NSQHSS 9 Recognising and responding to clinical deterioration

Department

Personnel

9.1.1 Governance arrangements are in place to support the development, implementation and maintenance of organisation-wide recognition and response systems

9.1.2 Policies, procedures and/or protocols for the organisation are implemented in areas such as: measurement and documentation of observations escalation of care establishment of a rapid response system communication about clinical deterioration

9.2.2 Deaths or cardiac arrests for a patient without an agreed treatment-limiting order (such as not for resuscitation or do not resuscitate) are reviewed to identify the use of the recognition and response systems, and any failures in these systems

9.2.3 Data collected about recognition and response systems are provided to the clinical workforce as soon as practicable

9.2.4 Action is taken to improve the responsiveness and effectiveness of the recognition and response systems

9.3.1 (D) When using a general observation chart, ensure that it: is designed according to human factors principles includes the capacity to record information about respiratory rate, oxygen saturation, heart rate, blood pressure, temperature and level of consciousness graphically over time includes thresholds for each physiological parameter or combination of parameters that indicate abnormality specifies the physiological abnormalities and other factors that trigger the escalation of care includes actions required when care is escalated

9.3.2 Mechanisms for recording physiological observations are regularly audited to determine the proportion of patients that have complete sets of observations recorded in agreement with their monitoring plan

9.3.3 Action is taken to increase the proportion of patients with complete sets of recorded observations, as specified in the patient’s monitoring plan

9.4.1 Mechanisms are in place to escalate care and call for emergency assistance

9.4.2 Use of escalation processes, including failure to act on triggers for seeking emergency assistance, are regularly audited

9.4.3 Action is taken to maximise the appropriate use of escalation processes

9.5.1 Criteria for triggering a call for emergency assistance are included in the escalation policies, procedures and/or protocols

9.5.2 The circumstances and outcome of calls for emergency assistance are regularly reviewed

9.6.1 The clinical workforce is trained and proficient in basic life support

9.6.2 A system is in place for ensuring access at all times to at least one clinician, either on-site or in close proximity, who can practice advanced life support

9.7.1 (D) Information is provided to patients, families and carers in a format that is understood and meaningful. The information should include: the importance of communicating concerns and signs/symptoms of deterioration, which are relevant to the patient’s condition, to the clinical workforce local systems for responding to clinical deterioration, including how they can raise concerns about potential deterioration

9.8.1 (D) A system is in place for preparing and/or receiving advance care plans in partnership with patients, families and carers

9.8.2 (D) Advance care plans and other treatment-limiting orders are documented in the patient clinical record

9.9.1 (D) Mechanisms are in place for a patient, family member or carer to initiate an escalation of care response

9.9.2 (D) Information about the system for family escalation of care is provided to patients, families and carers

9.9.3 (D) The performance and effectiveness of the system for family escalation of care is periodically reviewed

9.9.4 (D) Action is taken to improve the system performance for family escalation of care