NRS 3803 Essay: Analyzing Failure to Rescue in Australian Hospitals

This essay critically analyzes the concept of failure to rescue within the context of the deteriorating patient in an acute healthcare environment. It defines failure to rescue and discusses the incidence of adverse events in Australian hospitals, including falls, infections, and medication errors. The essay evaluates the consequences of failure to rescue, such as chronic diseases, increased hospital stays, and negative impacts on patients and their families. Furthermore, it examines two key nursing strategies: interprofessional practice and evidence-based research, emphasizing their roles in preventing patient deterioration and maintaining patient safety. The importance of early identification, communication, teamwork, and a safety culture are also discussed in relation to the prevention of failure to rescue.

Running head: NURSING
Written Essay: 3803NRSInterprofessional Practice and Patient Safety
Name of the Student
Name of the University
Author Note

1NURSING
Introduction
The acute healthcare environment or hospital setting refers to a unique environment that
contains the standards and protocols of safety and practice, which might not be applicable to
different domains of delivery of healthcare service like outpatient clinic. Nurses play an
important role in preventing all such instances of failure to rescue (Craven et al., 2017). Four
different aspects of preventing failure to rescue are: accurate and careful monitoring of the health
of the client, timely recognition of all health problems, well-timed implementation of
intervention for addressing the problem, and opportune response activation (Rao, Kumar &
McHugh, 2017). The objective of the assignment is to critically analyse the concept of failure to
rescue, in relation to worsening health status of a patient admitted to the acute healthcare
environment. The assignment will also discuss the incidence of adverse health events in the
Australian healthcare system, following which two nursing strategies for maintaining patient
safety will be evaluated.
Failure to rescue
The concept of failure to rescue is based on the premises that though not all
complications observed in acute healthcare settings are avoidable, it is imperative, for the
healthcare professionals to quickly recognize and treat the complications amongst all patients
(Sheetz, Dimick & Ghaferi, 2016). According to Tamirisa et al. (2016) failure to rescue typically
occurs when hospitalized patients starts showing signs and symptoms of health complication,
and a decline in the health status, following which there occurs adverse outcomes. The
deterioration and complications most commonly comprise of understated signs and symptoms,

2NURSING
which are initially observed by the healthcare professionals as not being that important or often
completely preventable.
All patients entering the healthcare system generally assume that they will be treated in a
region of safety. Together with their family members, the patients show confidence that any kind
of decline in their health status will be immediately detected and efficiently treated by healthcare
experts. Nonetheless, truth is far from reality. Several instances of patients facing severe
outcomes are the reminders that quality of care and patient safety often get compromised in few
healthcare settings (Ghaferi & Dimick, 2016). Taking into consideration the fact that several
patient complications cannot be avoided and are inevitable, it must be the primary objective to
put off any errors that directly lead to failure to rescue, which can be achieved by decreasing
system deficiencies.
Incidence of adverse events
Adverse events create a negative impact on patient safety and refer to do any kind of
preventable or avoidable occurrences in healthcare settings that directly threaten the health and
wellbeing of the people who are being provided a plethora of care services and facilities (Baines,
2018). Failure to rescue is a kind of adverse health event in hospital that leads to a considerable
harm to a patient. Some other adverse events that commonly occur consist of medication error,
incontinence, falls, malnutrition, and hospital acquired infections and pressure injuries.
According to data obtained from the National Hospital Morbidity Database adverse event rates in
hospitals showed an increase to 5.4 from 4.8 adverse events per 100 separations, between 2007–
08 and 2015–16, in Australia. During 2015-16, the rate of adverse events was more than twice
for emergency hospital admissions, when compared to the non-emergency hospital admission
(9.7 vs. 3.9 per 100 separations, respectively). In addition, adverse events demonstrated and

3NURSING
increase likelihood of occurrence during surgical admissions, in contrast to non surgical
admissions (7.7 vs. 4.7 per 100 separations) (AIHW, 2018).
In relation to falls of patients in hospitals, there were 1756 fall related incidents in 2015-
16 in public hospitals. Higher rate of fall was observed across public hospitals, in comparison to
the private healthcare institutes, and when combined, older adults aged more than 85 years
reported maximum age specific fall rate within hospital settings (13 falls per 1,000 separations)
(ACSQHC, 2018). In relation to hospital acquired bloodstream infections, the rates were found
to be less than the nationwide standard of 2.0 per 10,000 patient days in 2018-19 (AIHW, 2018).
The rate of Staphylococcus aureus associated bloodstream infection has demonstrated stability
over the last 5 years (0.79 vs. 0.75 in 2014-15 and 2018-19, respectively) (AIHW, 2020).
According to Mitchell et al. (2017) an anticipated 165,000 hospital acquired infections (HAI)
that happen each year in Australia. The findings suggest that of the 83,096 HAIs that take place
each year in Australia, there are 3946 surgical site infections, 71,186 urinary tract infections,
1962 respiratory infections, 4902 Clostridium difficile infections, and 1100 hospital associated
Staphylococcus aureus bacteraemia.
Consequences of failure to rescue
In the words of Mushta, Rush and Andersen (2018) failure to rescue has been identified
as a nurse sensitive indicator, and it has been identified to be the process that is predominantly
characterized by sequence of circumstances, together with four major attributes that are namely:
failure in identifying alterations in the patient’s condition, errors related to admission in care
delivery, failure in communicating changes in patient health status, and failure in the significant
aspect of clinical decision making. The notion of rescue has conventionally been correlated with
patients who are critically ill, and the necessity for identifying and treating their health

4NURSING
complications in an effective manner. This correlation exists in the form of elective operations
where the healthcare professionals anticipate any kind of physiological changes in the patient,
and the deviation from normal recovery pathways (Hravnak et al., 2017). Several principles that
are directly associated with failure to rescue are early identification, communication, team work,
culture, and safety organisation. However, a failure to rescue the patient from an adverse health
event typically results in certain abnormalities in the physiological functioning, which either
result in disability or even death.
There are correlated consequences with an increase in the frequency of adverse health
events in acute healthcare environment, under conditions when the deteriorating health
circumstances in a particular patient cannot be modified, through the delivery of effective
interventions. These consequences not only create a direct impact on the patient but adversely
affect their family members and the entire healthcare systems (Nalder et al., 2016). Patients who
have been subjected to experiences of failure to rescue are found to typically develop serious
health complications like chronic diseases, or acute failure of the cardiovascular system. Patients
admitted to acute healthcare environment do not always suffer from severe conditions but a
failure on the part of the nursing professional to respond immediately to the changing healthcare
needs of the patient often triggers the development of chronic complications.
Research evidences have highlighted the common practice of administering opioids like
codeine or morphine for the management of pain amongst patients, following a
surgery. However, such opioid administration has been associated with serious harm in the
patients such as, overdose or even death (Dowell et al., 2016). Severe neonatal jaundice is
another such incident that is predominantly characterized by yellowing in the skin and/or white
region of the eye in a newborn, which in turn can be attributed to high levels of bilirubin pigment

5NURSING
(Olusanya, Teeple & Kassebaum, 2018). Taking into consideration the fact that in several cases
there is an absence of a particular underlying physiologic disorder leading to the condition, the
healthcare professionals often fail to notice the rapid increase in levels of bilirubin, following
which there occurs death of the affected infants. Globally, not less than 100,000 late preterm
babies die due to neonatal jaundice each year (Olusanya, Teeple & Kassebaum, 2018). This
creates a noteworthy influence on the family members, particularly the mother and affects their
psychosocial and emotional wellbeing as well.
Failure to rescue also results in an extended length of hospitalization of the patients in
acute healthcare environment, owing to the development and progress of severe complications,
which take a toll on the financial wellbeing of the patient and family members. Unnecessary
longest stay in hospital requires more treatment and medical equipment, by this means forcing
the family members of the patients to spend extra currency for paying the hospital bills (Chen et
al., 2017). In addition, futile efforts taken by a hospital to rescue the life of a particular patient, or
prevent the deteriorating condition generally tarnish its reputation, and also decrease the number
of consumers. Not only does it result in the establishment of disconnect between the nursing
professional and patients, but also directly affects performance of the staff, in that way
deteriorating the quality of care delivered. Such instances of failure to rescue make it stressful for
the family to cope and adapt to the situation, and also elicit cognitive, behavioral, and physical
changes in the healthcare staff (Simpson, Lyndon & Ruhl, 2016).
Nursing strategies
The two nursing strategies that can prevent the nursing staff from demonstrating of
failure to rescue, thus helping them uphold patient safety and wellbeing are namely,
interprofessional practice and evidence based research. Evidence based nursing research

6NURSING
encompasses the procedure by which the nursing professionals will be able to rely on
mathematical and scientific evidence, to develop strong deductive or inductive argument that
would guide them during clinical decision making (Mackey & Bassendowski, 2017). This would
help the nursing staff adopt a problem solving approach, with the aim of integrating best
available evidences from scholarly studies that have been conducted in the domain, to identify
the early indicators of worsening in health of a patient. Hence, they will be able to make
decisions that are able to prevent any adverse events. The significance of the strategy can be
accredited to the fact that it will help the nursing staff deliver the care that is most effective, for a
change in health status of the patient (Iowa Model Collaborative et al., 2017). The nurses will be
able to gain a sound understanding and awareness of physiological parameters that they must
monitor and keep a track of, while providing treatment to any patient. Not only will it help the
nursing staff to identify unpredictable health outcomes that result in adverse events, but will also
increase their accountability and responsibility towards protecting the patient.
By conducting a research on the different health ailments that the patients suffer from,
they will be able to get an idea of the health complications that are expected to occur in such
scenario, therefore will be adequately equipped for addressing such circumstances if they arise in
future, during the process of care delivery. Additionally, it will increase their clinical expertise,
and will help them make quality decisions, in so doing preventing any kind of delay in the
delivery of treatment. For example evidence based research will help nurses identify the
importance of using wearable sensors for patients who are old or disabled, thereby facilitating
prevention of fall related events in the hospital, and decreasing the rate of associated adverse
event (De Lima et al., 2017). Similarly, it will also help the nursing staff to comprehend the
effectiveness of phototherapy, while treating the health complications manifested by infants with

7NURSING
neonatal jaundice. Effectiveness of phototherapy has been associated with its capability to
transform trans-bilirubin to cis-bilirubin isomer, and if implemented based on evidences, the
mortality rate of preterm infants, due to neonatal jaundice can also be decreased (Hansen et al.,
2019).
Interprofessional practice in the domain of health and social care refers to the
collaborative effort when different healthcare providers work simultaneously, with individuals
belonging to their own or outside profession, in addition to patients and family members. Under
circumstances when the nursing professionals will initiate collaborative work, they will be able
to develop common goals, by discussing with the physicians, following which they will be able
to better identify and address the rising health complications in patients (Reeves et al., 2017).
Not only will theis help the nursing professionals to better utilise their skills and clinical
expertise for enhancing the patient health status, but will also help them to immediately
recognise and respond to the declining physiological conditions. Additionally collaboration with
the family members of the patients will also help the nursing staff to understand their demands
and preferences, which might prove effective, while addressing the unanticipated health
complications (Morgan et al., 2019).
Conclusion
Thus, it can be concluded that failure to rescue refers to a situation that is commonly
experienced when the healthcare professionals are not able to appropriately treat the deteriorating
conditions manifested by most patients. In other words, failure to rescue refers to the failure to
avert clinical deterioration in the health of the patient such as, disability or even death, in
addition to the development of complications due to an underlying disease due to the adverse
impacts of the care given. The experiences of nursing staff that are correlated with such adverse

8NURSING
events comprise of their failure to identify respond, communicate, and address the altered
physiological parameters. Hence, high incidence of adverse events in healthcare environment
suggests that nurses are often not able to appropriately respond to the changing health demands
of the patients, by this means demonstrating a failure in identifying the complications and
examining the risk levels associated.

9NURSING
References
Australian Commission on Safety and Quality in Health Care. (2018). Falls resulting in fracture
or intracranial injury.
https://www.safetyandquality.gov.au/sites/default/files/migrated/Falls-resulting-in-
fracture-of-intracranial-injury-detailed-fact-sheet.pdf
Australian Institute of Health and Welfare. (2018). Adverse events treated in hospital.
https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/
indicators-of-australias-health/adverse-events-treated-in-hospital
Australian Institute of Health and Welfare. (2018). Falls resulting in patient harm in hospitals.
https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/
indicators-of-australias-health/falls-resulting-in-patient-harm-in-hospitals
Australian Institute of Health and Welfare. (2020). Bloodstream infections associated with
hospital care 2018–19. https://www.aihw.gov.au/reports/health-care-quality-
performance/bloodstream-infections-associated-with-hospital-care/contents/introduction
Baines, R. (2018). Monitoring adverse events in hospitals.
https://www.nivel.nl/sites/default/files/bestanden/Proefschrif_Rebecca_Baines_Monitorin
g_adverse_events_in_hospitals.pdf
Chen, D., Liu, S., Tan, X., & Zhao, Q. (2017). Assessment of hospital length of stay and direct
costs of type 2 diabetes in Hubei Province, China. BMC health services research, 17(1),
199. https://doi.org/10.1186/s12913-017-2140-4

10NURSING
Craven, I., Denton, P., Perry, G., & Keeter, R. (2017). Failure to Rescue: Nursing Grand Rounds
2016. http://hdl.handle.net/10755/623086
De Lima, A. L. S., Evers, L. J., Hahn, T., Bataille, L., Hamilton, J. L., Little, M. A., ... & Faber,
M. J. (2017). Freezing of gait and fall detection in Parkinson’s disease using wearable
sensors: a systematic review. Journal of neurology, 264(8), 1642-1654.
https://doi.org/10.1007/s00415-017-8424-0
Dowell, D., Zhang, K., Noonan, R. K., & Hockenberry, J. M. (2016). Mandatory provider review
and pain clinic laws reduce the amounts of opioids prescribed and overdose death
rates. Health Affairs, 35(10), 1876-1883. https://doi.org/10.1377/hlthaff.2016.0448
Ghaferi, A. A., & Dimick, J. B. (2016). Importance of teamwork, communication and culture on
failure‐to‐rescue in the elderly. British Journal of Surgery, 103(2), e47-e51.
https://doi.org/10.1002/bjs.10031
Hansen, T. W. R., Maisels, M. J., Ebbesen, F., Vreman, H. J., Stevenson, D. K., Wong, R. J., &
Bhutani, V. K. (2019). Sixty years of phototherapy for neonatal jaundice–From
serendipitous observation to standardized treatment and rescue for millions. Journal of
Perinatology, 1-14. https://doi.org/10.1038/s41372-019-0439-1
Hravnak, M., Mazzoccoli, A., Bose, E., & Pinsky, M. R. (2017). Causes of failure to rescue.
In Textbook of rapid response systems (pp. 95-110). Springer, Cham.
https://doi.org/10.1007/978-3-319-39391-9_10
Iowa Model Collaborative, Buckwalter, K. C., Cullen, L., Hanrahan, K., Kleiber, C., McCarthy,
A. M., ... & Authored on behalf of the Iowa Model Collaborative. (2017). Iowa model of

11NURSING
evidence‐based practice: Revisions and validation. Worldviews on Evidence‐Based
Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223
Mackey, A., & Bassendowski, S. (2017). The history of evidence-based practice in nursing
education and practice. Journal of Professional Nursing, 33(1), 51-55.
https://doi.org/10.1016/j.profnurs.2016.05.009
Mitchell, B. G., Shaban, R. Z., MacBeth, D., Wood, C. J., & Russo, P. L. (2017). The burden of
healthcare-associated infection in Australian hospitals: a systematic review of the
literature. Infection, Disease & Health, 22(3), 117-128.
https://doi.org/10.1016/j.idh.2017.07.001
Morgan, C. J., Bowmar, A., McNaughton, S., & Flood, B. (2019). Transformative learning
opportunities during interprofessional healthcare practice experiences in higher
education: Viewed through the lens of a threshold concepts framework. Focus on Health
Professional Education: A Multi-disciplinary Journal, 20(2), 41.
https://search.informit.com.au/documentSummary;dn=704891007514292;res=IELAPA
Mushta, J., L. Rush, K., & Andersen, E. (2018, January). Failure to rescue as a nurse‐sensitive
indicator. In Nursing forum (Vol. 53, No. 1, pp. 84-92). https://doi.org/10.1111/nuf.12215
Nalder, E., Fleming, J., Cornwell, P., Foster, M., Skidmore, E., Bottari, C., & Dawson, D. R.
(2016). Sentinel events during the transition from hospital to home: A longitudinal study
of women with traumatic brain injury. Archives of physical medicine and
rehabilitation, 97(2), S46-S53. https://doi.org/10.1016/j.apmr.2014.07.428