Critical-care education Clinical deterioration ABCDE assessment Primary survey
The ABCDE approach is the most recognised tool for rapid patient assessment, it allows us to recognise life-threatening conditions early and provides a systematic method that focuses on identifying problems and implementing critical interventions in a timely manner.
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Why you should use an ABCDE approach to patient assessment
Performing a physical assessment on your patient is like brushing your teeth, should be routine, systematic, thorough and performed at least twice a day. The ABCDE approach is the most recognised tool for rapid patient assessment, it allows us to recognise life-threatening conditions early and provides a systematic method that focuses on fixing problems before moving on, meaning we implement critical interventions in a timely manner.
There’s a lot of information we can obtain just by looking and interacting with the patient.
In stable patients, the ABCDE approach can be performed in the time it takes to put the toothpaste on your toothbrush. Entering a patient’s room and exchanging ‘good mornings’ allows you to establish they have a patent airway (their voice sounded normal), they are breathing normally (able to say good morning and speak in sentences), they have good circulation (colour is normal, they are moving around and alert), they don’t have a neurological deficit (alert and respond appropriately).
ABCDE with deterioration or ED presentation
In the deteriorating patient, or patients presenting in an emergency the ABCDE assessment will take a little longer and should always include a Look, Listen, and Feel approach. The goal of the assessment is to identify and treat any life-threatening conditions, and ensure the delivery of oxygen to vital organs by optimising breathing and circulation. In trauma patients cervical spine immobilisation is included in the A-Airway assessment however airway will take precedence over spinal precautions in the setting of obstructed airway not able to be effectively managed. An example template to follow when performing an ABCDE appears below.
ABCDE in Resuscitation
In a resuscitation setting, the ABCDE assessment tool is useful when establishing initial causes of arrest, and for recapping and prioritising during resuscitation efforts. An initial assessment helps prioritise life-threatening problems that may prevent successful outcomes from resuscitation such as airway obstruction. After rhythm checks it is helpful to recap using the ABCDE approach by checking in with team members e.g.
Airway - "is the airway secure, can you verify we haveeTCO2"
Breathing - "is there equal rise and fall of the chest"
Circulation - “are there any signs of bleeding or hypovolaemia”
Disability -“ what’s the patient’s blood glucose level”
Exposure -“ can you check the patient’s temperature”
ABCDE after initial stabilisation or for ongoing care
Once a patient has been stabilised, the ABCDE should be revisited routinely to assess the effects of treatment and confirm patient outcomes are being achieved. At any point during the assessment if a problem is observed or expected response to treatment not achieved then this should be managed before proceeding to the next stage of the assessment.
(Adapted from Peran et.al. 2020)
If you would like to see the ABCDE assessment tool in action and how it applies to the clinically deteriorating patient, register for our upcoming workshop on Recognising and responding to clinical deterioration. This workshop is taking a new approach to learning and will include a range of eLearning, pre-recorded lectures, live or on demand webinars and interactive case studies to provide practical application into clinical practice.
Recognising and Responding to Clinical Deterioration
References
Olgers R.., Dijkstra R., Klerck D., Maaten J. (2017) The ABCDE primary assessment in the emergency department in medically ill patients: an observational pilot study. The Netherlands Journal of Medicine Vol 75 (3)
Peran D., Kodet J., Pekara J., Mala L., Truhlar A., Cnorej P., Lauridsen K., Sari F., Sykora R. (2020) ABCDE cognitive aid tool in patient assessment - development and validation in a multicenter pilot simulation study BMC Emergency Medicine 20:95
Resuscitation Council UK (2021) The ABCDE Approach www.resus.org
Thim T., Krarup N., Grove E., Løfgren B. (2021) Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach International Journal of General Medicine (5) 117-121
World Health Organisation The ABCDE and SAMPLE History Approach Basic Emergency Care Course
- 01 July 2021
- by Susan Helmrich
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Clinical deterioration ABCDE assessment Patient assessment Physical assessment Primary survey
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Susan Helmrich
Susan is the Head of Nursing Education for the Medcast Group.
DipAppScNsg, BN, CritCareCert, CoronaryCareCert, TraumaNsgCareCert, CertIV(TAE), MN(Ed), and GradCert(Ldrshp& Mgt).
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FAQs
Why is it important to use a structured approach when undertaking patient assessment and communicating the findings? ›
Structured communication tools have been widely implemented in hospitals to streamline communication between healthcare workers. These tools have been shown to increase patient safety, reduce unexpected deaths and decrease incidents due to communication errors (De Meester et al., 2013.
What do you do after Abcde assessment? ›- Take a full clinical history from the patient, relatives or friends, other staff.
- Review the patient's notes and charts: ...
- Review the results of laboratory and radiological investigations.
- Consider which level of care is required (e.g. ward, HDU, ICU)
The nurse's initial action is patient assessment. 1 Assessment is the foundation of effective nursing care, improved patient outcomes may result from any strategy that enhances patient safety. 2 An appropriate and rapid assessment will improve patient safety.
Why is the ABCDE assessment important? ›The ABCDE approach is a strong clinical tool for the initial assessment and treatment of patients in acute medical and surgical emergencies, including both prehospital first-aid and in-hospital treatment. It aids in determining the seriousness of a condition and to prioritize initial clinical interventions.
What is an advantage of a system approach to patient assessment? ›It will help you to run scenarios or real life jobs with greater efficiency, with less likelihood of missing something crucial or “getting stuck” on scene. Having a good systematic approach will allow you to provide better patient care, and hopefully improve outcomes for both clinical scenarios and real-life patients.
What is the ABCDE strategy? ›The ABCDE coaching model is a behavioral therapy model. It has five stages: Activating event or situation, Beliefs, Consequences, Disputation of the beliefs and Effective new approach to dealing with the problem.
Why is it important to Recognise and respond to patients who are deteriorating? ›Early identification of deterioration may improve outcomes and lessen the intervention required to stabilise patients whose condition deteriorates in a health service organisation. The warning signs of clinical deterioration are not always identified or acted on appropriately.
When should you assess a patient? ›When assessing a patient, you should: Observe, Move, Feel, Rate.
What is the most important skill that you need to have in assessing a patient? ›Empathy. In health care, it's important that you can empathize with patients and the difficult situations that others are facing.
What is the purpose of the assessment? ›The purpose of assessment is to gather relevant information about student performance or progress, or to determine student interests to make judgments about their learning process.
What are some important things that should be included in a patient assessment? ›
- Stature.
- Overall health status.
- Body habitus.
- Personal hygiene, grooming.
- Skin condition such as signs of breakdown or chronic wounds.
- Breath and body odor.
- Overall mood and psychological state.
The ABCDE approach enables nurses to perform a holistic and systematic assessment of deteriorating patients that is underpinned by the following principles (Resuscitation Council (UK) 2015):
Why is it important to take a systems approach? ›The systems approach allows you to look at an organization from the different perspectives of its subsystems, which gives you more insight and control. Changes can be made to each of the subsystems to make a positive impact on the entire organization.
What are the benefits of a systems approach? ›Benefits of a Systems Approach
More knowledge since the right questions are being asked. Stakeholder involvement in the process. A shared understanding of the problem. Many perspectives considered and integrated.
A systems approach highlights the importance of the circumstances, or context, in which an action is taken in order to understand its implementation and potential impact.
What is an example of the ABCDE model? ›For example, “I received a C in English on my first term report card.” B is the student's belief about what is true about this activating event (A). “I have never gotten above a C for this teacher, I am no good, I will never get above a C, I'm a failure.”
What is the five step ABCDE decision making model? ›The Sileo and Kopala (1993) A-B-C-D-E Ethical Decision-Making Model is one such model that involves five steps: Assessment, Benefit, Consequences and Consultation, Duty, and Education.
What is the ABCD approach in psychology? ›ABCD (Approach focused on Behaviour Change Determinants) is a socio-anthropological approach based on the studying of behaviours and their psychological, socio-cultural and environmental determinants, aimed at helping humanitarian and development professionals to design relevant and sustainable WASH interventions.
Why is it important for patients to be involved in quality improvement in health care? ›There are many reasons why quality improvement is important. Quality improvement can lead to increased patient safety, more effective and efficient care, and improved patient outcomes. It can also help to reduce the cost of health care.
Why is it important to provide good patient care? ›Giving quality patient care can absolutely have an effect on health outcomes. It contributes to a more positive patient recovery experience and can improve the physical and mental quality of life for people with serious illnesses, such as cancer.
Why is it important for patients to understand their care? ›
In the chronic disease management space, patient education helps with patient self-management. Most chronic disease management happens outside of the healthcare facility, so patients who are knowledgeable about their conditions and the steps they must take to stay well will see better outcomes.
How do you assess a patient properly? ›WHEN YOU PERFORM a physical assessment, you'll use four techniques: inspection, palpation, percussion, and auscultation. Use them in sequence—unless you're performing an abdominal assessment. Palpation and percussion can alter bowel sounds, so you'd inspect, auscultate, percuss, then palpate an abdomen.
What should a nurse consider when assessing a patient? ›- environmental assessment.
- cultural assessment.
- physical assessment.
- psychological assessment.
- safety assessment.
- psychosocial assessment.
Performing a Rapid Primary Survey
During the primary survey, you should assess the patient's airway, breathing, circulation and mental status. You are determining if the airway is patent and if the patient is responsive and has an adequate pulse. It should only take about a minute to do a primary survey.
It aims to prevent and reduce risks, errors and harm that occur to patients during provision of health care. A cornerstone of the discipline is continuous improvement based on learning from errors and adverse events. Patient safety is fundamental to delivering quality essential health services.
How can you improve clinical skills in patient's assessment? ›- DEVELOP A PATIENT ASSESSMENT ROUTINE. The first thing you can do once you start learning in a clinical setting is to develop a routine. ...
- RECOGNIZE THE LITTLE SIGNS. ...
- USE EVERY INFORMATION SOURCE. ...
- KEEP LEARNING. ...
- WATCH AND LEARN. ...
- INTERACT WITH YOUR PATIENTS. ...
- WORK WITH THE TEAM.
- Make your practice look and feel engaging. Patients will judge your practice before they even meet you. ...
- Honor patients with respect and attention. ...
- Improve communication at every step of the patient visit. ...
- Make ease-of-access a top priority. ...
- Commit to timeliness.
Meaning of Assessment
It is a systematic process. By which we assess the performance of students through tests. Furthermore, they help in collecting data related to skills knowledge and attitude of students. In addition, they help to improve students' performance.
- Assessments Guides Teacher Planning. ...
- Assessments Support School and Family Partnerships.
This article argues that each of the three basic purposes of assessment, assessment to support learning; assessment for accountability; assessment for certification, progress, and transfer need to enjoy appropriate attention to support quality education.
What is the most important tool that you use for physical assessment? ›
The single most useful device for optimal performance of the physical examination is an inquisitive and sensitive mind. Next most useful is mastery of the techniques of observation, palpation, percussion, and auscultation. Less important are the tools required for the examination (Table 4.1).
Why is it important to use a structured approach in nursing? ›It is important to ensure that the patient is the focus and that interventions and services are actioned and measured from the patient's perspective when managing any care environment. The nursing process of assess, plan, implement and evaluate remains a solid foundation on which to develop nursing care.
Why is structured data important in healthcare? ›Electronic health records (EHRs) that use structured data elements are documenting patient information using controlled vocabulary rather than narrative text. The historic lack of structured data and standardization in the healthcare industry today causes problems when sharing EHR content between providers.
What is effective structured communication in healthcare? ›SBAR is a structured method for communicating critical information that requires immediate attention and action, contributing to effective escalation of management and increased patient safety.
Why is communication important in patient assessment? ›Good communication also improves the quality of care provided to patients, which is observed in the results. Additionally, it is considered an inalienable right and a prerequisite for building a genuine and meaningful relationship between patients and nurses and other health professionals (30).
What does Abcde mean in nursing? ›The airway, breathing, and circulation, disability and exposure (ABCDE) assessment is the mainstay management approach used in managing critically ill patients. Clinician–Patient Relationship . The ABCDEs are the essential 1st steps to perform in many situations including unresponsive patients.
Why is health assessment important in nursing? ›Assessments help nurses objectively identify the unique needs and concerns of each patient as well as any potential barriers to care that may affect compliance and outcomes.
Why is it important to look at a patient as a whole? ›Because disease and dysfunction can negatively impact a patient's entire world, healthcare providers must address the entirety of the patient when administering treatment to truly promote health and well-being.
What is the benefit of using structured data? ›Easily used by machine learning algorithms: The largest benefit of structured data is how easily it can be used by machine learning. The specific and organized nature of structured data allows for easy manipulation and querying of that data.
What are the benefits of well structured health records? ›Enabling safer, more reliable prescribing. Helping promote legible, complete documentation and accurate, streamlined coding and billing. Enhancing privacy and security of patient data. Helping providers improve productivity and work-life balance.
Why is structured content important? ›
In simple terms, using structured content makes things far easier for Google to understand and interpret, which ultimately means that your content may rank better — and is shown to the most relevant audiences — as result.
How do you maintain effective communication with patients? ›- Be attentive. “Listen completely and attentively. ...
- Ask open questions. ...
- Be curious. ...
- Summarise throughout. ...
- Involve friends and family. ...
- Use the right tone. ...
- Be aware of your patient's situation. ...
- Get help from colleagues.
- Verbal Communication.
- Non-verbal Communication.
- Active Listening.
- Written Communication.
- Educating Patient.
- Making Personal Connections.
- Cultural Awareness.
- Compassion and Trust.
Skillful communication is essential to health care. Clear, honest communication between patient and provider paves the way for accurate diagnoses and treatment decisions.
Why is effective communication important for quality patient care? ›Effective communication — both intrahospital and interhospital — is important for health care providers to protect their patients, save on costs, and increase day-to-day operating efficiency. Meanwhile, patients benefit from increased access to their medical histories, which reduces chances of medical errors.
What communication skills are important when assessing the needs and concerns of clients? ›Excellent verbal communication is key. Aim to always speak with clarity, accuracy, and honesty. It's also important to know your audience and speak appropriately according to the person's age, culture, and level of health literacy.
Why is nurse communication important for patient safety and quality care? ›When health care professionals are not communicating effectively, patient safety is at risk for several reasons: lack of critical information, misinterpretation of information, unclear orders over the telephone, and overlooked changes in status. Lack of communication creates situations where medical errors can occur.