Thursday, January 14, 2010


Red News Readers,

As a nurse of over 30 years experience, I am ambivalent about the distribution across the State of this Observation Form. This Form no doubt allows inexperienced and unqualified nursing staff to perform observations, and to easily recognise when they should seek further advice. But there are already emergency call systems in place in hospitals and emergency departments, when a patient goes beyond certain parameters, and a literal interpretation of those parameters, and these Observation Charts can have doctors called out to already known situations, and nursing staff being abused by doctors for being ignorant. Knowledge, skill, judgement and care (the words of the Nurses Act of 1991) are required to interpret observations in the context of each patient. It is not just a mechanical matter of limits and parameters.

Jenny Haines

Beach jargon can be lifesaver in hospitals, too


January 14, 2010

Carmel Tebbutt at Liverpool Hospital with a patient, Enid Gillam, and her sister, Elaine Bovis. Photo: Nick Moir

IT IS a no-brainer, the Health Department concedes, but it took the unnecessary death of a teenager at Royal North Shore Hospital for it to develop a statewide system of monitoring vital signs to detect deteriorating patients.

The Health Minister, Carmel Tebbutt, launched a standardised observation chart with a colour-coded warning system yesterday; it will be implemented at all NSW hospitals this year.

Ms Tebbutt said it was a world-first system and would improve patient care and safety.

Dubbed ''Between the Flags'', the system dictates exactly what action staff must take when a person's vital signs put them into the ''yellow'' zone, which indicates early deterioration and the need for a clinical review, and the more critical ''red'' zone, which calls for a rapid response.

It comes 20 years after Liverpool Hospital pioneered the concept, which then spread to the US and Europe yet failed to be implemented by more than a handful of NSW hospitals, simply because of a lack of will.

The system is in response to a recommendation made after the 2008 Garling public hospitals inquiry found the deteriorating patient was a ''prevalent'' problem.

''Detection and management of deterioration in a patient's condition by hospital staff can be problematic, particularly where the problems occur overnight when patients are under the care of junior clinicians who may lack the experience to deal with the problem or are reluctant to wake a consultant,'' Peter Garling, SC, said.

The inquiry was called after what Deputy State Coroner Carl Milovanovich called the ''tragic and avoidable'' death of Vanessa Anderson, 16, at the Royal North Shore Hospital in November 2005, after she was hit in the head by a golf ball. He noted a litany of failures including that ''record taking, and clinical notes were either non-existent or deficient".

The Between the Flags system uses five key measurements - blood pressure, temperature, heart rate, breathing rate and drowsiness - to monitor patients. Ms Tebbutt said this would ensure any move out of the safe zones was quickly recognised and there was a rapid response.

''In a hospital setting, the frontline clinical staff are the lifeguards … They know when a patient is between the flags by observing vital signs and clinical condition,'' she said. ''It means patients will get even safer care.''

Professor Cliff Hughes, chief executive officer of the Clinical Excellence Commission, which developed the chart, said ''it is to make sure we reach patients before it's too late''.

The president of the NSW branch of the Australian Medical Association, Brian Morton, said it was a ''major advance in patient care'' and should be expanded nationally.

The Opposition health spokeswoman, Jillian Skinner, welcomed the chart but said staff shortages would undermine its success.