Title Page

  • Site conducted

  • Conducted on

  • Audit conducted by

  • People consulted during this audit, if applicable

  • 1. Is this audit based on a mock scenario or an actual deteriorating patient event?

  • 2. Was the incident a Clinical review or a Medical Emergency Response (MET)?

  • Did the patient have any alteration to clinical escalation criteria documented by the treating doctor?

  • What clinical review criteria was met?

  • Did a doctor conduct a patient review within 30mins of being contacted?

  • Were vital signs recorded in vital signs tab or appropriate track and trigger form?

  • What was the outcome for the patient?

  • Other - please list

  • Please add any further comments as appropriate

  • Which medical emergency criteria was met?

  • If the incident was a medical emergency response, did the first responder initiate DRSABCD?

  • If a medical emergency, how long until the medical emergency team/ paramedics arrived?

  • Were frequent vital signs completed as per protocol?

  • Did the medical emergency result in the need for Basic Life Support measures?

  • Was an incident report completed?

  • Was a debrief conducted post the incident for staff involved? Please note significant topics to explore during a debrief Include: individual and /or group reflections. what went well during the incident? Are there any areas were we could improve?

  • Please comment

  • Were there any actions or areas of improvement identified in the incident debrief?

  • Have these addressed or logged in an action plan?

  • Deteriorating patient date: , Riskman ID # patient UR#

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