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How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients

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  • Duncan Smith
  • Mandeep Sekhon
  • Jill J. Francis
  • Leanne M. Aitken

Abstract

Background To optimise care of deteriorating patients, healthcare organisations have implemented rapid response systems including an “afferent” and “efferent” limb. Afferent limb behaviours include monitoring vital signs and escalating care. To strengthen afferent limb behaviour and reduce adverse patient outcomes, the National Early Warning Score was implemented in the UK. There are no published reports of how National Early Warning Score guidance has translated into trust‐level deteriorating patient policy and whether these documents provide clear, actionable statements guiding staff. Aim To identify how deteriorating patient policy documents provide “actionable” behavioural instruction for staff, responsible for actioning the afferent limb of the rapid response system. Design A structured content analysis of a national guideline and local policies using a behaviour specification framework. Methods Local deteriorating patient policies were obtained. Statements of behaviour were extracted from policies; coded using a behaviour specification framework: Target, Action, Context, Timing and Actor and scored for specificity (1 = present, nonspecific; 2 = present, specific). Frequencies and proportions of statements containing elements of the Target, Action, Context, Timing and Actor framework were summarised descriptively. Reporting was guided by the COREQ checklist. Results There were more statements related to monitoring than escalation behaviour (65% vs 35%). Despite high levels of clear specification of the action (94%) and the target of the behaviour (74%), context, timing and actor were poorly specified (37%, 37% and 33%). Conclusion Delay in escalating deteriorating patients is associated with adverse outcomes. Some delay could be addressed by writing local protocols with greater behavioural specificity, to facilitate actionability. Relevance to clinical practice Numerous clinical staff are required for an effective response to patient deterioration. To mitigate role confusion, local policy writers should provide clear specification of the actor. As the behaviours are time‐sensitive, clear specification of the time frame may increase actionability of policy statements for clinical staff.

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  • Duncan Smith & Mandeep Sekhon & Jill J. Francis & Leanne M. Aitken, 2019. "How actionable are staff behaviours specified in policy documents? A document analysis of protocols for managing deteriorating patients," Journal of Clinical Nursing, John Wiley & Sons, vol. 28(21-22), pages 4139-4149, November.
  • Handle: RePEc:wly:jocnur:v:28:y:2019:i:21-22:p:4139-4149
    DOI: 10.1111/jocn.15005
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    References listed on IDEAS

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    1. Mackintosh, Nicola & Sandall, Jane, 2010. "Overcoming gendered and professional hierarchies in order to facilitate escalation of care in emergency situations: The role of standardised communication protocols," Social Science & Medicine, Elsevier, vol. 71(9), pages 1683-1686, November.
    2. Caroline McGraw & Vari M Drennan, 2015. "Evaluation of the suitability of root cause analysis frameworks for the investigation of community‐acquired pressure ulcers: a systematic review and documentary analysis," Journal of Clinical Nursing, John Wiley & Sons, vol. 24(3-4), pages 536-545, February.
    3. Duncan J Smith & Leanne M Aitken, 2016. "Use of a single parameter track and trigger chart and the perceived barriers and facilitators to escalation of a deteriorating ward patient: a mixed methods study," Journal of Clinical Nursing, John Wiley & Sons, vol. 25(1-2), pages 175-185, January.
    4. Mackintosh, Nicola & Humphrey, Charlotte & Sandall, Jane, 2014. "The habitus of ‘rescue’ and its significance for implementation of rapid response systems in acute health care," Social Science & Medicine, Elsevier, vol. 120(C), pages 233-242.
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