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Recognition of Early Deteriorating Signs (REDS)
A project conducted OCT 09 to APRIL 10 at Kapooka Health
Centre
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Presentation Objectives
• Background• Demographics of project• Project justification• Project implementation• Initial findings• Monitoring of project• Outcomes of trial
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Background
• National push to recognise the deteriorating patient
• To comply with national standards
• Develop a suitable trial chart for ADF
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Demographics of Project• Project implemented at Kapooka Health Centre – 50 bed capacity, Level 2 facility (Wagga Wagga NSW)
• ARTC 500 -1500 recruits in training: 700 ADF staff
• 17 – 60 years of age (predominately male)
• Contracted health staff
• Hospital separations – approx 1200 per annum
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Project Justification
• Incident occurred
• Quality improvement activity initiated
• Approval from SHO
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Project Implementation• Researched information on deteriorating patient
• Trial obs chart REDS developed, MEWS scoring system utilised, Traffic Light system developed
• Education of health care staff
• 6 month trial
• Audits - Pre-audit of PM 013, Audits of REDS chart compliance
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Go to handout sheet 1
Current Defence observation chart PM 013
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Initial Findings
• Many variations of charts available within Australia
• Majority of charts for acute care patients
• Most escalation plans require 24 hr on-site medical cover
• Most require MO notification of a single vital sign reaching a particular trigger point
• Need to develop a Defence specific chart
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Our REDS chart• Based on the ACT Health Compass program
• System of scoring individual vital signs to achieve overall score ( MEWS )
• MEWS score linked to Traffic Lights escalation plan (designed to meet ADF requirements)
• All link together to provide overall picture of deterioration
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Monitoring of Project
• Ongoing education & support for staff to ensure sustainability
• Auditing to maintain compliance
• Listen to user related difficulties
• Chart adapted several times to improve usability
• Staff survey at trial completion
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Go to handout sheet 2
Final version of REDS observation chart
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Outcomes of Trial• Audits demonstrate improved compliance
• Staff survey indicate preference to continue using chart
• Greater awareness of early signs of deterioration, traffic lights system prompts earlier MO review and intervention
• MEWS scores demonstrates when patients require to transfer to civilian facilities
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STAFF SURVEY RESULTS (end of project)
0102030405060708090
100
Poor opion ofREDs chart atbeginning of
project
Poor opion ofREDs chart atend of project
Rate ofsatisfaction with
chart
Understandingof MEWs
RED chartassists with
patientassessments
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Conclusion
The trial chart was effective and meets national standards for recognising and responding to clinical deterioration in acute health care
Improved patient outcomes and enabled nursing and medical staff in our facility to provide a safer level of care, and earlier recognition of the deteriorating patient.
Where to from here?Further trials are needed across the
AHS, before any potential introduction across ADF
Education must be intensive and ongoing inclusive of all nursing & medical staff
Continued organizational support of he trial is imperative
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THANKYOU