Acute physiological deterioration, recognising and responding to it
NSQHS Standard 8: Recognising and Responding to Acute Deterioration includes actions relating to physiological deterioration in particular:
- 8.4 The health service organisation has processes for clinicians to detect acute physiological deterioration
8.6 The health service organisation has protocols that specify criteria for escalating care
8.8 The health service organisation provides the workforce with mechanisms to escalate care and call for emergency assistance
8.9 The workforce uses the recognition and response systems to escalate care
8.10 The health service organisation has processes that support timely response by clinicians with the skills required to manage episodes of acute deterioration
8.11 The health service organisation has processes to ensure rapid access at all times to at least one clinician, either on site or in close proximity, who can deliver advanced life support
- 8.13 The health service organisation has processes for rapid referral to services that can provide definitive management of acute physical deterioration
The SA Health Accreditation Resource Standard 8: Recognising and Responding to Acute Deterioration (PDF 184KB) identifies the resources that are available to support each action.
See also the Clinician Fact Sheet Acute Deterioration.
The National Consensus Statement: Essential elements for recognising and responding to acute physiological deterioration is based on the following guiding principles:
- Recognising patients whose physiological condition is acutely deteriorating and responding to their needs in an appropriate and timely way is essential for safe and high-quality care.
- Recognition and response systems must apply to all patients, in all patient care areas, at all times.
- Overall accountability for a patient’s care rests with the attending medical officer or team, along with treating nurses and allied health. Recognition and response systems should therefore promote effective action by clinicians working in the wards, and the attending medical officer or team. This includes calling for emergency assistance when required.
- Effectively recognising and responding to acute physiological deterioration requires appropriate communication of diagnosis and overall goals of care. This involves documentation within the health care record, as well as communicating information at clinical handover and during routine clinical rounds.
- Effectively recognising and responding to acute physiological deterioration requires development and communication of plans for monitoring vital sign observations and ongoing management of the patient.
- Recognition of, and response to, acute physiological deterioration requires access to appropriately qualified, skilled and experienced staff.
- Recognition and response systems should encourage a positive, supportive response to escalation of care, irrespective of circumstances or outcome. No one should be criticised for escalating the care of a deteriorating patient.
- Care should align with the needs and expressed preferences of the patient, including previously documented advanced care plans and goals of care.
- If a patient lacks capacity to participate in decision making about their care then, when possible, the views of a substitute decision maker should be sought.
Sample observation charts
The following Rapid Detection and Response (RDR) to Clinical Deterioration Observation sample charts are used at SA Health facilities.
Adult observation charts
- Adults (MR59A) (PDF 267)
- Emergency Department (MR59A-ED) (PDF 348KB)
- Maternal 20 weeks gestation to 6 weeks postpartum (FROM MR59G) (PDF 111KB)
Paediatric observation charts
- under 3 months (MR59B) (PDF 280KB)
- 3 months to 1 year (MR59C) (PDF 282KB)
- 1 to 4 years (MR59D) (PDF 304KB)
- 5 to 11 years (MR59E) (PDF 294)
Neonate observation charts
The following tools provide further information
- Recognising and responding to clinical deterioration information sheet by observation chart parameter (PDF 1.8MB)
- Rapid Detection and Response Observation Charts: Frequently Asked Questions (PDF 84KB)
Safety and Quality
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