Healthcare teams in hospitals have been recognising the vulnerability of the deteriorating patient in acute care for nearly 20 years. UK national organisations such as National Confidential Enquiry into Patient Outcome and Death (NCEPOD), National Patient Safety Association (NPSA) and National Institute for Clinical Excellence (NICE) have recognised this in recent publications. As a result, there has been considerable clinical interest and service innovation in optimising the recognition and management of the deteriorating and acutely ill ward patient.
Following the publication of Comprehensive Critical Care (DOH 2000), the Intensive Care Society (ICS) published definitions of levels of care in 2002 to better understand the needs of acutely ill and critical patients; these definitions have recently been updated (Levels of Adult Critical Care, Consensus Statement, Second Edition, March 2021) and we are please to see the Level 1 recognised as Enhanced Care.
NOrF and the Critical Care Network National Leads (CC3N) gathered a wide group of key stakeholders to develop a practice focused competency framework for registered nurses and allied health professionals (AHPs) who care for level 1 patients in Enhanced Care Areas. The group worked in collaboration with other relevant professional bodies such as RCN, BACCN, UKCCNA, ICS, ICUsteps and SAM UK.
This suite of multi-professional competencies has been designed to support safe, compassionate and effective care and treatment to Level 1 patients within the acute provider organisation. They are intended to compliment organisations existing educational programmes and competency based training packages, to provide an evidenced based framework to assess the performance of registered nurses and AHP's with regular exposure to the Level 1 patient. They are recommended by the Faculty of Intensive Care Medicine Enhanced Care as the generic level of competence required by the staff working in the enhanced care areas.
The focus of the competency framework is to: