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Level 4: Urgent Care

Site: OpenLearn Create
Course: Welsh Levels of Care E-Learning Program
Book: Level 4: Urgent Care
Printed by: Guest user
Date: Monday, 9 February 2026, 5:11 AM

Description

The patient is in a highly unstable and unpredictable condition either related to their primary problem or an exacerbation of other related factors.

Table of contents

Lay Descriptors

  • The patient is in a highly unstable and unpredictable condition either related to their primary problem or an exacerbation of other related factors
  • The existing or longer term plan of care may be postponed, while alternate urgent treatments and interventions are put in place to avoid any further deterioration, or protect the patient
  • The patient’s condition may change rapidly and therefore high levels of observation and supervision are in place, or provided on a continuous basis for the majority of the day
  • There is regular senior clinical review
  • The work to deliver care is multifaceted with a number of highly skilled interventions and technical procedures interspersed with numerous tasks to provide full personal care
  • The patient’s ability to participate in the ongoing care, and maintain their own safety and that of others, may be the primary factor in their ongoing instability and therefore, require actions and interventions beyond the normal routines of the nursing team

Clinical Descriptors

  • Requiring a similar level of nursing care as a patient within a typical high dependency environment, for example, a bed dedicated to high risk patients
  • Patients requiring two-to-one care for 24 hours or one-to-one care for the majority of the day
  • Requires highly skilled, proactive intervention to prevent the patient deteriorating or requires urgent intervention due to a rapidly changing condition or ongoing instability
  • Deteriorating or compromised single organ system
  • Maintain and stabilise prior to urgent transfer
  • Pre-operative invasive monitoring and extended post operative optimisation
  • Severe infection or sepsis

Nursing Theme 1 - Assessment and Observation

  • Instability requiring continuous observation, for example cardiac monitoring, invasive pressure monitoring, invasive neurological monitoring
  • Patient receiving interventions for high NEWS
  • Emergency admissions requiring immediate therapeutic intervention
  • Patients requiring two-to-one care for 24 hours or one-to-one care for the majority of the day
  • Requires ongoing monitoring and observations 1-2 hourly due to unstable and unpredictable condition
  • Cord compression with unstable spine, for example requires log roll

Nursing Theme 2 - Respiration

  • First 24 hours following tracheostomy insertion or ongoing care of an unstable tracheostomy
  • Patients in acute respiratory failure, requiring non-invasive ventilation or respiratory support using CPAP or BiPAP
  • Greater than 50% oxygen continuously
  • CNS depression of airway and reflective reflexes
  • Frequent de-saturations on high flow oxygen
  • High risk of aspiration or requires oral pharyngeal suction

Nursing Theme 3 - Personal Care, Nutrition and Hydration

  • Patients requiring one-to-one care for the majority of the day and also requiring two or more staff for most activities of daily living
  • Fungating or constant bleeding wound, requiring interventions more than three times a day
  • High risk of falls and history of falls requiring close supervision

Nursing Theme 4 - Cognition and Communication

  • Patients with mental health or learning disabilities requiring supervision, support and frequent intervention for the majority of the day
  • Risk of harm to self and others which could result in injury
  • Patients may be cohorted to provide continuous supervision at a ratio of two-to-one for the majority of the day
  • Patients with enduring mental health problems and requiring enhanced supervision

Nursing Theme 5 - Medication

  • Pain management
  • Intrathecal analgesia
  • Drug infusions that require continuous intensive monitoring, for example vasoactive drugs (amiodarone, inotropes, GTN) or potassium, magnesium
  • Unstable patient requiring medication regime requiring frequent changes