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Document Type: PROCEDURE

Unique Identifier: CORP/PROC/627

Title: Recording, Monitoring and assessment of fluid balance and recognition of risk factors for Acute Kidney Injury (AKI)

Version Number: 1 Status: Ratified

Scope: All Adult Patients (Acute Trust)

Classification: Organisational

Author/Originator and title: Sr Louise Kippax-Davis (Critical care outreach Lead) Sr Kate Lutz (Critical care Outreach)

Responsibility: Clinical Governance Directorate

Replaces: New Procedure

Description of amendments:

Name Of: Divisional/Directorate/Working Group:

Date of Meeting:

Risk Assessment: Not Applicable Financial Implications Not Applicable

Validated by: Care of the Acutely Ill Patient Group, (C.A.I.P.G.)

Validation Date: 11/11/2014

Which Principles of the NHS Constitution Apply? 1 - 4

Ratified by: Clinical Improvement Committee

Ratified Date: 20/04/2015

Issue Date: 20/04/2015

Review dates may alter if any significant changes are made Review Date: 01/11/2017

Does this document meet the requirements of the Equality Act 2010 in relation to Race, Religion and Belief, Age, Disability, Gender, Sexual Orientation, Gender Identity, Pregnancy & Maternity, Marriage and Civil Partnership, Carers, Human Rights and Social Economic Deprivation discrimination? Initial Assessment

Blackpool Teaching Hospitals NHS Foundation Trust ID No. CORP/PROC/627


Revision No: 1 Next Review Date: 01/11/2017

Do you have the up to date version? See the intranet for the latest version of 17

CONTENTS 1 PURPOSE ................................................................................................................... 3

1.1 Rationale ................................................................................................................. 3 2 SCOPE ........................................................................................................................ 4

2.1 Exclusions ............................................................................................................... 4 2.2 Adult patients attending Accident and Emergency (A&E) with minor injuries

deemed not to have been sustained as consequence of illness; e.g. minor injury sustained from a mechanical fall versus ‘fall’ secondary to illness requiring investigation, observation and monitoring. .............................................................. 4

3 PROCEDURE ............................................................................................................. 4 3.1 Introduction ............................................................................................................. 4 3.2 Duties ...................................................................................................................... 4 3.3 Early Warning Systems in Place for the Recognition of Patients at Risk of

Deterioration (Adults) .............................................................................................. 4 3.3.1 Frequency of measurement ............................................................................ 4 3.3.2 Initiating Fluid Balance Monitoring .................................................................. 5 3.3.3 Frequency of calculating fluid balance ............................................................ 5

3.4 Process ................................................................................................................... 5 3.4.1 Completion of the fluid balance chart:- ........................................................... 5

3.5 Patients Causing Concern ...................................................................................... 6 3.5.1 Respondents................................................................................................... 6 3.5.2 Expectations ................................................................................................... 6 3.5.3 Further Guidance for Responders .................................................................. 7

3.6 Staff Training ........................................................................................................... 7 3.7 Process for Monitoring Compliance ........................................................................ 7

4 ATTACHMENTS ......................................................................................................... 8 5 ELECTRONIC AND MANUAL RECORDING OF INFORMATION .............................. 8 6 LOCATIONS THIS DOCUMENT ISSUED TO ............................................................. 8 7 OTHER RELEVANT/ASSOCIATED DOCUMENTS .................................................... 8 8 SUPPORTING REFERENCES/EVIDENCE BASED DOCUMENTS ........................... 9 9 CONSULTATION WITH STAFF AND PATIENTS ....................................................... 9 10 DEFINITIONS/GLOSSARY OF TERMS...................................................................... 9 11 AUTHOR/DIVISIONAL/DIRECTORATE MANAGER APPROVAL .............................. 9 Appendix 1: AKI Pathway .................................................................................................. 10 Appendix 2: POTTS chart including ‘Patients Causing Concern ‘Who to Call’ flow chart’

(Graded Response Strategy). .................................................................................... 11 Appendix 3: Guidance for initiating fluid balance ............................................................... 12 Appendix 4: Example of how to complete a fluid balance chart ......................................... 13 Appendix 5: Audit Proforma ............................................................................................... 14 Appendix 6: Process for Monitoring Compliance for the purpose of NHSLA 3.4.8 ............ 15 Appendix 7: Equality Impact Assessment Form ................................................................. 16





1 PURPOSE To provide a Trust wide procedure for recording, monitoring and assessment of fluid balance in adult patients. This includes instructions for frequency, quality of recording and documentation, in line with the key priorities identified by the National Institute for Health and Care Excellence, Clinical Guideline 50: Acutely ill patients in hospital (2007) and National Confidential Enquiry into Patient Outcomes and Death: Adding Insult to Injury (2009) To ensure nursing staff, including healthcare and nursing assistants, receive the necessary information and education to recognise the patient at risk of deterioration, where fluid imbalance is a contributory factor and to initiate fluid balance monitoring. Provide direction for recognition and management of Acute Kidney Injury (AKI) via the Trust corporate pathway (Appendix 1). Provide instruction for utilisation of the Graded Response Strategy (GRS) (Appendix 2). This includes instructions for frequency; quality of recording and documentation in nursing/medical records To recognise the triggers for AKI risk, using the GRS pathway and to escalate ‘a cause for concern’ to the appropriate health care professional. 1.1 Rationale Maintaining an adequate fluid balance is vital to health. Failure to accurately monitor a patient’s fluid input and output by careful completion of a fluid balance chart, has been identified as a contributory factor in delaying or failing to recognise and manage the deteriorating patient.(NICE 2007; NICE 2013; NPSA 2007; NCEPOD 2009). The resulting avoidable harm has a significant impact upon hospital mortality and morbidity. Inadequate fluid input with or without excessive fluid loss will lead to dehydration, which increases the risk of cardiac dysfunction, AKI, electrolyte disorders, including toxicity and acid base imbalance. Failure to identify excessive fluid input and suboptimal urine production may lead to multi organ dysfunction. Altered physiological observations and elevated renal chemistry are a late sign of dehydration and hypovolaemia. Careful clinical assessment plus accurate completion and attention to fluid balance charts could alert staff to fluid imbalances before symptoms occur.





2 SCOPE All nursing staff, including healthcare and nursing assistants, and all medical staff (Generic term for Doctor) who care for all adult patients admitted to Blackpool Teaching Hospitals NHS Foundation Trust, with the exception of:- 2.1 Exclusions 2.1 Adult patients being treated with comfort measures, with an explicit decision that no

further intervention or escalation of therapy is appropriate. 2.2 Adult patients admitted to the nurse-led therapy unit, who have been medically

discharged, with the proviso fluid balance should be initiated at the discretion of the nurse in charge, should a patient demonstrate a ‘cause for concern’ requiring investigation (Appendix 2 and 4).

2.2 Adult patients attending Accident and Emergency (A&E) with minor injuries deemed

not to have been sustained as consequence of illness; e.g. minor injury sustained from a mechanical fall versus ‘fall’ secondary to illness requiring investigation, observation and monitoring.

2.3 Patients cared for in a community setting (none hospital). 3 PROCEDURE 3.1 Introduction This procedure will identify the standards for frequency; quality of recording and documentation of fluid balance on adult patients (Appendix 3). 3.2 Duties All staff who undertake fluid balance monitoring on adult patients, except those indicated in the exclusion category, are required to adhere to the processes outlined in this procedure. They must have accessed the appropriate level of teaching and training identified in the Mandatory Risk Management Training Policy (CORP/POL/354) Namely ‘Recognise and Act: Managing the Deteriorating Patient’. The registered nurse responsible for completing or for supervising completion of the fluid balance chart MUST sign the chart in the appropriate duty shift box. (Appendix 5). Staff must complete the Staff Record Sheet held in the patient case notes, as per the Trust Procedure “Recording on the Staff Record Sheet in the Patient/s Health Records Folder (known as Case notes) (CORP/PROC/153). 3.3 Early Warning Systems in Place for the Recognition of Patients at Risk of

Deterioration (Adults) 3.3.1 Frequency of measurement All adult patients admitted to Blackpool Teaching Hospitals NHS Foundation Trust, except patients indicated in the Scope as ‘exclusions’, must have a complete set of physiological observations performed by the nurse/health care assistant, at least 8 hourly,





(CORP/PROC/080) unless a decision has been made by the nurse in charge / medical team, to either decrease or increase the frequency for an individual patient (Guidance for observation frequency Appendix 2). 3.3.2 Initiating Fluid Balance Monitoring Fluid balance monitoring should be initiated when the patient meets any of the criteria identified in Appendix 3. Fluid balance monitoring should be initiated, if parameters recorded on the POTTS chart indicate an increased risk of AKI (Appendix 1 and 3). A systolic fall of 40mmhg or more, either suddenly or over an 8 hour period, requires a medical staff review (Appendix 2) and commencement of a fluid balance chart. NB this fall in systolic BP may not ‘trigger’ a score on EWS, but is of significant ‘concern’ increasing the risk of AKI (Appendix 1). Failing to pass urine in an 8 hour period requires commencement of a fluid balance chart and medical staff review (Appendix 2 and 3). 3.3.3 Frequency of calculating fluid balance Fluid balance calculation should be made in conjunction with measuring physiological observations i.e. if the patient is requiring 4 hourly observations the fluid balance calculation must be 4 hourly. Patients causing concern will require more frequent monitoring of input and output (Appendix 2). 3.4 Process Guidance as to when to initiate a fluid balance chart is located in Appendix 3. Guidance on how to accurately complete the fluid balance chart is located in Appendix 4. 3.4.1 Completion of the fluid balance chart:- All entries must be legible, utilising black ink. The patient identification label must be attached over the demographics box. Alternatively the patient’s hospital number, surname and forename must be entered legibly utilising black ink. Each fluid balance chart must indicate the hospital location of the patient; the date and time using the 24 hour clock. The registered nurse responsible for completing or for supervising completion of the fluid balance chart MUST sign the chart in the appropriate duty shift box. (Appendix 4). Should the patient ‘trigger’ a cause for concern, they fail to meet the targets set; this must be escalated as identified in GRS flow chart (Appendix 2).





Fluid balance monitoring must be documented using the method demonstrated on the ‘Guidance for completing the Fluid Balance chart’ (Appendix 4) Patients requiring fluid balance monitoring should be clearly identified to the nursing teams via handover mechanisms and medical / nursing documentation. 3.5 Patients Causing Concern Actions must be taken to minimize or prevent further deterioration in a patient’s condition. It is the responsibility of the nursing staff to establish ongoing total input and output determining any obvious negative or positive balance. A minimum of 4 hourly balance calculations is required, as highlighted by the shaded area on the fluid balance chart. (Appendix 4). Identification of a significant negative (> 1000mls) or positive (> 1000mls) fluid balance, requires a parent team review, and an adequate treatment plan documented and initiated. A documented plan including clear volume targets e.g. total 24 hour input ; restrictions and target urine volumes must be in evidence in the notes. ‘The Patients Causing Concern ‘Who to call’ flow chart (GRS) must be followed (Appendix 2). It must be emphasised that low urine output (i.e. less than 0.5mls/kg) is not part of the EWS scoring system but is a significant cause for concern EWS system may not trigger a score in some patients who are becoming acutely unwell. Therefore, healthcare practitioners must remember this tool alone will not always highlight when a patient is deteriorating and should be used to guide best practice. Healthcare practitioners must use their clinical judgement in conjunction with the EWS tool at all times. 3.5.1 Respondents (see Section 10) • The nurse in charge of the area must be informed if a patient requires a review. • The nurse in charge must contact the appropriate member of staff (Respondent)

using the ‘The Patients Causing Concern ‘Who to call’ (GRS)flow chart (Appendix 2) 3.5.2 Expectations The respondent must: Attend within the time frame stated for the given level of concern (Appendix 2) 1. Assess the patient 2. Document how frequently to perform a full set of observations





3. Leave a clear directive for appropriate interventions if indicated, 4. Set clear parameters/ criteria for further review, 5. Fully communicate all of the above with the nurse in charge. 3.5.3 Further Guidance for Responders Once appropriate interventions have taken place, response to these interventions must be assessed. If there is no improvement in clinical condition within 1 hour and the patient continues to fall within the medium to high risk criteria, a senior doctor ST3 (SpR) or above must be informed and review the patient within 30 minutes or immediately if clinical condition dictates. Any existing medical management plan must be reviewed and refined by the senior doctor and if appropriate, a decision made with regards escalation to a higher level of care or treatment limitation. The fluid balance chart for use must be obtained from the Stores Department under code V5880(R5)02.07 The blank charts must not be photocopied. 3.6 Staff Training Staff training is undertaken as outlined in the Mandatory Risk Management Training Policy (CORP/POL/354). They must have accessed the appropriate level of teaching & training identified in the Mandatory Risk Management Training Policy (CORP/POL/354) Namely ‘Recognise and Act: Managing the Deteriorating Patient’. 3.7 Process for Monitoring Compliance • The process for monitoring the effectiveness and compliance of the recording of fluid

balance procedure will be through an addendum to the NICE CG 50 audit undertaken by the Critical Care Outreach Team at least annually

• Fluid balance compliance with particular reference to AKI, is monitored via the ‘AKI

Pathway’ daily audit • Completion of fluid balance charts, including documentation of referrals to medical

staff for patients assessed as being at risk, will be monitored monthly as part of the Nursing Care Indicators assessment by the Clinical Audit Team

• Action plans arising from Clinical Audit NICE CG 50, will be developed, monitored

and implemented via the Care of the Acutely Ill Patient Group • Bi monthly progress reports to the Care of the Acutely Ill Patient Group will be

presented to the Clinical Improvement Committee at least twice yearly.





4 ATTACHMENTS Appendix Number Title

1 Trust AKI Pathway 2 POTTS chart including ‘Patients Causing Concern ‘Who to Call’ flow

chart’ (Graded Response Strategy). 3 Guidance for initiating fluid balance 4 Example of how to complete a fluid balance chart 5 Audit Proforma 6 Process for Monitoring Compliance for the purpose of NHSLA 3.4.8 7 Equality Impact Assessment

5 ELECTRONIC AND MANUAL RECORDING OF INFORMATION Electronic Database for Procedural Documents Held by Policy Co-ordinators/Archive Office 6 LOCATIONS THIS DOCUMENT ISSUED TO Copy No Location Date Issued 1 Intranet 20/04/2015 2 Wards, Departments and Service 20/04/2015 7 OTHER RELEVANT/ASSOCIATED DOCUMENTS Unique Identifier Title and web links from the document library CORP/PROC/076 Nutritional Assessment of Adult Patients using MUST

http://fcsharepoint/trustdocuments/Documents/CORP-PROC-076.doc

CORP/PROC/080 Recording of Physiological Observations on Adult Patients (including Graded Response Strategy) http://fcsharepoint/trustdocuments/Documents/CORP-PROC-080.docx

CORP/PROC/153 Recording on the Staff Record Sheet in the Patient’s Health Records Folder (known as Casenotes) http://fcsharepoint/trustdocuments/Documents/CORP-PROC-153.docx

CORP/POL/354 Mandatory Risk Management Training http://fcsharepoint/trustdocuments/Documents/CORP-POL-354.docx

Trust Pathway Acute Kidney Injury (AKI) Pathway http://fcsharepoint/divisions/corporateservices/clinicalpathways/acute%20kidney%20injury/Pages/default.aspx

Trust Pathway Sepsis Pathway http://fcsharepoint/DIVISIONS/CORPORATESERVICES/CLINICALPATHWAYS/SEPSISV2/Pages/default.aspx

V5880 (R5)02.07 fluid balance chart for use must be obtained from the Stores Department under code http://fcsharepoint/divisions/corporateservices/informationgovernance/healthrecords_library/Documents/42714_BFWH%20VS880%20POTTS.pdf



http://fcsharepoint/trustdocuments/Documents/CORP-PROC-080.docx




http://fcsharepoint/trustdocuments/Documents/CORP-POL-354.docx

http://fcsharepoint/trustdocuments/Documents/CORP-POL-354.docx

http://fcsharepoint/divisions/corporateservices/clinicalpathways/acute%20kidney%20injury/Pages/default.aspx


http://fcsharepoint/DIVISIONS/CORPORATESERVICES/CLINICALPATHWAYS/SEPSISV2/Pages/default.aspx

http://fcsharepoint/DIVISIONS/CORPORATESERVICES/CLINICALPATHWAYS/SEPSISV2/Pages/default.aspx

http://fcsharepoint/divisions/corporateservices/informationgovernance/healthrecords_library/Documents/42714_BFWH%20VS880%20POTTS.pdf







8 SUPPORTING REFERENCES/EVIDENCE BASED DOCUMENTS References In Full

National Patient Safety Agency (2007) Safer Care For Acutely Ill Patient: learning from serious incidents National Institute of Health and Care Excellence (NICE) Clinical Guide 50 (2007) Acutely Ill Patients In Hospital. Recognition of and Response to Acute Illness in Adults in Hospital National Confidential Enquiry into Patient Outcomes & Deaths (NCEPOD) (2009) Adding Insult to Injury A review of the care of patients who died in hospital with a primary diagnosis of acute kidney injury (acute renal failure) NICE CG 169 (2013) Acute Kidney Injury: Prevention, detection and management up to the point of renal replacement therapy NICE CG 174 (2014) IV Therapy in Adults 9 CONSULTATION WITH STAFF AND PATIENTS Name Designation Dr Nigel Randall Consultant Intensivist Dr Rob Thompson Consultant Intensivist CN Rob Instrell Critical Care Outreach Sr Clair Watson Critical Care Unit Manager 10 DEFINITIONS/GLOSSARY OF TERMS A&E Accident and Emergency AKI Acute Kidney Injury A.R.T. Acute Response Team (Specialist Nurses) C.C.O.S Critical Care Outreach Service (Specialist Nurses) GRS Graded Response Strategy medical staff Generic term for Doctor Respondents All medical and surgical staff (Doctors) requested to review a

patient causing concern 11 AUTHOR/DIVISIONAL/DIRECTORATE MANAGER APPROVAL Issued By Louise Kippax-Davis Checked By Dr Rob Thompson Job Title Critical Care

Outreach Lead Job Title Consultant

Intensivist; CCOS Medical Lead

Date 11.12.2014 Date 19.01.2014





Appendix 1: AKI Pathway http://fcsharepoint/divisions/corporateservices/clinicalpathways/acute%20kidney%20injury/Pages/default.aspx







Appendix 2: POTTS chart including ‘Patients Causing Concern ‘Who to Call’ flow chart’ (Graded Response Strategy). http://fcsharepoint/divisions/corporateservices/informationgovernance/healthrecords_library/Documents/42714_BFWH%20VS880%20POTTS.pdf







Appendix 3: Guidance for initiating fluid balance





Appendix 4: Example of how to complete a fluid balance chart

File in Section 3

Registered Nurse Responsible

EARLY

LATE

NIGHT

INPUT (A) OUTPUT (B) Time ORAL

NG VOL IV (1) VOL IV (2) VOL Other VOL RUNNING

Total URINE Other

sPoma Other Grain

Other Other vomiP

Running Total

Balance (+ve / - ve)

01:00 NaCl 125 02:00 125 350 350 03:00 125 04:00 125 500 400 750 250 -ve 05:00 125 500 06:00 water 150 125 150 07:00 125 08:00 125 1150 1400 250 -ve 09:00 TPN 83 250 10:00 tea 100 83 11:00 83 12:00 83 1582 1650 68 -ve 13:00 tea 150 83 14:00 83 35 400 15:00 83 40 16:00 83 2064 60 2185 121 -ve 17:00 83 50 18:00 coffee 200 83 Blood 75 19:00 83 260 100 140 20:00 83 2856 70 2620 236 +ve 21:00 83 40 22:00 water 50 83 35 23:00 83 60 24:00 83 3238 80 2835 403 +ve

HOSPITAL LOGO

PATIENT LABEL FLUID BALANCE CHART

Ward: Date:

Weight :

Previous 24hr Balance:

Target hourly urine volume:

Running total A minus Running total B = Balance (+ve or – ve)

Appendix 5: Audit Proforma

Audit against Corp/ proc 627 utilising Trust Fluid Balance Chart

No. Question Yes No Unknown NA 1 Did the patient have a complete set of observations as part of the

initial assessment including AKI risk?

2 Was there a clear written monitoring plan specifying observation & fluid balance monitoring frequency (initial assessment)

3

Did all patients admitted, have a complete set of physiological observations performed by the nurse/HCA and recorded and monitored on the POTTS chart at least every 8 hours unless a decision has been made by the nurse in charge to increase or decrease this frequency for an individual patient.

4

Was the commencement of fluid balance monitoring indicated as directed in the procedure?

5 Requires assistance with feeding 6 Nil By Mouth 7 IV Fluids 8 Enteral Feeding 9 NG Tube for aspiration & drainage 10 Urinary Catheter 11 Vomiting 12 Diarrhoea 13 Drains / hyper-active stoma 14 Failure to pass urine in 8hrs 15 Medical condition requiring fluid balance monitoring eg Heart failure; sepsis ;

renal failure

16 Recovering from Critical Illness 17 Was fluid balance monitoring commenced? 18 Was the fluid balance completed with same frequency as observations? 19 Was the fluid balance chart accurately completed? 20 Were entries recorded on the fluid balance chart using black ink and were

these legible

21 Was the following information recorded on the fluid balance chart 22 Clinical Ward Area 23 Patient’s hospital number 24 Patient’s surname 25 Patient’s forename 26 Or was the Patient’s information sticker attached 27 Was the date recorded on the chart? 28 Did the registered nurse sign the form in the appropriate ‘Shift Box’ ? 29 In the event of a systolic fall of 40mmhg or more either suddenly or over an 8

hour period did the patient receive a medical staff review

30 In the event of a systolic fall of 40mmhg or more either suddenly or over an 8 hour period was the patient commenced on a fluid balance chart

31 In the event of the patient failing to pass urine in an 8 hour period was did the patient receive a medical staff review

32 In the event of the patient requiring a review was the nurse in charge of the area informed

33 Did the nurse in charge contact the appropriate member of staff (respondent) using the ‘Patients Causing Concern Who to Call’ Flow chart

34 Did the Respondent attend within the timeframe stated for the given level of concern as identified in the ‘Patients Causing Concern Who to Call’ Flow chart

35 Did the Respondent assess the patient 36 Did the Respondent document how frequently to perform a full set of

observations

37 Did the Respondent leave a clear directive for appropriate interventions if indicated

38 Did the Respondent set clear parameters / criteria for further review Double click above to see the whole audit.





Appendix 6: Process for Monitoring Compliance for the purpose of NHSLA 3.4.8 Minimum

requirement to be monitored

Process for

monitoring e.g. audit

Responsible individual/

group/ committee

Frequency of

monitoring


group/ committee for

review of results


group/ committee for development of action plan

Responsible individual/group/

committee for monitoring of

action plan and Implementation

a) Requirement for a

documented plan for vital

signs monitoring

that identifies which

variables need to be measured,

including the frequency of

measurement

Audit Senior Resuscitation

Officer/ Outreach

Team Leader

Annual Senior Resuscitation

Officer/ Outreach Team Leader /

Care of the Acutely Ill Patient

Group / Resuscitation

Committee

Senior Resuscitation

Officer/ Outreach Team Leader /

Care of the Acutely Ill Patient


Committee


Officer/ Outreach Team Leader / Care

of the Acutely Ill Patient Group / Resuscitation

Committee

b) Use of an early warning system within

the organisation to recognise patients at

risk of deterioration

NCG 50 Audit

Critical Care Outreach

Team

Annual Outreach Team Leader / Care of

the Acutely Ill Patient Group / Resuscitation

Committee

Outreach Team Leader / Care of

the Acutely Ill Patient Group / Resuscitation

Committee

Outreach Team Leader / Care of the

Acutely Ill Patient Group /

Resuscitation Committee

c) Actions to be taken to

minimise or prevent further

deterioration in patients


Officer


Officer / Care of the Acutely Ill

Patient Group / Resuscitation

Committee




Committee


Officer

/ Care of the Acutely Ill Patient Group /


d) Do not attempt

resuscitation orders

(DNAR)


Officer


Officer/ Care of the Acutely Ill


Committee




Committee


Officer

Care of the Acutely Ill Patient Group /


e) How the organisation documents

that resuscitation equipment is

checked, stocked and

fit for use


Officer




Committee

Outreach Team Leader / Care of

the Acutely Ill Group /


Outreach Team Leader / Care of the Acutely Ill Group /






Appendix 7: Equality Impact Assessment Form Department Service or Policy CORP/PROC/627 Date Completed: GROUPS TO BE CONSIDERED Deprived communities, homeless, substance misusers, people who have a disability, learning disability, older people, children and families, young people, Lesbian Gay Bi-sexual or Transgender, minority ethnic communities, Gypsy/Roma/Travellers, women/men, parents, carers, staff, wider community, offenders. EQUALITY PROTECTED CHARACTERISTICS TO BE CONSIDERED Age, gender, disability, race, sexual orientation, gender identity (or reassignment), religion and belief, carers, Human Rights and social economic / deprivation.

QUESTION RESPONSE IMPACT Issue Action Positive Negative

What is the service, leaflet or policy development? What are its aims, who are the target audience?

The Recording of Physiological Observations on Adult Patients (Including the Graded Response Strategy) procedure is to ensure that all members of staff working within the Trust are aware of the processes in relation to Recording of Physiological Observations on Adult Patients and to utilise the Graded Response Strategy (GRS).

Ensure medical and nursing staff, including healthcare and nursing assistants receive the necessary information and education to perform physiological observations and make effective use of the GRS.

Yes – Clear process identified to enable staff to perform their duties.

Does the service, leaflet or policy/ development impact on community safety • Crime • Community cohesion

No N/A N/A

Is there any evidence that groups who should benefit do not? i.e. equal opportunity monitoring of service users and/or staff. If none/insufficient local or national data available consider what information you need.

No. This procedure should ensure a positive impact in relation to all adult patients and staff.

N/A Yes

Does the service, leaflet or development/ policy have a negative impact on any geographical or sub group of the population?

No N/A N/A

How does the service, leaflet or policy/ development promote equality and diversity?

Ensures a standardised approach in relation to the processes utilised for Recording of Physiological Observations on Adult Patients and to utilise the Graded Response Strategy (GRS).

N/A Yes

Does the service, leaflet or policy/ development explicitly include a commitment to equality and diversity and meeting needs? How does it demonstrate its impact?

The procedure includes a completed EA which provides the opportunity to highlight any potential for a negative / adverse impact.

N/A Yes

Does the Organisation or service workforce reflect the local population? Do we employ people from disadvantaged groups

Our workforce is reflective of the local population.

N/A Yes

Will the service, leaflet or policy/ development i. Improve economic social conditions

in deprived areas

ii. Use brown field sites iii. Improve public spaces including

creation of green spaces?

No N/A N/A

Does the service, leaflet or policy/ development promote equity of lifelong learning?

No N/A N/A

Does the service, leaflet or policy/ development encourage healthy lifestyles and reduce risks to health?

No N/A N/A

Does the service, leaflet or policy/ development impact on transport? What are the implications of this?

No N/A N/A

Does the service, leaflet or policy/development impact on housing, housing needs, homelessness, or a person’s ability to remain at home?

No N/A N/A





Appendix 7: Equality Impact Assessment Form Are there any groups for whom this policy/ service/leaflet would have an impact? Is it an adverse/negative impact? Does it or could it (or is the perception that it could exclude disadvantaged or marginalised groups?

This policy will have an impact on all adult patients and all staff involved in recording their physiological observations.

N/A Yes

Does the policy/development promote access to services and facilities for any group in particular?

The Policy promotes access to information for those members of staff working within the Trust.

N/A Yes

Does the service, leaflet or policy/development impact on the environment • During development • At implementation?

No N/A N/A

ACTION: Please identify if you are now required to carry out a Full Equality Analysis

Yes No (Please delete as appropriate)

Name of Author: Signature of Author:

Louise Kippax-Davies Date Signed:

Name of Lead Person: Signature of Lead Person:

Date Signed:

Name of Manager: Signature of Manager

Date Signed: