ISBAR Handover / Communication Policy

May I speak with Dr. (state receivers name)

I (Introduction) This is (state callers name)
I am calling about our patient (name, HC number, location)

I am calling because state situation

Qatar Early Warning System (QEWS) S (Situation)
The latest obervations are: state significant observations

Standard Pediatric Observation Chart

This patient is ______ years old,
admitted for diagnosis , who underwent procedure (if any),
B (Background)
with previous history of relevant past medical history,
and is currently on: significant ongoing management
FACILITY:
HGH WH RH NCCCR AKH HH AWH TCH OTHER A (Assessment) I think state perceived problem
Could you please come and assess the patient?

1 - 4 YEARS
R (Recommendation) Is there anything you would like me to do until you get there?
Read back a summary of the conversation

Patient Diagnosis:
Altered Calling Criteria
OTHER CHARTS IN USE
REFER TO YOUR LOCAL DETERIORATING PATIENTS RESPONSE SYSTEM (DPRS) PROTOCOL FOR INSTRUCTIONS
Weight (kgs) Height (cms) Head Circumference (cms) ON HOW TO MAKE A CALL TO ESCALATE CARE FOR YOUR PATIENT
Neurological Observations RBS Monitoring Sheet Growth Chart
CHECK THE HEALTH CARE RECORD FOR AN END OF LIFE CARE PLAN WHICH MAY ALTER
Neurovascular Pain Scoring / Epidural Other
24 Hrs Intake & Output Chart DNAR Sheet Other
THE MANAGEMENT OF YOUR PATIENT

PRESCRIBED FREQUENCY OF OBSERVATIONS

YELLOW ZONE RESPONSE
Observations must be performed routinely at least 4 hourly, unless advised below
Date: Additional YELLOW ZONE Criteria
Partially obstructed airway New, increasing or uncontrolled pain
Time:
Moderate Respiratory Effort / Distress Sternal Capillary Refill 3sec
Frequency Required Poor peripheral circulation (e.g. mottled / pallor) Inconsolable

BINDING MARGIN - NO WRITING

Consistent with clinical Greater than expected fluid loss BGL 2-3mmol/L
pathway for Concern by any staff, patient and family member
Reduced urine output or anuria (<1mL/kg/hr)
Resident / Specialist
Agitation

1 - 4 Years Chart
Stamp and Signature IF YOUR PATIENT HAS ANY YELLOW ZONE OBSERVATIONS OR ADDITIONAL CRITERIA YOU MUST
1. Initiate appropriate clinical care
2. Repeat and increase the frequency of observations, as indicated by your patients condition
3. Inform the nurse in-charge that you have called for clinical review
Consultant Stamp and
Signature Consider the following:
What is usual for your patient and are there documented ALTERATIONS TO CALLING CRITERIA?
Does the trend in observations suggest deterioration?
ALTERATIONS TO CALLING CRITERIA
Is there more than one Yellow Zone observation or additional criterion?
MUST BE REVIEWED WITHIN 48 HOURS OR EARLIER IF CLINICALLY INDICATED
Any alterations MUST be signed by a Resident/Specialist and countersigned by Consultant Are you concerned about your patient?
Document rationale for altering CALLING CRITERIA in the patients health care record IF A CLINICAL REVIEW IS CALLED:
Date: 1. Reassess your patient and escalate according to your local DPRS if the call is not attended within 30 minutes
Time: or you are becoming more concerned
2. Document an ABCDE assessment, reason for escalation, treatment and outcome in your patients health care
Frequency Required record
3. Inform the consultant in-charge that a call was made as soon as it is practicable
Respiratory Rate

SpO2 CONSIDER IF YOUR PATIENTS DETERIORATION COULD BE DUE TO SEPSIS, DEHYDRATION,

HYPOVOLEMIA/HEMORRHAGE, OVERDOSE/OVER SEDATION
Heart Rate
RED ZONE RESPONSE
Other
Additional RED ZONE Criteria
Resident / Specialist
Imminent airway obstruction Floppy
Stamp and Signature Severe Respiratory Effort / Distress Deterioration not reversed within 1hr of clinical review
Significant Bleeding Lactate 4 mmol/L
GCS less than 14 Patient deteriorates further, before or during Clinical
2 point drop in GCS Review
Consultant Stamp and New or prolonged seizures 3 or more simultaneous yellow zone observations
Signature
BGL< 2mmol/L or symptomatic Serious concern by any staff or family member

NURSES CALL REGISTRY IF YOUR PATIENT HAS ANY RED ZONE OBSERVATIONS OR ADDITIONAL CRITERIA YOU MUST CALL FOR A RAPID
DATE TIME TYPE OF CALL REASON FOR CALLING SIGNATURE RESPONSE (as per local DPRS) AND
1. 1. Initiate appropriate clinical care
2. 2. Inform the NURSE IN-CHARGE that you have called for a RAPID RESPONSE
3. Repeat and increase the frequency of observations, as indicated by your patients condition
3.
4. Document an ABCDE assessment, reason for escalation, treatment and outcome in your patients health care
4. record
5. Inform the consultant in-charge that a call was made as soon as it is practicable
15-0649/Forms
 Altered Calling Criteria ALL OBSERVATION MUST BE GRAPHED
Date Date
Time Time

80 80
75
70
75
70
Qatar Early Warning System (QEWS)
65 65 Standard Pediatric Observation Chart
60 60
(Breaths per minute)
Respiratory Rate

55 55
50 50
45 45 Altered Calling Criteria
40 40 Date Date
35 35 Time Time
30 30
25 25 Level of LoC
20 20 Consciousness CS = Conscious, CF = Confused, S = Stupor, U = Unconscious
AIRWAY/BREATHING

15 15 Rt
10 Rt
10

DISABILITY
Lt Lt
5 5

Pupil
Size
Normal Normal
1 2 3 4 5 6 7 8
Distress

Mild Mild
Resp

Moderate Moderate
Rt Rt

Reaction
Severe Severe

Pupil
Lt Lt
100 100
B = Brisk, S = Sluggish, N = No Response, NA = Not Applicable
(in any amount of O2)

95 95
90 90 Glasgow Coma
2

GCS
SpO

85 85 Scale Score 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15
80 80
75 75 41 41
BINDING MARGIN - NO WRITING

70 70 40.5 40.5

Probe Change Probe Change 40 40

L/min or % L/min or % 39.5 39.5
Oxygen

Device 39 39
1 - 4 Years Chart

Device

38.5 38.5

Temperature (oC)
Key: RA = Room Air, NC = Nasal Cannula, FM = Simple facemask, NRBM = Non Re-breather Mask, VM = Venturi Mask, TC = Trach Collar,

EXPOSURE
CPAP = Continuous Positive Airway Pressure, BiPAP = Bi-level Positive Airway Pressure 38 38
37.5 37.5
t 220 220 37 37
210 210 36.5 36.5
200 200 36 36
190 190 35.5 35.5
(Apical)(Beats per minute)

180 180
170 170 35 35
160 160 34.5 34.5
Heart Rate

150 150 34 34

140 140 Route Route
130 130
120 Key: A = Axillary, O = Oral, R = Rectal, E = Aural/Ear
120
110 110 Girth (cms) Girth
100 100
CIRCULATION

90 90 Weight (kgs) Weight

80 80

SN Initial Initials
70 70
60 60 RESPIRATORY DISTRESS
50 50
40 40 MILD MODERATE SEVERE GLASGOW COMA
Capillary >2 Seconds >2 Seconds SCALE
Refill <2 Seconds <2 Seconds
Airway Stridor on exertion Stridor at rest
Partial airway obstruction
New onset of stridor
Imminent airway obstruction
Normal Some/intermittent irritability Drowsy 4 Spontaneously
150 150 Talks in sentences Difficulty talking or crying Agitated/confused
Behavior & Feeding 3 To shout

EYE
Difficulty feeding or eating Unable to talk or cry
140 140
Blood Pressure (mmHg)

2 To pain
Systolic Blood Pressure is trigger

Unable to feed or eat

130 130 Respiratory rate in the red zone 1 No Response
120 120 Respiratory Rate Mildly increased Respiratory rate in the yellow zone
Decreasing (exhaustion) 5 Smiles, coos appropriately
110 110 4

VERBAL
None / minimal Moderate recession Severe recession Appropriate cry
100 100 Tracheal tug Gasping 3 Inappropriate cry or scream
Nasal flaring Grunting
90 90 Accesory Muscle Use Extreme pallor
2
1
Grunts
No Response
80 80 Cyanosis
Absent breath sounds 5 Localizes pain
70 70 4 Flexion Withdrawal

MOTOR
60 60 Apnoeic Episodes None Abnormal pauses in breathing Apnoeic episodes
3 Decorticate flexion
50 50 No oxygen requirement Mild hypoxaemia, corrected by oxygen Hypoxaemia, may not be 2 Decorticate extension
40 40 Oxygen Increasing oxygen requirement corrected by oxygen 1 No Response
30 30
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20 20 CONSIDER EARLIER ESCALATION OF PATIENTS WITH

Chronic or complex conditions Opioid Infusions
ADDITIONAL
Rapid Response Clinical Review
Post-operative
Pre-Existing cardiac or
Preterm or post-term
neonates
CRITERIA FOR ESCALATION
respiratory conditions Congenital conditions ON BACK PAGE