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:
A (Assessment) I think state perceived problem
HGH WH RH NCCCR AKH HH AWH TCH OTHER
Could you please come and assess the patient?
R (Recommendation)
0 - 28 DAYS
Is there anything you would like me to do until you get there?
Read back a summary of the conversation

Patient Diagnosis: REFER TO YOUR LOCAL DETERIORATING PATIENTS RESPONSE SYSTEM (DPRS) PROTOCOL FOR INSTRUCTIONS ON
Weight (kgs) Height (cms) Head Circumference (cms) HOW TO MAKE A CALL TO ESCALATE CARE FOR YOUR PATIENT
Altered Calling Criteria
OTHER CHARTS IN USE 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 THE MANAGEMENT OF YOUR PATIENT
24 Hrs Intake & Output Chart DNAR Sheet Other
PRESCRIBED FREQUENCY OF OBSERVATIONS YELLOW ZONE RESPONSE
Observations must be performed routinely at least 4 hourly, unless advised below Additional YELLOW ZONE Criteria
Date: New, increasing or uncontrolled pain
Partially obstructed airway Sternal Capillary Refill 3sec
Time:
Moderate Respiratory Effort / Distress Inconsolable

BINDING MARGIN - NO WRITING

Frequency Required Poor peripheral circulation (e.g. mottled / pallor) BGL 2-3mmol/L
Consistent with clinical Greater than expected fluid loss Concern by any staff and family member
BINDING MARGIN - NO WRITING

pathway for Reduced urine output or anuria (<1mL/kg/hr)

Resident / Specialist Agitation

0 - 28 Days 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
Consultant Stamp and 3. Inform the nurse in-charge that you have called for clinical review
Holes Punched as per

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 Are you concerned about your patient?
Any alterations MUST be signed by a Resident/Specialist and countersigned by Consultant
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
or you are becoming more concerned
Time: 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
CONSIDER IF YOUR PATIENTS DETERIORATION COULD BE DUE TO SEPSIS, DEHYDRATION,
SpO2
HYPOVOLEMIA/HEMMORHAGE, OVERDOSE/OVER SEDATION
Heart Rate
RED ZONE RESPONSE
Other Additional RED ZONE Criteria
Floppy
Resident / Specialist Imminent airway obstruction Deterioration not reversed within 1hr of clinical review
Stamp and Signature Severe Respiratory Effort / Distress Lactate 4 mmol/L
Significant Bleeding Patient deteriorates further, before or during Clinical
GCS less than 14 Review
Consultant Stamp and 2 point drop in GCS 3 or more simultaneous yellow zone observations
Signature New or prolonged seizures Serious concern by any staff and family member
BGL< 2mmol/L or symptomatic
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
4. health care record
5. Inform the consultant in-charge that a call was made as soon as it is practicable
 Altered Calling Criteria ALL OBSERVATIONS MUST BE GRAPHED
Date Date
Time Time

90 90
85
80
85
80
Qatar Early Warning System (QEWS)
75 75 Standard Pediatric Observation Chart
70 70
(Breaths per minute)
Respiratory Rate

65 65
60 60
55 55 Altered Calling Criteria
50 Date Date
50
45 45 Time Time
40 40
AIRWAY/BREATHING

35 35 Level of LoC
30 30 Consciousness CS = Conscious, CF = Confused, S = Stupor, U = Unconscious
25 25 Rt Rt
20 20

DISABILITY
Lt Lt
15 15

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
GCS
2

Scale Score
SpO

85 85 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

39 39
0 - 28 Days Chart

Device 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 35 35
170 170 34.5 34.5
160 160
Heart Rate

34 34
150 150

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

100 100 Weight (kgs) Weight

90 90
80 80 SN Initial Initials

70 70
60 60 RESPIRATORY DISTRESS
GLASGOW COMA
Capillary >2 Seconds
Refill <2 Seconds
>2 Seconds
MILD MODERATE SEVERE SCALE
<2 Seconds
Stridor on exertion Stridor at rest New onset of stridor
120 120
Airway Partial airway obstruction Imminent airway obstruction
Blood Pressure (mmHg)

4 Spontaneously
Systolic Blood Pressure is trigger

110 110 Normal Irritability Drowsy

3 To shout
Behavior & Feeding

EYE
Age appropriate vocalisation Difficulty crying Unable to cry
100 100 Difficulty feeding or sucking Unable to feed or suck 2 To pain
90 90 Mildly increased Respiratory rate in the yellow zone Respiratory rate in the red zone 1 No Response

80 Respiratory Rate
80 Decreasing (exhaustion) 5 Smiles, coos appropriately
70 4

VERBAL
70 None / minimal Moderate recession
Tracheal tug
Severe recession
Gasping 3
Appropriate cry

60 60 Nasal flaring Grunting

Inappropriate cry or scream

50 50 Accesory Muscle Use Head bobbing Extreme pallor

2 Grunts
1 No Response
40 40 Cyanosis
Absent breath sounds 5 Localizes pain
30 30 4 Flexion Withdrawal
Apnoeic Episodes

MOTOR
None Abnormal pauses in breathing Apnoeic episodes
20 20
><

3 Decorticate flexion
No oxygen requirement Mild hypoxaemia, corrected by oxygen Hypoxaemia, may not be 2
Oxygen Increasing oxygen requirement corrected by oxygen
Decorticate extension
Rapid Response Clinical Review 1 No Response

CONSIDER EARLIER ESCALATION OF PATIENTS WITH

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