Standard 9

Recognising and Responding to Clinical Deterioration in Acute Health Care

NSQHS Standards Standard 9 - Recognising and Responding to Clinical Deterioration in Acute Health Care

Advisory

This page contains information about the first edition of the NSQHS standards. This edition has been superseded by the second edition that was endorsed by the Health Ministers in June 2017 and released in November 2017.

This latest edition addresses the gaps that were identified in the first edition, including mental health and cognitive impairment, health literacy, end-of-life care, and Aboriginal and Torres Strait Islander health.

Health service organisations will be assessed to the second edition from January 2019.

To find information and resources for the second edition, visit the Australian Commission on Safety and Quality in Health Care's new NSQHS Standards microsite.

Key messages

  1. Serious adverse events such as unexpected death or cardiac arrest are often preceded by observable physiological abnormalities.
  2. Recognition and response systems aim to ensure that patient deterioration is recognised promptly and receives appropriate and timely treatment.
  3. Action taken during early stages of deterioration can prevent further patient harm.
  4. Families and carers must be informed about processes to escalate care as they are familiar with the patient and may recognise signs of early deterioration.

Introduction

Recognising that a patient’s condition is deteriorating and responding to their needs in an appropriate and timely way is an essential component of safe and high quality care.

Serious adverse events such as unexpected death and cardiac arrest often follow observable deterioration in the patient’s condition. Early identification of deterioration, followed by prompt and effective action, can minimise the occurrence of these events, and may improve outcomes and lessen the level of intervention required to stabilise patients whose condition deteriorates.

There is evidence that the warning signs of clinical deterioration are not always identified or acted on appropriately. The organisation and workforce factors that contribute to a failure to recognise and respond to a deteriorating patient are complex and overlapping. Systems to recognise deterioration early and respond to it appropriately need to deal with all of these factors, and need to apply across a healthcare facility.

The aim of this Standard is to ensure a patient’s deterioration is recognised promptly, and appropriate action is taken. The Standard applies to all patients in acute healthcare facilities including adults, adolescents, children and babies, and to all types of patients including medical, surgical, maternity and mental health patients. Acute healthcare facilities range from large tertiary referral centres, to small district and community hospitals. This Standard does not apply to deterioration of a patient’s mental state.

Facts and Figures

Factors that contribute to failure to recognise and respond to deteriorating patients include:

  • not monitoring physiological observations consistently or not understanding observed changes in physiological observations
  • lack of knowledge of signs and symptoms that could signal deterioration
  • lack of formal systems for responding to deterioration
  • lack of skills to manage patients who are deteriorating
  • failure to communicate clinical concerns, including in handover situations.

In brief this Standard requires that

  • Health services use organisation-wide systems consistent with the National Consensus Statement to support and promote recognition of, and response to, patients whose condition deteriorates in an acute health care facility.
  • Patients whose condition is deteriorating are recognised and appropriate action is taken to escalate care.
  • Appropriate and timely care is provided to patients whose condition is deteriorating.
  • Patients, families and carers are informed of recognition and response systems and can contribute to the processes of escalating care.

Information above is taken directly from the Safety and Quality Improvement Guide Standard 9: Recognising and Responding to Clinical Deterioration in Acute Health Care, October 2012 document published in the Australian Commission on Safety and Quality in Health Care website.

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Responsibilities under Standard 9 include:

  • assess and monitor patient, including physiological observations
  • measure and document observations:
    • with appropriate frequency
    • on an observation chart incorporating track and trigger systems
  • understand the significance of physiological observations and assessment in identifying clinical deterioration
  • communicate effectively with other clinicians to ensure the transfer of critical information
  • respond to clinical deterioration in a timely manner
  • escalate care until satisfied with the patient’s condition
  • assist patients and families to escalate care if they have concerns
  • are competent to provide basic life support
  • educate patients and carers about their role in recognising and reporting signs of clinical deterioration and escalating care when necessary
  • support colleagues to escalate care as required.

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Further information

Below is a full copy of the Recognising and Responding to Clinical Deterioration in Acute Health Care contained in the National Safety and Quality Health Service Standards. It includes the criteria, items and actions required for health services to meet this Standard and is available on the Commission’s website at www.safetyandquality.gov.au.

  • Download Safety and Quality Improvement Guide Standard 9: Recognising and Responding to Clinical Deterioration in Acute Health Care, October 2012