Excerpt

Patients who are admitted to hospital believe that they are entering a place of safety, where they, and their families and carers, have a right to believe that they will receive the best possible care. They feel confident that, should their condition deteriorate, they are in the best place for prompt and effective treatment.

Yet there is evidence to the contrary. Patients who are, or become, acutely unwell in hospital may receive suboptimal care. This may be because their deterioration is not recognised, or because – despite indications of clinical deterioration – it is not appreciated, or not acted upon sufficiently rapidly. Communication and documentation are often poor, experience might be lacking and provision of critical care expertise, including admission to critical care areas, delayed.

We have endeavoured to produce practical guidance with recommendations for the measurement and recording of a set of physiological observations, linked to a ‘track and trigger’ system (see section 2.1.1). We have emphasised the importance of a full clinical assessment, and of tailoring the written monitoring and management plans to the individual patient’s clinical circumstances. Throughout the document we have emphasised the importance of training; by ensuring that routine measurements are accurately taken and recorded by staff that understand their clinical relevance, and by linking these observations to a graded track and trigger system, care can be escalated appropriately. The foundations for patient safety are laid through doing and recording simple measurements well and having agreed response strategies in place.

Contents

• Foreword
• 1. Summary
  • 1.1. Patient-centred care
  • 1.2. List of recommendations and care pathway
  • 1.3. Overview
• 2. Evidence review and recommendations
  • 2.1. Identification and evaluation of risk scoring tools
  • 2.2. Response strategies for patients identified as having a deteriorating clinical condition
  • 2.3. Transfer of patients from critical care areas
  • 2.4. Research recommendations
• 3. Methods
  • 3.1. Scope and purpose
  • 3.2. Contributors
  • 3.3. Development methods
  • 3.4. Declarations
• 4. References, glossary and abbreviations
  • 4.1 Reference list
  • 4.2 Glossary
  • 4.3 Abbreviations
• Appendices
  • 5.1 Appendix 1. The Scope
  • 5.2 Appendix 2. Key Clinical Questions
  • 5.3 Appendix 3. Search Strategies
  • 5.4 Appendix 4. Evidence Tables
  • 5.5. Inclusion and Exclusion Criteria

NICE clinical guidelines are recommendations about the treatment and care of people with specific diseases and conditions in the NHS in England and Wales

This guidance represents the view of the Institute, which was arrived at after careful consideration of the evidence available. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. The guidance does not, however, override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer and informed by the summary of product characteristics of any drugs they are considering.