Date Date Surname: ...... NHI: ...... Vital Signs EWS Time (24 hour) Time (24 hour) First Names:...... > 35 MET > 35 Date of Birth: ...... /...... /...... Sex: ...... 25-35 3 25-35 Respiratory Rate 21-24 2 21-24 PLACE PATIENT ID HERE (breaths/min) 12-20 0 12-20 9-11 1 9-11 write value in box Radiology Interventional Recovery Ward 5-8 3 5-8 < 5 MET < 5 Vital Signs Chart Supplemental O2 write value L/min 2 L/min Medical Staff Modification to Early Warning Score (EWS) Triggers ≥ 96 0 ≥ 96 O2 Saturation(%) 94-95 1 94-95 The EWS can be changed to prevent chronic disease incorrectly triggering escalation. write value in box 92-93 2 92-93 This can only be authorised by a Consultant or Registrar and should be regularly ≤ 91 ≤ 91 3 reviewed by the primary team. Ignore any modification that is not signed & dated. ≥ 39s 2 ≥ 39s Temperature 38s 1 38s Accepted Values & Date Doctors name, (oC) Vital Sign 37s 37s Modified EWS & time designation & contact details 0 36s 36s mark with X / / 35s 1 35s write value if off scale : ≤ 34s 2 ≤ 34s Write ≥ 220 3 Write ≥ 220 / / : 210s 210s / / 200s 200s : 190s 190s Blood Pressure / / 180s 180s (mmHg) : 170s 170s / / NOT FOR CPR NOT FOR MET score systolic 160s 0 160s : value only 150s 150s All limitations must be documented in the patient’s clinical record. 140s 140s 130s 130s Mandatory Early Warning Score Escalation Pathway 120s 120s Total Early Warning Score Mandatory Action 110s 110s 100s 1 100s EWS 1-5 ▪▪ Manage pain, fever or distress Increase frequency of vital sign monitoring 90s 2 90s or any vital sign in yellow zone ▪▪ 80s 80s EWS 6-7 3 70s 70s or any vital sign in ▪▪ Inform nurse in charge House officer review Refer to Patient At Risk 60s 60s orange zone ▪▪ MET within 60 minutes (PAR) nurse #6785 50s 50s Acute illness or unstable ▪▪ Increase frequency Write ≥ 140 MET Write ≥ 140 chronic disease of vital signs 130s 3 130s ▪▪ Document plan including EWS 8-9 Registrar review 120s 120s intervention, escalation 2 or any vital sign in red zone within 20 minutes & 110s 110s & review timeframe suggest ICU referral Heart Rate 100s 100s Likely to deteriorate rapidly (bpm) 1 90s 90s EWS 10+ ▪▪ Dial 777 80s or 80s any vital sign in blue zone ▪▪ State ‘Medical Emergency Team’ mark with X 70s 70s & give your location 0 Immediately life threatening 60s 60s critical illness ▪▪ Support Airway, Breathing & Circulation 50s 50s 40s 2 40s CALL 777 FOR ANY PATIENT YOU ARE WORRIED ABOUT 30s MET 30s REGARDLESS OF VITAL SIGNS OR EWS Alert 0 Alert Level of Consciousness Voice / Pain 3 Voice / Pain A full set of vital signs with corresponding EWS must be taken & calculated each time Unresponsive MET Unresponsive at the frequency stated in the ‘Essential Vital Sign Measurement - Adult Inpatients’ EARLY WARNING SCORE TOTAL EWS TOTAL protocol. If there is no timely response to your request for review, escalate to the next coloured zone Pain write score (0-10) = satisfactory Each vital sign is scored according to the coloured zone it falls within (see key below) Wound site = refer to notes = present Any patient receiving supplemental oxygen automatically scores 2, regardless of rate Pulse Hand / Foot = absent = satisfactory Neurovascular Obs CWMS = refer to notes Pressure (mmHg) or Early Warning Score Colour Key Vascular compression air removed (mL) 0 1 BSL mmol / L 2 3 MET: MEDICAL EMERGENCY TEAM Capital Docs ID: 1.102512 | Issue date: August 2015 | Review date: August 2019 Surname: ...... NHI: ...... RADIOLOGY INTERVENTIONAL RECOVERY WARD Date: / / First Names:...... ADULT FLUID BALANCE CHART Date of Birth: ...... /...... /...... Sex: ...... Weight: PLACE PATIENT ID HERE Input (mls) Output (mls) Oral / Bolus (I/V) enteral intake (pushed) Line 1 (I/V) Line 2 (I/V) Line 3 (I/V)

RUNNING RUNNING TOTAL Time Urine / Vomit loss NG Bowels / stoma Drain(s) Running total Time pH Aspirate typeFluid Feeding Method (PO/NG/NJ/PEG) amount / Rate volume Total given typeFluid given Volume volume Total infused typeFluid Rate Total typeFluid Rate Total typeFluid Rate Total 2 hrly Phlebitis score signature Nurse’s 0000 0000 0100 0100 0200 0200 0300 0300 0400 0400 0500 0500 0600 0600 0700 0700 0800 0800 8 hr 8 hr total total 0900 0900 1000 1000 1100 1100 1200 1200 1300 1300 1400 1400 1500 1500 1600 1600 8 hr 8 hr total total 1700 1700 1800 1800 1900 1900 2000 2000 2100 2100 2200 2200 2300 2300

8 hr 24 hr Input total

24 hr Output

INTRAVENOUS ‘FLUID TYPE’ ABBREVIATIONS PHLEBITIS SCORE: 0 1 2 3 4 5 24 hr Balance (indicate + or -) • NS = 0.9% Saline • FFP = Fresh Frozen Plasma • IVM = IV medications • D5 = 5% dextrose All of 4 and: Slight: Two of: All of: All of 3 and: exudate, • NSD = 0.9% Saline + 5% Dextrose • IVAB = IV antibiotics • D10 = 10% dextrose • TPN = Aqueous IV SITE: Site healthy pain or pain, redness pain, redness, palpable thrombosis redness or swelling swelling venous cord • Plt = Platelets • Alb = Albumin • LIP = Lipids • RBC = Blood and/or pyrexia