Recognition of the deteriorating resident
This information does not replace clinical judgement. Refer to Conditions of use and copyright for further T&Cs.
Any rapid deterioration in condition should be treated with suspicion: the parameters below should not replace clinical judgement and resident's baseline vital signs must be considered when assessing a resident's condition and determining actions to take. Change in residents’ behaviours may also be an indication of deterioration and should prompt review of vital signs as below; successive vital sign measurements are more sensitive to change.
If you are concerned about a resident call the GP and discuss
Flowchart
The flowchart shows all of the information at one time. Health professionals should always remain within their scope of practice; these pathways should never replace clinical judgement.
Click the link below to view the full flowchart.
-
DDangerAccess to environment and situaton for hazard to self and others, ensure the appropriate infection control practices and procedures and appropriate personal protective equipment are used.
RResponseAssess resident response using AVPU: Alert? Responsive to voice only? Responsive to pain only? Unresponsive?
AAirwaysPatent? Obstructed?
BBreathingRate - abnormally fast or slow? Effort? Respiratory distress
CCirculationPulse rate - abnormally fast or slow? Blood pressure abnormally high or low?
DDisabilityReassess response (AVPU); Check finger prick blood glucose level
EExposureAssess resident's temperature. Pain (use a cognition appropriate assessment tool)
Vital signs
RED (DANGER)
Potential life-threat, urgent medical review indicated: review Management of residents with unstable vital signs
YELLOW (CAUTION)
Medical review indicated
NORMAL
Medical review as indicated by presenting complaint
* Vital sign reference ranges should always be interpreted in the context of the individual's baseline vital signs
** Check resident's medical notes for GP documented reportable blood glucose levels
-
QH has developed a learning module to support clinicians in learning about management of the deteriorating resident. The learning module is available via QHs iLearn portal - RACF clinicians practicing in public or private RACFs in Queensland can access the module free of charge. You will simply need to register to create an iLearn account - find the link to register at the bottom of the iLearn account page - if you already have a log-in simply log into your iLearn account.
-
- Hewitt J. Aged Care Emergency Manual, https://www.aci.health.nsw.gov.au/_data/assets/pdf_file/0019/274132/aged-care-emergency-manual-24032014.pdf accessed 1/1/2015. 2013.
- Chester JG, Rudolph JL. Vital signs in older patients: age-related changes. J Am Med Dir Assoc. 2011;12(5):337-43.
- Cretikos MA, Bellomo R, Hillman K, Chen J, Finfer S, Flabouris A. Respiratory rate: the neglected vital sign. Med J Aust. 2008;188(11):657-9.
- Campbell V, Conway R, Carey K, Tran K, Visser A, Gifford S, et al. Predicting clinical deterioration with Q-ADDS compared to NEWS, Between the Flags, and eCART track and trigger tools. Resuscitation. 2020;153:28-34.
- Dunning T, Duggan N, Savage S. The McKellar guidelines for managing older people with diabetes in residential and other care settings. Geelong: Centre for Nursing and Allied Health, Deakin University and Barwon Health; 2014
-
Pathway Recognition of the deteriorating resident Document ID CEQ-HIU-FRAIL-60001 Version no. 2.0.2 Approval date 16/03/2022 Executive sponsor Executive Director, Healthcare Improvement Unit Author Improving the quality and choice of care setting for residents of aged care facilities with acute healthcare needs steering committee Custodian Queensland Dementia Ageing and Frailty Network Supersedes Version 1.0 Applicable to Residential aged care facility (RACF) registered nurses and general practitioners in Queensland serviced by a RACF acute care Support Service (RaSS) Document source Internal (QHEPS) and external Authorisation Executive Director, Healthcare Improvement Unit Keywords Recognition of deterioration, vital signs in aged care, deteriorating resident Relevant standards Aged Care Quality Standards:
Standard 2: ongoing assessments and planning with consumers
Standard 3: personal care and clinical care, particularly 3(3)
Standard 8: organisational governance