NHS KNOWLEDGE AND SKILLS FRAMEWORK

NHS Knowledge and Skills Framework





NHS Knowledge and Skills Framework

Introduction

Despite increasing emphasis on quality assurance frameworks, clinical governance and evidenced based health care, the incidence of adverse events (AE) in the acute care sector is increasing both nationally and internationally. In addition an adverse event has been defined as“(Nolan, 2004, 3-9)an unintended injury that results in temporary or permanent disability, including increased length of stay, which is caused by health care management rather than the disease process” (Wilson et al., 1995, p. 461).

Adverse events are a national and international concern. The frequency of in hospital adverse events is 16.6% in Australia,4 10.8% in the United Kingdom,3 7.5% in Canada5 and is 2.9-3.7% in the USA (Justham, 2001, 5-6).

Friedman and Phillips evidence suggests that adverse events within the acute care patient cohort are related to suboptimal care (Friedman and Phillips, 2004, 361-376). Suboptimal care implies a lack of knowledge regarding the significance of clinical findings relating to dysfunction of airway, breathing and circulation2 or problems related to system failures that inhibits care delivery. An exploration of factors that may contribute to, and influence suboptimal ward care in the acute care setting is therefore timely and important for a number of reasons. Acutely ill ward patients commonly experience unplanned admission to Intensive Care Units (ICU) which is associated with increased morbidity and mortality and prolonged hospital stays (Watson, 2002, 426-480). and Patients may be discharged from ICU prematurely to facilitate the unplanned admission of acutely ill ward patients. Untimely discharge also, is associated with increased morbidity and mortality (Friedman and Phillips, 2004, 361-376).

There is clearly a need for an exploration to elucidate the factors that contribute to suboptimal ward care of the acutely ill ward patient. This literature review critically analyses and syntheses published research focusing on the factors influencing suboptimal ward care in the acute care setting. Thus it aims to develop and enhance critical care practitioners' knowledge and understanding of this topic and therefore improve patient care outcomes.

Methodology

Databases that were searched for relevant studies included MEDLINE, CINAHL, EMBASE databases and Cochrane databases In an attempt to demonstrate a transparent decision making process an explicit inclusion and exclusion criteria was developed. Literature was included if it was published from 1995-2007 to 2007. This span of 10 years was chosen to provide the most current articles relevant to the subject. Also, it was acknowledged that the concept of suboptimal care of the acutely ill ward patient appeared to emerge from literature published in the late 1990s.

Search terms that were used includedsuboptimal ward care, critically ill ward patients, acutely ill wards patients and adverse events Literature was excluded if it was not written in English, if it concentrated more on strategies aimed at identifying acutely ill patients for example early warning scores. Following a search of the databases 110 papers were identified for potential inclusion. These papers were critically evaluated using a recommended framework described by Polit and Beck. The use of a theoretical framework for critically ...