CHHS18/073

Canberra Hospital and Health ServicesOperational Procedure Patient & Family Escalation Process - Call And Respond Early (CARE) for Patient Safety Contents

Contents....................................................................................................................................1

Purpose.....................................................................................................................................3

Alerts.........................................................................................................................................3

Scope........................................................................................................................................ 3

Section 1 – CARE Information for patients and carers..............................................................3

Section 2 – Staff Responsibilities...............................................................................................4

Section 3 – CARE calling criteria and process............................................................................4

Section 4 – UCH CARE Process..................................................................................................6

Implementation........................................................................................................................ 7

Related Policies, Procedures, Guidelines and Legislation.........................................................7

References................................................................................................................................ 8

Definition of Terms...................................................................................................................9

Search Terms.......................................................................................................................... 10

Attachments............................................................................................................................10

Attachment 1 – Switch CARE call flow chart.......................................................................11

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What is your call

regarding?

Medical management or discharge

plan

Complaint or

compliment YES

Medical condition

getting worse

Refer to ward CNC/Nursing Team Leader

"I will now transfer you to the CARE

Nurse"0478407073

If call is unanswered - "You have come back

unanswered, may I take your name, number and ward and I

will have the nurse call you back soon".

Text CARE Nurse0478407073

Regarding missed CARE call

CARE Nurse contact switch regarding CARE call details

YES

Stay on line to ensure that you

have been connected.

YES

............................................................................................................................................ 11

Attachment 2 – Guidelines for Responders.........................................................................12

Attachment 3 – Referral of a call that is not relating to medical deterioration...................14

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Purpose

The Call And Respond Early (CARE) program is a patient and family escalation program that respects and values the input from patients, their carers and family members in the coordination of clinical care. This program ensures compliance with Standard 9 (Recognising and Responding to Clinical Deterioration in Acute Health Care) and Standard 2 (Partnering with Consumers) of the National Safety and Quality Health Service Standards.

The purpose of this operational procedure is to provide staff with guidance on how to respond when patients and their family/carers raise their concerns regarding clinical deterioration of the patient and when they believe their concerns regarding clinical deterioration are not being responded to by ward clinician(s).

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Alerts

CARE responders will only respond in ward areas where the patient is located and for safety reasons will not respond outside ward areas.

This process does not replace the Code Blue Medical Emergency process. In the event that the patient is identified as requiring urgent medical assistance a Code Blue should be activated by staff.

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Scope

This operational procedure pertains to all patients on the Canberra Hospital and the University of Canberra Hospital (UCH) campus.

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Section 1 – CARE Information for patients and carers

Information will be made available on the wards for patients and families/carers through: CARE for Patient Safety Posters at every ward entrance and every bedspace Information in the ACT Health Guide to the Canberra Hospital booklet and the University

of Canberra Hospital Booklet.

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Section 2 – Staff Responsibilities

Ward staff will: Communicate with their patients about the CARE for Patient Safety process on

orientation to the ward and at the beginning of each shift Engage with patients and families to address concerns as they arise on the ward.

Team Leaders will: Ensure that all newly admitted patients and their families/carers have received

information regards to CARE for Patient Safety Process Ensure all ward staff are familiar with CARE for Patient Safety and are able to convey the

information to patients and their families/carers Engage with patients and families to address concerns as they arise on the ward.

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Section 3 – CARE calling criteria and process

Calling criteria: Patients who feel their medical condition is deteriorating and feel they are not receiving

an adequate response from the staff on the ward can use this process. Family members or carers can use this process if they are concerned the patient’s

medical condition is deteriorating and feel there is not an adequate response from the ward staff.

Process for CARE for Patient Safety:1. Patients/family members/carers will talk to their nurse/midwife or doctor regarding their

concerns2. If patients/family members/carers are still concerned after the response from their

nurse/midwife or doctor they will talk to the nurse/midwife in charge of the shift regarding their concerns

3. If patients/family members/carers are still concerned, they may phone 62443337, to activate a CARE response.

CARE Responders will be either: Medical Emergency Team (MET)/Outreach nurse from 07:30 hours to 15:30 hours

Monday to Friday (excluding public holidays) Afterhours CNC from 15:30 hours to 07:30 hours and 24hour coverage for weekends and

public holidays Alternative senior trained CARE responders can be used to meet operational demands.

These staff will be up to date in Basic Life Support (BLS), COMPASS training, and have completed training in responding to and documentation of CARE calls.

Process to talk to a CARE responder:

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Patients/family members/carers phone 62443337 and will speak to a switchboard representative

The switchboard staff member will use the Switch CARE call flow chart at Attachment 1 to determine if the caller requires a CARE response

The caller will either be transferred to the CARE mobile phone or they will direct the call via normal switchboard procedures

If the call is unanswered by the CARE nurse, the call will return to switch and they will take the name, number and ward

Switch will then forward this information to the CARE nurse mobile phone via text message.

Responders will: Answer the phone as a priority Introduce themselves Establish the caller’s concern Establish patient’s identification Establish the ward/unit area they are calling from Review the patient within 10 minutes Inform the caller when they arrive to see the patient In the event that the responder is unable to promptly follow up on the call due to a

conflicting Code Blue Medical Emergency, the responder is to contact the CNC/team leader of the area to review the patient in the interim until a CARE review can be made

All face to face contact is to occur on the ward location of the patient. If required the CARE responder can request to use a meeting room or office on the ward for more private discussion but due to personal safety the responder should not meet outside of the ward location

Obtain the patient’s or family member/carer’s consent Assess the patient, address concerns and refer as appropriate (see Attachments 1&2) Liaise with ward nursing/midwifery staff and the home team as appropriate Call a Code Blue if the patient meets the criteria Communicate to the ward nursing/midwifery staff and document any action taken,

including instructions regarding ongoing management in the patient’s clinical record Provide feedback to the family member/carer who made the call if patient has given

consent to the feedback Record CARE call details under responder profile in Riskman

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Section 4 – UCH CARE Process

Procedure As per Section 2 of the CHHS procedure

Calling criteria As per Section 3 of the CHHS Procedure

Process for CARE for Patient Safety: As per Section 3 of the CHHS Procedure

CARE Responders will be either: Hospital Emergency Response Officer (HERO) CNC from 07:30 hours to 15:30 hours

Monday to Friday (excluding public holidays). After hours hospital manager from 15:30 hours to 07:30 hours and 24hour coverage for

weekends and public holidays. Alternative senior trained CARE responders can be used to meet operational demands.

These staff will be up to date in Basic Life Support (BLS), COMPASS, and have completed training in responding to and documentation of CARE calls.

UCH Process to talk to a responder: Patients/family members/carers phone 62443337 and will speak to a switchboard

representative If the switchboard staff member determines that the caller is not requiring a CARE

response they will direct the call via normal switchboard procedures Switchboard staff will ascertain if it is a CARE call and transfer the call to the CARE nurse

mobile phone for UCH If the call is unanswered by the CARE nurse, the call will return to switch and they will

take the name, number and ward Switch will then forward this information to the CARE nurse mobile phone via text

message.

Responders will: Answer the phone as a priority Introduce themselves Establish the caller’s concern Establish patient’s identification Establish the ward/unit area they are calling from Review the patient within 10 minutes Inform the caller they will arrive to see the patient In the event when the responder is unable to promptly follow up the call due to a

conflicting Medical Emergency, the responder is to contact the CNC/team leader of the area to review the patient in the interim until a review can be made

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In the event the concern is about a patient on the CNC’s own ward where they have already been involved in the concern referral should be made to an alternative CNC for independent review.

All face to face contact is to occur on the ward location of the patient. If required the CARE responder can request to use a meeting room or office on the ward for more private discussion but due to personal safety the responder should not meet outside of the ward location

Obtain the patient’s consent Assess the patient, address concerns and refer as appropriate (see Attachment 1 & 2) Liaise with ward nursing staff and the home team as appropriate Call a Code Blue/HERO call if the patient meets HERO criteria Communicate to the ward nursing staff and document any action taken, including

instructions regarding ongoing management in the patient’s clinical record Provide feedback to the person who made the call if patient has given consent to the

feedback Record CARE call details under responder profile in Riskman

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Implementation

Clinical Staff will receive education on the CARE program and process, at orientation and mandatory update days through the COMPASS education program.

CARE responders will be educated on the CARE response and data recording by contacting the Early Recognition of the Deteriorating Patient Program Officer as part of orientation to their roles.

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Related Policies, Procedures, Guidelines and Legislation

Policies Nursing and Midwifery Continuing Competence Policy Consent and Treatment

Procedures Vital signs and early warning scores Clinical Procedure Code Blue Emergency Management Plan Clinical Policy Patient Identification & Procedure Matching Consent and Treatment Policy Violence and Aggression by patients, Consumers or Visitors: Prevention and

Management Policy

Guidelines National Safety and Quality Health Service Standards: Standard 9 – Recognising and Responding to Clinical Deterioration.

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o Criterion 4- Communicating with patients and carers- 9.7- Ensuring patients, families and carers are informed about, and are supported

so that they can participate in recognition and response systems and processes.- 9.9- Enabling patients, families and carers to initiate an escalation of care

response. Standard 2 – Partnering with Consumers

o Criterion 2- Consumer partnership in designing care- 2.6- Implementing training for clinical leaders, senior management and the

workforce on the value of and ways to facilitate consumer engagement and how to create and sustain partnerships.

Legislation Health Records (Privacy and Access) Act 1997 Human Rights Act 2004 Work Health and Safety Act 2011

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References

1. AHRQ innovations Exchange –“Patient – and Family- Activated Response Team Averts Potential Problems and Generates High Levels of Patient , Family, and Staff Satisfaction”. Retrieved from www.innovations.ahrq.gov/content.aspx?id=1759

2. Australian Commission on Safety and Quality in Health Care – “ Escalating Care in Response to Clinical Deterioration: Systems for Enabling Patients, Families and Carers to Call for Help”- Retrieved from http://www.safetyandquality.gov.au

3. Baird, S.K., Turbin,L.B., (2011) – “Condition Concern, An Innovative Response System for Enhancing Hospitalized Patient Care and Safety” Journal Of Nursing Care Quality 2011 pp 1-9.

4. Bogert, S., Ferrell,C., Rutledge, D.N., CNE Series MEDSURG NURSING July/August 2010 Vol.19/No.4 “Experience with Family Activation Of Rapid Response Teams” pp215 – 223.

5. Gerdik, C., Vallish, R.O.Miles,K., Godwin,S.A., Wludyka,P.S., Panni,M.K., “Successful implementation of a family and patient activated rapid response team in an adult level1trauma center” – Resuscitation 81 (2010) 1676 – 1681.

6. Gilleland J., Department of Paediatrics, Division of Critical Care Hamilton Health Sciences, McMaster Children’s Hospital Hamilton Ontario- “ The Experience with Family Triggered Activation of the Critical Care Response Team at an Academic Children’s Hospital in Ontario” – Retrieved from www.marylandpatientsafety.org/

7. Greehouse,P.K., Kuzminsky,B., Martin, S.C., Merryman,T., Calling a Condition H(elp) “One facility gives patients and Families the ability to summon a rapid response team”. American Journal of Nursing Volume 106 (11) November 2006 pp 63 – 66.

8. Healthcare Risk Management – February 2006 Vol28.NO.2.(pages 13 -24) – “Condition H phone lines provides last chance to prevent serious errors” ‘Family or patient can

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make emergency call if no one will listen’ – Downloaded from www.njha.com/qualityinstitute/pdf/616200661528PM35.pdf

9. Josie King Foundation, ‘Condition H _ the Josie King Call .... A help line for families’ - retrieved from www. josieking .org

10. Maryland Patient Safety Center 2009 : ‘ Condition Help (H) Toolkit – Implementing Condition H in Your Hospital www.marylandpatientsafety.org

11. N.C. Children’s Center for Clinical Excellence 2005 ‘Pediatric Rapid Response System. Retrieved from www.med.unc.edu/cce/... /pediatric-rapid-response-system

12. Odell, M., Gerber, K., Gager, M., - “Call 4 Concern: patient and relative activated critical care outreach” British Journal of Nursing, 2010 Vol 19 No; 22 pp 1390 – 1395.

13. Smith, L.W., Giuliano, K.K., “Rapid Response Teams: Improve Patient Safety & Patient Outcomes” – Technology Today AACN Advanced Critical Care Volume 21 November 2 pp 126 – 129, 2010.

14. Strategies for Nurse Managers.com 2011 CE Article: “ New rapid response teams stress family involvement” – retrieved fromwww.strategiesfornursemanagers.com/ce_detail/223394.cfm

15. Schade Willis,T., Pediatric Critical Care Medicine 2011 Power Presentation ... “Family Activation of Pediatric Rapid Response Systems”- retrieved from rapidresponsesystems.org /Pittsburgh2010/.../Family_Act_Ped_RRS_Willis. Pdf

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Definition of Terms

ADON – Assistant Director of NursingADO – Allocated Day OffAHCNC – After Hours Clinical Nurse ConsultantBLS – Basic Life SupportCARE – Call And Respond EarlyCNC – Clinical Nurse ConsultantCHHS – Canberra Hospital and Health ServicesDON – Director of NursingMET – Medical Emergency TeamMEWS – Modified Early Warning ScoreR/V – ReviewT/L – Team Leader

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Search Terms

CARE, Patient and family escalation, MET, Code Blue, clinical deterioration

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Attachments

Attachment 1 – Switch CARE call flow chart Attachment 2 – Guidelines for RespondersAttachment 3 – Referral of a call that is not relating to medical deterioration

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Services specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Policy Team ONLY to complete the following:Date Amended Section Amended Divisional Approval Final Approval 21/02/2018 Complete Review Narelle Boyd, ED Crit

CareCHHS Policy Committee

This document supersedes the following: Document Number Document NameCHHS13/579 Patient and Family Escalation Process SOP

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Attachment 1 – Switch CARE call flow chartWhat is your

call regarding?

Medical management or discharge

plan

Complaint or

compliment YES

Medical condition

getting worse

Refer to ward CNC/Nursing Team Leader

"I will now transfer you to the CARE

Nurse"0478407073

If call is unanswered - "You have come back

unanswered, may I take your name, number and ward and I

will have the nurse call you back soon".

Text CARE Nurse0478407073

Regarding missed CARE call

CARE Nurse contact switch regarding CARE call details

YES

Stay on line to ensure that you

have been connected.

YES

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Attachment 2 – Guidelines for Responders

When assessing a patient following a CARE for Patient Safety call, the following may be of assistance with decision making.

STEP 1 - Nurse/Midwife/Doctor – Has the patient or their family member/carer spoken to the nurse/midwife/doctor regarding their concern?STEP 2 – Nurse/Midwife in Charge – Has the patient/family member/carer spoken to the Nurse/Midwife in charge of the shift regarding their concerns?STEP 3 – CARE for Patient Safety call – What are the concerns of the person who made the call?

Concern Business Hours Outside Business HoursMeets MET criteria Call a Code Blue/MET Call a Code Blue/MET

MEWS/PEWS 4 or more Assist local staff to call relevant home team doctor based on score (Intern, Registrar, Consultant).

Educate and involve the treating nurse/doctor re: The action you are taking/took, the reason and the follow up that will be provided.

Assist local staff to call relevant home team doctor based on score:MEWS 4-5 = InternMEWS 6-7 = RegistrarMEWS ≥8 = Registrar urgent R/V & contact ConsultantPEWS 4-5 = Nursing T/L or JMOPEWS 6-7 = RegistrarPEWS ≥8 = Registrar urgent R/V & contact Consultant

Pain Assessment of the patient and location of the pain combined with a full MEWS score will be required prior to escalating the call.The home team and/ or Pain Team may be of assistance.

Assessment of the patient and location of the pain combined with a full MEWS score will be required prior to escalating the call.

The on call medical officer or Anaesthetic Registrar may be of assistance.

Unsure of plan of care Notify the CNC or team leaderContact home team

Clarify plan from notes if possible, if non urgent handover to home team in am. If urgent contact relevant cover medical officer.

Results of tests Notify the CNC or team leaderContact home team

If non urgent or no results yet available handover to home team in am. If urgent contact relevant cover medical officer

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Concern Business Hours Outside Business HoursDisagreement with ward nursing staff

Ensure that the CNC for the area is involved/aware.

If CNC or team leader already aware refer to ADON via mobile (See attachment 2).

Act as liaison between staff and patient/family. Contact consumer engagement team if unresolved-6207 7627. Provide family with consumer feedback information.

Ensure the team leader is aware.

If team leader already aware refer to A/H CNC &/ AHHM (See attachment 2).

Act as liaison between staff and patient/family. Leave a message with consumer engagement team if unresolved- 6207 7627. Contact social worker if appropriate. Provide family with consumer feedback information.

Disagreement with ward medical staff

Ensure that the CNC for the area is involved/aware.

If CNC or team leader already aware refer to ADON via mobile (See attachment 2).Act as liaison between staff and patient/family. Contact Consultant if not present. Contact consumer engagement team if unresolved-6207 7627. Contact social worker if appropriate. Provide patient/ family with complaints information.

Ensure the team leader is aware.

If team leader already aware refer to A/H CNC &/ AHHM (See attachment 2).

Act as liaison between staff and patient/family. Contact Consultant if not present. Leave a message with consumer engagement team if unresolved-6207 7627. Contact social worker if appropriate. Provide patient/family with consumer feedback information.

Disagreement between family members

Ensure that the CNC for the area is involved/aware.

If CNC or team leader already aware refer to ADON via mobile (See attachment 2)

Act as a liaison and contact social worker if appropriate.

Ensure the team leader is aware.

If team leader already aware refer to A/H CNC &/ AHHM (See attachment 2).

Act as a liaison and contact social worker if appropriate.

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Attachment 3 – Referral of a call that is not relating to medical deterioration

In the event the call is regarding a complaint or communication issue the CARE responder should attend and gather the information: If the CNC or team leader is not aware of the concern then the CARE responder should

hand over the concern to the Team leader/CNC for them to deal with and escalate If the CNC/Team leader is involved already and the concern relates to them or is not able

to be escalated further by them or resolved by your visit then the following escalation applies:

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CARE Call – Non-deterioration Escalation Flow Chart

Please note that afterhours the call will be directed to the After Hours Hospital Manager in place of the ADON, DON and the Exec on call as required

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