1

Recognition of Early Deteriorating Signs (REDS)

A project conducted OCT 09 to APRIL 10 at Kapooka Health

Centre

JOINT HEALTH COMMAND

2

Presentation Objectives

• Background• Demographics of project• Project justification• Project implementation• Initial findings• Monitoring of project• Outcomes of trial

JOINT HEALTH COMMAND

3

Background

• National push to recognise the deteriorating patient

• To comply with national standards

• Develop a suitable trial chart for ADF

JOINT HEALTH COMMAND

4

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

JOINT HEALTH COMMAND

5

Project Justification

• Incident occurred

• Quality improvement activity initiated

• Approval from SHO

JOINT HEALTH COMMAND

6

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

JOINT HEALTH COMMAND

7

Go to handout sheet 1

Current Defence observation chart PM 013

JOINT HEALTH COMMAND

8

9

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

JOINT HEALTH COMMAND

10

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

JOINT HEALTH COMMAND

11

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

JOINT HEALTH COMMAND

12

Go to handout sheet 2

Final version of REDS observation chart

JOINT HEALTH COMMAND

13

14

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

JOINT HEALTH COMMAND

15

JOINT HEALTH COMMAND

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

JOINT HEALTH COMMAND

JOINT HEALTH COMMAND

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

JOINT HEALTH COMMAND

JOINT HEALTH COMMAND

THANKYOU