Recognising and Responding to Acute Deterioration Standard

Safety and quality systems support clinicians in recognising and responding to acute deterioration.

• How are the health service organisation’s safety and quality systems used to:
  • support implementation of policies and procedures for recognising and responding to acute deterioration
  • identify and manage risks associated with recognising and responding to acute deterioration
  • identify training requirements for recognising and responding to acute deterioration?

• Establish and implement governance structures for recognising and responding to acute deterioration
• Develop and implement policies and procedures for recognising and responding to acute deterioration
• Use risk management systems to identify, monitor, manage and review risks associated with recognising and responding to acute deterioration
• Develop and provide training to the workforce on recognising and responding to acute deterioration.

Quality improvement systems are used to support recognition of, and response to, acute deterioration.

• How are the health service organisation’s recognition and response systems continuously evaluated and improved?
• How are the outcomes of improvement activities reported to the governing body, the workforce, consumers and other organisations?

• Review, measure, and assess the effectiveness and performance of, recognition and response systems
• Implement quality improvement strategies for recognition and response systems based on the outcomes of monitoring activities
• Provide information on the outcomes of quality improvement activities to the governing body, the workforce, consumers and other organisations.

Clinicians understand the systems for partnering with consumers and use them when recognising and responding to acute deterioration.

• What processes from the Partnering with Consumers Standard do clinicians use to involve patients in planning and making decisions about recognising and responding to acute deterioration?
• How does the health service organisation collect feedback from patients about information provided on recognising and responding to acute deterioration?

• Review strategies in the Partnering with Consumers Standard to inform the implementation of actions in the Recognising and Responding to Acute Deterioration Standard
• Provide information to patients about recognition and response systems tailored to their specific needs and level of health literacy.

Patients with acute physiological deterioration are identified early.

• What systems are in place for documenting vital sign monitoring plans?
• What processes are used to ensure that there is enough equipment for patient monitoring?
• How does the health service organisation ensure that clinicians have the skills to monitor patients according to their monitoring plan?
• What processes are in place for documenting vital sign observations graphically and over time?

•  Implement a system for documenting vital sign monitoring plans
• Ensure that clinicians have the necessary skills and equipment to monitor patients as required by their individualised monitoring plans
• Implement an observation chart or other mechanism for graphically documenting vital sign observations and tracking changes over time.

Adverse outcomes relating to acute deterioration in a person’s mental state are prevented through early recognition and effective response.

• How does the health service organisation ensure that clinicians are trained to be alert for the signs of acute deterioration in a person’s mental state?
• How does this apply to people who have not been identified as being at high risk of deterioration in mental state?

• Use comprehensive care plans to guide monitoring of people who are at risk of acute deterioration in mental state, incorporating knowledge from the person, and their carers and families about individual early warning signs
• Ensure that members of the workforce are alert to signs of deterioration in a person’s mental state, including for people who have not been previously identified as being at high risk
• Ensure that members of the workforce are alert to the signs of delirium
• Ensure that members of the workforce can implement an initial response and keep the person safe until arrangements are made for specialist review.

The health service organisation has an effective system for escalation of care to minimise risks for patients who are acutely deteriorating.

• What protocols are used to specify the criteria for escalating care?

• Work with clinical groups to agree on parameters that indicate acute deterioration and require escalation of care
• Develop and implement protocols for escalating care when acute deterioration in a patient’s condition is detected.

Patients, family members and carers can directly escalate care.

• What processes are in place for patients, carers or families to directly escalate care?

• Develop and implement a system for patients, carers and families to directly escalate care.

The health service organisation has mechanisms for the workforce to escalate care.

• What mechanisms are in place for the workforce to escalate care and call for emergency assistance?

• Provide the workforce with mechanisms to escalate care and call for emergency assistance.

Members of the workforce take prompt action to deal with acute deterioration.

• How does the health service organisation ensure that the workforce knows how and when to use the recognition and response systems?

• Escalate care when acute deterioration is recognised.

Clinicians have the skills and knowledge to deal with deterioration, as appropriate for their role.

• How does the health service organisation ensure that clinicians are competent in the skills required to respond to patients whose condition is acutely deteriorating?

• Develop systems to ensure that clinicians are competent in the skills required to respond to patients whose condition is deteriorating.

Expert input and assistance is available to manage acute physiological deterioration.

• What processes are in place to ensure that clinicians who are competent in providing advanced life support are available to respond to patients who acutely deteriorate?

• Provide a system to ensure rapid access to advanced life support for patients who acutely deteriorate.

Care for patients whose mental state is deteriorating is escalated safely and effectively.

• How does the health service organisation ensure that the workforce knows the local processes for escalating care to mental health specialists?
• What partnerships are in place to help patients gain access to mental health services if they are not provided within the health service organisation?
• How are patients, carers and families informed about rapid referral to mental health services?

• Develop a protocol for escalating care when a person’s mental state is deteriorating, which includes designation of roles and responsibilities for members of the healthcare workforce and time frames for response
• Develop partnerships with other relevant organisations if responding to acute deterioration in a person’s mental state is outside the scope of the health service organisation
• Ensure that members of the workforce are aware of, and use, the escalation protocol.

Patients who need other services to resolve the cause of their acute deterioration are rapidly referred to these services.

• What services may be required by patients who acutely deteriorate but cannot be safely provided?
• What referral mechanisms are in place to ensure that patients whose acute deterioration cannot be definitively managed within the health service organisation are rapidly referred to other organisations?

• Map the causes of acute deterioration against the capacity of the health service organisation to provide for their definitive management
• If the organisation is not able to provide definitive care, develop systems for rapid referral of patients with acute deterioration to other services.