Advocating for deteriorating patients: what my role as a DART nurse involves

A deteriorating adult response team (DART) – also known as the Critical Care Outreach Team at some trusts – is there to support staff and be a safety net for patients who are deteriorating, in the hope that further deterioration can be prevented.

Katie Luker, a DART nurse at University Hospitals of Leicester NHS Trust, explains what the role involves.  Perhaps it could be your next nursing job.

No two days are the same in DART and there are many different aspects to the role, including: 

• Monitoring patients for signs of respiratory failure and delivering interventions, such as high-flow oxygen and non-invasive ventilation if required 
• Escalating patients who are critically unwell or require additional support to intensive care levels 2 and 3
• Assisting with the safe transfer of patients from areas such as the emergency department 
• Screening patients who meet read flag sepsis criteria, such as a heart rate above 130 beats per minute and a respiratory rate greater than 25 breaths per minute, and ensuring they have received the sepsis six bundle. 
• Overseeing the discharge of patients from intensive care and high dependency units 
• Assisting with the care of patients with acute kidney injury 

We take referrals from staff over the phone, via bleep, and in person, and ask questions using the SBAR (situation, background, assessment, recommendation) format to gain a thorough understanding of the clinical picture.

We also take electronic observation referrals – so if a patient has a NEWS2 score of 5 or above or a score of 3 in any single parameter, staff can send us the observations electronically to look at.

An important part of the role of a DART nurse is to advocate for our patients, ensuring we are acting in their best interests. It is not always appropriate to put a patient through invasive treatments or procedures if they are fragile or it is not their wish, so part of our role is to assist with difficult conversations and ensure patients are comfortable.

My role is a band 6 specialist nurse post. If you are interested in a similar role, spend time with a DART team to learn about what we do, undertake training and build up the experience you need to make you the ideal candidate by working in an area that manages deteriorating on a regular basis, such as intensive care or the emergency department.

Katie Luker is a deteriorating adult response team (DART) nurse at University Hospitals of Leicester NHS Trust

This is an abridged version of the article What I’ve learned from advocating for deteriorating patients which was first published in Nursing Standard.