The iMobile team comprises nurses and doctors who care for patients in the hospital who have required critical care or may need it going forward. They provide rapid response, stabilisation and ward-based interventions.
07:15 Aoife arrives at King’s for her shift. “I start at 7.30am and will finish at 8pm this evening. We’re kept busy so the time passes very quickly,” she says. “I haven’t had breakfast yet so will eat when I get some time later.”
07:30 The nursing teams who were working overnight handover to the nurses working the day shift. They discuss patients who have been cared for overnight and need to be followed up today.
08:00 The iMobile nurses then meet with the doctors to discuss patients who were unwell during the night and their treatment plans. Aoife reads up on a patient she’s going to see before heading to the ward to see her.
On the ward a patient has been identified as having the early signs of sepsis. Aoife says, “Sepsis can be difficult to detect because the symptoms can be similar to other conditions. They typically include high or low temperature, clammy skin, low blood pressure and high heartrate."
08:38 Aoife examines the patient and takes blood. She explains, “Sepsis is a life-threatening condition so it’s vital we begin treatment without delay. We’ve prescribed antibiotics and we’re replacing her electrolytes.” Aoife then takes the patient’s blood to one of the critical care wards to check for other sepsis indicators.
09:02 Aoife records the results of the blood test so other members of the team can see it before going to see the next patient on her list.
09:16 As Aoife enters a neurological ward to see a patient who was unwell overnight her phone rings with an urgent referral. A patient with sepsis on one of the liver wards is deteriorating and needs be reviewed so Aoife goes to see him immediately.
09:32 Aoife arrives on the ward and goes to see the liver patient. His breathing is laboured so has been put on oxygen, his heartrate and temperature are high and his blood pressure is low. He has been given antibiotics and fluids but he isn’t responding so Aoife and ward staff alert the critical care team so he can be transferred.
09:47 Back on the neurological ward Aoife goes to see a patient who has developed sepsis. It can develop from a number of sources including open wounds, blood poisoning, infections and abbesses.
The patient has an erratic heartrate so she speaks to the ward team about a cardiology review. The patient is given medication to control his heartrate.
10:12 Aoife heads back to the office to document the care provided in the patients’ records.
10:45 Other members of the iMobile meet Aoife back on the neurological ward to review the patient from earlier as they have concerns about his condition.
10:56 Following a call regarding a referral in the Emergency Department, Aoife gathers the equipment she’ll need before going to see the patient.
The patient doesn’t have sepsis but does require care from the iMobile team.
11:44 Aoife checks the observation notes of a patient following treatment for cancer. “Patients can deteriorate quickly so timely treatment is crucial,” she adds.
12:11 Aoife gets confirmation of a bed in critical care that has become available so she goes to the liver ward to help transfer the deteriorating patient.
12:47 It’s lunch time so Aoife begins writing up her notes while eating lunch at her desk.
13:21 After her break, Aoife goes back to the wards. She has nine patients to review, many of whom will have sepsis, and she may also get emergency referrals throughout the afternoon.
15:57 After reviewing several patients Aoife explains that with all cases of sepsis the things she’ll be monitoring are bloods, urine output, fluids, antibiotics, lactate and oxygen. “BUFALO is the acronym we use, and these are key in monitoring and treating patients with sepsis,” she adds.
19:30 After seeing several more patients across the hospital it’s time to handover to staff on the nightshift. Aoife discusses the patients she has seen so the oncoming staff can continue to monitor them over night.
20:02 It’s now 12 and a half hours since Aoife began her shift and it’s time to go home. “This evening will consist of relaxing in front of the TV,” she says.
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