Action Taken Signature Date Time Trigger And Rationale & Grade

Escalation Process

Routine physiologicalobservations

(minimum 12 hourly)

Patient triggers 3 or more on EWSS OR O2 saturation OR urine output

l Initiate 1/2 hourly or hourly cardiovascular observationsl Nurse in charge must assess patient

Do you need to escalate?NoNurse must document actions

on reverse of observation chart and confirm DNAR status

Document actions and rationale on the reverse of

the observation chart

Non-Urgentl Inform doctor

Yes

URGENT**Fast bleep doctor & CCOT

to attend immediately

l Assess patientl Consider immediate escalation for senior reviewl Implement and document management planl Review within 1 hourl Has the patient responded to treatment?

l Assess patientl Implement and document management planl Review within 1 hourl Has the patient responded to treatment?

NoYes

l Continue 2 hourly observations for a minimum of 4 hours

l Continue 1 hourly observations for a minimum of 4 hours

l Inform SpR and/or consultantl Inform CCOTl Consider referral to Radnor Ward

NoYes

**Urgent - any 1 of the followingAirwayl Patient is not maintaining an airwayBreathingl Respiratory rate > 40 or < 8l Sudden decrease in oxygen saturations to <80%Circulationl Systolic blood pressure <70l Heart rate < 40 or > 150 with a decrease in systolic blood pressureDisabilityl Sudden loss of consciousness

ESCALATION RECORD