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ISBAR Handover / Communication Policy

May I speak with Dr. (state receivers name)


I (Introduction) This is (state callers name)
I am calling about our patient (name, HC number, location)

I am calling because state situation


Qatar Early Warning System (QEWS) S (Situation)
The latest obervations are: state significant observations

Standard Pediatric Observation Chart



This patient is ______ years old,
admitted for diagnosis , who underwent procedure (if any),
B (Background)
with previous history of relevant past medical history,
FACILITY: and is currently on: significant ongoing management
HGH WH RH NCCCR AKH HH AWH TCH OTHER A (Assessment) I think state perceived problem
Could you please come and assess the patient?

5 - 11 YEARS
R (Recommendation) Is there anything you would like me to do until you get there?
Read back a summary of the conversation

Patient Diagnosis:
REFER TO YOUR LOCAL DETERIORATING PATIENTS RESPONSE SYSTEM (DPRS) PROTOCOL FOR INSTRUCTIONS
Altered Calling Criteria Weight (kgs) Height (cms) Head Circumference (cms) ON HOW TO MAKE A CALL TO ESCALATE CARE FOR YOUR PATIENT
OTHER CHARTS IN USE Neurological Observations RBS Monitoring Sheet Growth Chart
Neurovascular Pain Scoring / Epidural Other CHECK THE HEALTH CARE RECORD FOR AN END OF LIFE CARE PLAN WHICH MAY ALTER
24 Hrs Intake & Output Chart DNAR Sheet Other THE MANAGEMENT OF YOUR PATIENT
PRESCRIBED FREQUENCY OF OBSERVATIONS
Observations must be performed routinely at least 4 hourly, unless advised below YELLOW ZONE RESPONSE
Date: Additional YELLOW ZONE Criteria
Time: Partially obstructed airway New, increasing or uncontrolled pain
Frequency Required Moderate Respiratory Effort / Distress Sternal Capillary Refill 3sec

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Poor peripheral circulation (e.g. mottled / pallor) Inconsolable
Consistent with clinical
pathway for Greater than expected fluid loss BGL 2-3mmol/L
Reduced urine output or anuria (<1mL/kg/hr) Concern by any staff, patient and family member
Resident / Specialist Agitation

5 - 11 Years Chart
Stamp and Signature
IF YOUR PATIENT HAS ANY YELLOW ZONE OBSERVATIONS OR ADDITIONAL CRITERIA YOU MUST
1. Initiate appropriate clinical care
2. Repeat and increase the frequency of observations, as indicated by your patients condition
Consultant Stamp and 3. Inform the nurse in-charge that you have called for clinical review
Signature Consider the following:
What is usual for your patient and are there documented ALTERATIONS TO CALLING CRITERIA?
ALTERATIONS TO CALLING CRITERIA Does the trend in observations suggest deterioration?
MUST BE REVIEWED WITHIN 48 HOURS OR EARLIER IF CLINICALLY INDICATED Is there more than one Yellow Zone observation or additional criterion?
Any alterations MUST be signed by a Resident/Specialist and countersigned by Consultant Are you concerned about your patient?
Document rationale for altering CALLING CRITERIA in the patients health care record
Date:
IF A CLINICAL REVIEW IS CALLED:
1. Reassess your patient and escalate according to your local DPRS if the call is not attended within 30 minutes
Time: or you are becoming more concerned
Frequency Required 2. Document an ABCDE assessment, reason for escalation, treatment and outcome in your patients health
care record
Respiratory Rate 3. Inform the consultant in-charge that a call was made as soon as it is practicable

SpO2 CONSIDER IF YOUR PATIENTS DETERIORATION COULD BE DUE TO SEPSIS, DEHYDRATION,


HYPOVOLEMIA/HEMORRHAGE, OVERDOSE/OVER SEDATION
Heart Rate

Other RED ZONE RESPONSE


Additional RED ZONE Criteria
Resident / Specialist Imminent airway obstruction Floppy
Stamp and Signature
Severe Respiratory Effort / Distress Deterioration not reversed within 1hr of clinical review
Significant Bleeding Lactate 4 mmol/L
GCS less than 14 Patient deteriorates further, before or during Clinical
Consultant Stamp and 2 point drop in GCS Review
Signature New or prolonged seizures 3 or more simultaneous yellow zone observations
BGL< 2mmol/L or symptomatic Serious concern by any staff or family member
NURSES CALL REGISTRY
DATE TIME TYPE OF CALL REASON FOR CALLING SIGNATURE
IF YOUR PATIENT HAS ANY RED ZONE OBSERVATIONS OR ADDITIONAL CRITERIA YOU MUST CALL FOR A RAPID
RESPONSE (as per local DPRS) AND
1.
1. Initiate appropriate clinical care
2.
2. Inform the NURSE IN-CHARGE that you have called for a RAPID RESPONSE
3. 3. Repeat and increase the frequency of observations, as indicated by your patients condition
4. 4. Document an ABCDE assessment, reason for escalation, treatment and outcome in your patients
health care record
5. Inform the consultant in-charge that a call was made as soon as it is practicable
15-0648/Forms
Altered Calling Criteria ALL OBSERVATION MUST BE GRAPHED
Date Date
Time Time

60 60
55
50
55
50
Qatar Early Warning System (QEWS)
per minute)
Respiratory Rate
45 45 Standard Pediatric Observation Chart
40 40
35 35
30 30
25 25 Altered Calling Criteria
(Breaths

20 20 Date Date
AIRWAY/BREATHING

15 15 Time Time
10 10
5 5 Level of LoC
Consciousness CS = Conscious, CF = Confused, S = Stupor, U = Unconscious
Normal Normal
Distress

Mild Mild Rt Rt
Resp

Moderate Moderate Lt Lt

DISABILITY
Pupil
Size
Severe Severe

100 100 1 2 3 4 5 6 7 8
(in any amount of O2)

95 95
90 90 Rt Rt

Reaction
2

Pupil
SpO

85 85 Lt Lt
80 80 B = Brisk, S = Sluggish, N = No Response, NA = Not Applicable
75 75
70 70 Glasgow Coma
Scale Score GCS

Probe Change
15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15
Probe Change

L/min or % L/min or %
41 41
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Oxygen

Device Device

Key: RA = Room Air, NC = Nasal Cannula, FM = Simple facemask, NRBM = Non Re-breather Mask, VM = Venturi Mask, TC = Trach Collar,
40.5 40.5
CPAP = Continuous Positive Airway Pressure, BiPAP = Bi-level Positive Airway Pressure
40 40
39.5 39.5
5 - 11 Years Chart

t 180 180 39 39
38.5 38.5

Temperature (oC)
170 170
160 160 38 38
37.5 37.5

EXPOSURE
150
(Apical)(Beats per minute)

150
140 140 37 37
130 130 36.5 36.5
Heart Rate

120 120 36 36
110 110 35.5 35.5
100 100 35 35
90 90 34.5 34.5
80 80 34 34
70


70
60 60 Route Route
CIRCULATION

50 50 Key: A = Axillary, O = Oral, R = Rectal, E = Aural/Ear


40 40

Girth (cms) Girth


Capillary >2 Seconds >2 Seconds
Refill <2 Seconds <2 Seconds Weight (kgs) Weight
160 160 SN Initial Initials
150 150
140 140 RESPIRATORY DISTRESS
Blood Pressure (mmHg)

130 130
Systolic Blood Pressure is trigger

120 120 MILD MODERATE SEVERE


GLASGOW COMA
110 110 SCALE
100 100 Airway Stridor on exertion Stridor at rest
Partial airway obstruction
New onset of stridor
Imminent airway obstruction
90 90 Normal Some/intermittent irritability Drowsy 4 Spontaneously
80 80 Behavior & Feeding Talks in sentences Difficulty talking or crying Agitated/confused 3 To shout

EYE
Difficulty feeding or eating Unable to talk or cry
70 70 Unable to feed or eat 2 To pain
60 60 Respiratory rate in the red zone
1 No Response
50 50 Respiratory Rate Mildly increased Respiratory rate in the yellow zone
Decreasing (exhaustion) 5 Smiles, coos appropriately
40 40 4

VERBAL
None / minimal Moderate recession Severe recession Appropriate cry
3
30 30 Tracheal tug Gasping Inappropriate cry or scream
><

Nasal flaring Grunting


20 20 Accesory Muscle Use Extreme pallor
2 Grunts
1 No Response
Cyanosis
Absent breath sounds/silent chest 5 Localizes pain
4 Flexion Withdrawal

MOTOR
Apnoeic Episodes None Abnormal pauses in breathing Apnoeic episodes
3 Decorticate flexion
Rapid Response Clinical Review Oxygen No oxygen requirement Mild hypoxaemia, corrected by oxygen Hypoxaemia, may not be 2 Decorticate extension
Increasing oxygen requirement corrected by oxygen 1 No Response

CONSIDER EARLIER ESCALATION OF PATIENTS WITH


Chronic or complex conditions Opioid Infusions
ADDITIONAL
Post-operative
Pre-Existing cardiac or
Preterm or post-term
neonates
CRITERIA FOR ESCALATION
respiratory conditions Congenital conditions ON BACK PAGE