Photo Credit: © James Thew – Fotolia.com
Failure to Rescue
Failure to rescue is defined as the inability to save a patient’s life when the patient is experiencing a life threatening event. Although it originally began as a general term, it now has focused on nursing care, as nurses are usually the vigilant individual at the bedside monitoring patients; or, as in the case of correctional nursing, the first and a key healthcare staff member to see and evaluate a patient. Failure to rescue often involves a patient who is being cared for/monitored for a non-critical health condition. When they begin to show signs of an impending or worsening condition, the nurse either fails to identify the changes or fails to report the condition to a provider.
The following factors have been found to contribute to rescue failure:
- Staffing Issues: Not enough staff to allow the nurse to focus on monitoring symptoms rather than just the completion of tasks.
- Levels of Licensure: Placing nurses in situations where they are expected to function beyond their scope of practice.
- Levels of Experience: Inexperienced nurses who are refining their skills and clinical judgment may overlook issues and symptoms. Their ability to analyze patterns and symptoms which would lead them to respond appropriately may not be developed. However, experienced nurses must be careful to consider every piece of information and data, as their experience may lead to tunnel vision and mental short-cuts. As in the example above, nurses must always do a thorough assessment of their patients’ complaints, even if it is the tenth time this week they are in medical for the same complaint.
- Task Orientation: Staff who are overly concerned with getting tasks done, rather than evaluating their patient’s condition and providing true patient care, may overlook changes that have occurred. This is often the result of the culture of the healthcare program onsite.
To evaluate the information we obtain from assessing and re-assessing our patients (during monitoring and when following up to assess response to a nursing intervention), nurses use engaged analysis and trending of that information. If the nurse fails to review all the data presented, or only considers the information obtained at that one encounter, then there is a good chance that the analysis will be flawed, and a patient’s worsening condition will go unaddressed until he/she is critical; and the nurse has failed to rescue the patient.
Another issue leading to failure to rescue is the communication system among care givers, including the nurse/provider relationship. We discussed communication in an earlier post. If nurses are hesitant about contacting the provider (physician, nurse practitioner or physician assistant) for any reason (fear of anger, demeaning attitude, etc), they may not appropriately respond to subtle changes in a patient’s status, perhaps choosing to wait to see if the patient improves on their own before having to make that call to the provider. The delay in reporting condition changes may be the cause of a significant deterioration in the patient’s condition that results in a bad outcome.
Security concerns can restrict access to the supplies needed to initiate action or even complete usual monitoring activities. If patient care activities are delayed or postponed, nurses may not be able to do the thorough job required because of competing priorities.
The frequency of emergency assessments can reduce vigilance. If nurses are interrupted constantly during their job performance, patient error can result.
Do you think failure to rescue is a concern in corrections? Are there any circumstances unique to correctional nursing that makes it more possible for failure to rescue to occur? What can we do to address this issue? Please share your opinions in our comments section below.
Brandon says
Failure to rescue is a huge issue in corrections. We have huge patient populations that are generally in poorer health than their non-incarcerated counterparts. Additionally, they may have the sequelae associated with polysubstance abuse. When these concerns come into conflict with the security concerns of the facility in an emergency the result can be unfortunate. Having the wherewith all to tell the correctional staff that their extraction team needs to go in on a known violent inmate is intimidating.
Good assessment skills and vigilance are our best tools. Also, having the confidence to insist a medical emergency outweigh the current situation help to improve outcomes. But with even all this, there can still be failure.
Deborah Shelton, PhD, RN, NE-BC, CCHP, FAAN says
Thank you for this blog. It absolutely occurs and is referred to as “missed care” in the nursing and health care literature. I would have included education/ training to your list of contributors, the need for different models of nursing for these environments and leadership to leverage the nursing profession.
On a broader basis for the specialty, the lack of data about the Correctional Nurse workforce, our needs, role and working conditions and expectations for staffing will continue to impact us. We need to lobby on our own behalf to get this done to improve clinical conditions for ourselves and our patients.