Patient Deterioration in the Healthcare Setting

Early recognition and prevention of patient deterioration is an important component of the healthcare system. The use of medical emergency teams (METs), also known as rapid response teams (RRTs), is recommended by the Australian Resuscitation Council to respond to instances of acute patient deterioration.

A small number of studies have demonstrated the benefits of pharmacist involvement in both MET and Code Blue teams. With up to a quarter of MET calls potentially caused by medicines, there is an obvious role for pharmacists as the majority of these could be potentially preventable.

Medicines affecting the cardiovascular system contributed to 60% of the total medication errors. Tachycardia due to omission of beta blockers, and hypotension due to cumulative toxicity or inappropriate use of antihypertensive during acute illness were the most common causes of potentially preventable medication-related MET calls.

A study conducted in the United States which reviewed surgical RRTs identified that 88% of calls were for impending respiratory failure due to excessive fluid administration in surgical patients.

Pharmacists can provide support by reviewing patients when they deteriorate and assist in identifying potential medicine causes. They can play an essential role by providing clinical advice on medication dosing, administration, and IV compatibility, and ensuring the MET team has the necessary medicines when they are required.

There are currently no standard recommendations for which medicines should be available for MET, and practice varies widely between hospitals. Principles to facilitate safe, timely and effective access to, selection of, and administration of medicines have been proposed. These include:

• MET medicine management should be multidisciplinary, involving ward staff and MET nurses, doctors and pharmacists.
• Medicines should be available to the MET to manage the common causes of MET activation, but not duplicate other resources.
• Changes to medicine supplies should be based on the best available evidence, including feedback from ward and MET clinicians, data from local MET calls, interventions, and activation triggers, in addition to published literature and guidelines.

Frequent causes of patient deterioration and MET activation include pulmonary oedema, sepsis, arrhythmias and seizures.

Basic life support (BLS) steps include early detection and timely intervention of patient deterioration to stop progress to cardiac arrest. All hospital staff should be able to recognise cardiac arrest, call for help, start cardiopulmonary resuscitation and defibrillate using an automated defibrillator. The purpose of BLS is to maintain myocardial and cerebral oxygenation until advanced life support (ALS) personnel and equipment are available.