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 should:
Five track and trigger observation and response charts (ORCs) designed using human factors principles are available from the Commission.
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.
It is imperative to read the ORC fact sheets below prior to making modifications and implementing a chart.
One of the developmental criteria in National Safety and Quality Health Service Standard 9: Recognising and Responding to Clinical Deterioration in Acute Health Care is that when using a general observation chart, it is designed according to human factors principles. If acute health facilities are not using a state-wide observation chart, or one of the Commission observation and response charts, then to meet this criteria they must demonstrate that any non-approved modifications have been formally tested to assess potential risks. See EE1 ORC2 fact sheet Modifying the observation and response chart for local use (PDF 215KB) for a list of approved modifications.
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. The Commission has developed an escalation mapping tool (PDF 290 KB). A worked example of the escalation mapping tool (PDF 452 KB) is also available.
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.
In addition, it is necessary for hospitals and health services to 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.