Resuscitation Policy - Royal United Hospital Bath NHS Trust

Appendix 1: Escalation of Treatment Flow ChartDecision made about frequency of vital signs assessment (made by medical team aspart of management plan, local ward standards or as part of care plan)Monitoring plan delivered as agreed. Consider trigger reset if treatment optimal or ifchronic ill health makes threshold of 4 unsuitable (experienced nurse / doctor only)EWS = 0EWS = 1-2EWS = 3Observe (no immediate action)Observe (HCA must report observations & score tonurse)Repeat Respiratory Rate recording, Pulse, Bloodpressure, Oxygen saturation, GCS or AVPUCalculate urine output for last two hours (if known)Recalculate EWSIf the same observe closely(HCA must report observations and score to nurse)ConsiderOutreach orNNP supporton grounds ofclinicalconcern onlyEWS = 4Level of doctorcontacted willvary in differentareasEnsure that all treatment options have been used.Repeat Respiratory Rate recording, Pulse, Bloodpressure, Oxygen saturation, GCS or AVPURecalculate EWSEnsure that EWS trigger has not been re-setContact doctor immediately (according to local protocol)(HCA must report observations and score to nurse)Considercritical careoutreach ornight nursepractitionersupportEWS greaterthan 4Patient is at risk of deterioration and complications. Iftreatment plan is not appropriate or in place escalatetreatment with urgency and seek medical reviewRESUSCITATION TEAM CALLING CRITERIAON FINDING ANYONE INOR• Cardiac arrest• Respiratory arrest• Unrousable / not responding to painWith one or more of the following signs:• Respiratory rate < 8 per minute• Respiratory rate > 30 per minute• Heart rate < 40 per minute• Heart rate > 150 per minute• BP < 90 systolic• Oxygen saturation < 90% Dial 2222If EWS ishigh, suddendeteriorationis likely.Document name: Resuscitation Ref.: 774Issue date: 7 February 2013Status: ApprovedAuthor: Jerry Nolan Page 12 of 25