From the audit we identified the following problematic areas:
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Late recognition of patient deterioration
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Lack of systematic observation with specific intervals
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Lack of seeking advice early
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Discrepancies between medical and nursing reports
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Poor documentation
The focus group interviews revealed which common needs were identified as matters of concern:
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Early identification of patients at risk
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Lack of systematic observations and interdisciplinary guidelines
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Need for efficient communication and teamwork in acute settings
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Training and education of staff
Reviewing our test simulation we were confirmed of the results from the audit and the interviews and in CRM-terms in addition lack of re-evaluation and presence of fixation errors.