been implemented in the care setting, the chances would have been higher that the adverse events could have been prevented, and a positive patient outcome would have resulted (Southwick et al., 2016).

Nursing Interventions

Careful and Accurate Monitoring

            Careful and accurate monitoring is considered a desirable nursing intervention, which can be implemented to address the failure to rescue in the nursing profession. This strategy involves the patient because it requires nurses to effectively monitor their patients in acute care environments (Massey et al., 2016). Careful and accurate monitoring enhances the nurses’ surveillance capacity, making it easier for them to promptly recognize any changes in the patients’ state and swiftly respond to their deteriorating health (Massey et al., 2016). Significantly, failure to rescue in a caring environment has mostly been a result of the nurses’ failure to recognize and respond to their patients’ deteriorating health in a critical care setting, leading to the development of serious complications or even death in the worst-case scenarios (Massey, Chaboyer & Anderson, 2016).

            Careful and accurate monitoring of the patients will entail having the nurses present in the critical care environments record and document the patients' vital signs more closely. This places them in an ideal position to easily recognize and quickly respond to any obvious changes in their patients. Through this intervention, the nurses will also be able to effectively engage in proper physical assessment processes and ensure that the patients’ care needs are correctly addressed.

Conducting Patient Education

            Conducting patient education is desirable to ensure that the challenge of failure to rescue is addressed in critical care environments. Under this intervention, the nurses will be directly responsible for educating the patients about any early warning signs that may suggest they are at risk of complications. Subsequently, the nurses will also inform the patients about the best course of action to ensure that the risk is communicated to the nurses to prevent potential challenges through a timely response (Gröndahl et al., 2019).  Even though a lengthy education may not be possible due to lack of time or competing priorities, the nurses still have a duty to ensure that they use effective communication to understand the information.  This will effectively reduce instances of failure to rescue, as the nurses concerned will be informed on time about any potential cases of deteriorating patient health. Myhill et al. (2017) note that patients with a clear understanding of the care instructions to be implemented after a surgical procedure are less likely to face fatal complications. Using a multifaceted program such as the Re-Engineered Hospital Discharge program, trained registered nurses can assist patients in identifying alarming signs, understand their diagnosis and medication routine, and reinforce a plan for seeking a timely response. All of these measures can be effective in preventing instances of failure to rescue. Leafman and Mathieson (2018) suggest that patient education increases the chances that admitted individuals within an acute care setting would remain healthy even after their hospitalization.

Conclusion

Failure to rescue is a leading factor in the deterioration of a patient's health in an acute care environment, resulting in permanent disability or even death. Failure to rescue is a situation whereby care professionals fail to respond in time to changes or deterioration in a patient’s health, thus creating an environment whereby patients develop more severe or even fatal complications. Therefore, FTR is considered a safety metric that can be employed to gauge patients' safety. The incidence and prevalence of FTR rates in Australian critical care settings are on the rise, suggesting the need to use effective interventions. Patient education and careful and accurate monitoring strategies are considered effective and necessary interventions that registered nurses can implement to overcome FTR.