Observation and response charts

Monitoring and documenting physiological observations is a key component of recognition and response systems. An observation and response chart is a document that allows the recording of patient observations, and specifies the actions to be taken in response to deterioration from the norm. 

The purpose of these charts is to support accurate and timely recognition of clinical deterioration, and prompt action when deterioration is observed. The way in which observation charts are designed and used can contribute to both the poor recording of observations and failure to interpret them correctly.

Observation and response charts design and specifications

Observation and response charts should:

  • be designed according to human factors principles
  • have the capacity to record the core physiological observations specified in the National Consensus Statement
  • specify the physiological parameters and other factors that trigger an escalation of care
  • specify the actions required when care is escalated.

Examples of observation and response charts 

Five track and trigger observation and response charts (ORCs) designed using human factors principles are available from the Commission.

Customising observation and response charts

The clinical and organisational aspects of the observation and response charts need to be customised for local use. The PDF files of the observation charts are not modifiable. Facilities will need access to the InDesign program to make the required modifications to the charts. The InDesign files are available on request so that  individual facilities can modify the charts for local use.

It is important to note that the Commission does not recommend making changes to the design features of the charts. These charts have been designed with the benefit of human factors expertise to ensure they are user friendly, and fit for the purpose of supporting accurate and timely recognition of clinical deterioration.

Read the report on human factors:

Making changes to observation and response charts

Changes to observation and response charts may be appropriate depending on the population and services provided. Implementing a new chart or modifying an existing chart requires a number of steps. The Commission has developed supporting resources:

Layout maps of each of the observation and response charts are available to support implementation.

Escalation mapping tool

Facilities are responsible for evaluating their systems to ensure that trigger thresholds, parameters, and responses are safe for use in the population of patients for whom they provide care. An escalation mapping exercise should be done to identify the parameters, thresholds, levels of abnormality, and responses that will be included in the recognition and response systems.

Trigger thresholds

There is little evidence regarding ideal trigger thresholds for use in recognition and response systems.

The clinical parameters and trigger thresholds included on the Commission observation and response charts have been subject to review by the program’s Advisory Committee. Trigger thresholds may need to be adjusted by some hospitals in order to increase their specificity.

Response actions included on the charts are generic placeholders only and must be altered to provide clear and specific local guidance on the process for escalating care.

Consistency

Hospitals and health services must also ensure that any action taken to change their existing observation charts are consistent with state or territory decisions or programs. For example, in NSW, use of the Between the Flags Standard Adult General Observation Chart is required in most public facilities.