Patient at Risk Score (PARS)

Clinical Guideline

CONTENTS PAGE

1. Introduction 3

2. Use of the Patient At Risk (PARS) System 3

3. Staff Training in the use of the PARS System 4

4. Record and audit of the use of PARS 4

5. References 4

Appendix 1 MHPT Observations chart – including PARS 5

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1. Introduction.

The Patient at Risk Score (PARS) is designed to enable health care professionals to recognize “at risk”
patients and to trigger early referral to medical staff, so that early intervention can help to prevent
deterioration.
It will also help facilitate the early transfer of these patients to an appropriate higher care facility e.g.
the Accident and Emergency (A&E) department. Its use should also help prevent avoidable in-hospital
cardiac arrest (In Hospital Cardiac Arrest Prevention, 2004).
The PARS outlined in this guideline is based on the system used by Worcestershire Acute Hospitals
NHS Trust (Critical Care Outreach Operation policy, 2006). Staff working in Worcestershire Acute
Hospitals who receive a patient transferred form Worcestershire Mental Health Partnership Trust
(WMHPT) will therefore understand the PARS scoring system. PARS is also used by Worcestershire
Primary Care Trust (Worcestershire PCT, 2008).

2. Use of Patient at Risk Scoring System.

The PARS system may be used in all clinical areas within the WMHPT. The PARS should be
calculated by using the chart on the reverse side of the WMHPT Observations chart (see appendix
one). It should be used in all clinical areas where observations are used to assess patients. Any
abnormal measurement recorded during taking a set of patient observations should trigger a
calculation of the score. Points are allocated according to the reading and once a full set of
observations have been made a total score is calculated. The only observation that may not be
recorded is the urine output, which is only recorded if the patient’s urine output is being measured.

Health Care Professionals may refer patients, either to their Nurse in Charge/Senior Nurse, Clinical
Coordinator or Doctor depending on the PARS.

Score 4 or above Immediate review by Doctor (if on site) or phone for a 999 emergency
ambulance to transfer the patient (as per local policy) Ring A&E to advise of
imminent transfer.

Score 3 Call for urgent Doctor review within 1 hour.

Score 2 Increase frequency of observations and inform Nurse in Charge/Senior Nurse

or Clinical Coordinator. Minimum frequency of observations hourly for scores
of 2 and above.

Score 0 or 1 Continue observations at current frequency.

The guidance does not override the individual responsibilities of the health care professional to make
appropriate decisions, according to the circumstances of the individual patient in consultation with the
patient and or carer. However, if the health care professional chooses to deviate from this guideline the
reason for deviation and subsequent action taken must be documented. An example of where it may
be appropriate not to follow the PARS guideline is if the patient has a current Do Not Attempt
Resuscitation (DNAR) status (Worcestershire NHS DNAR policy, 2009)

If the health care professional has concerns about a patient, but a PARS score does not recommend
referral to a member of medical staff, then they can still contact a doctor for advice.

In situations where the PARS is 4 or above and a Doctor is not on site then the patient should be
transferred immediately to A&E using a 999 ambulance. Staff should ring A&E to advice of the transfer.
The WMHPT “Transfer and Record form for Medical Emergencies and Cardiac Arrests” should be
used to record the incident and for transferring information (details in Worcestershire MHPT
Resuscitation policy, 2008).

In cases where physical intervention and/or rapid tranquilisation have been used, the patient’s
observations must be recorded as per the WMHPT Rapid Tranquilisation policy (2007). However, in
situations where a Doctor is not present and where a nurse has any concerns regarding the patient’s
condition, then a PARS score should be obtained to help guide them in an appropriate referral.

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In situations where a patient has a suspected head injury a PARS score should be calculated and then
the on call Doctor must be contacted. After the medical assessment, as detailed in the WMHPT Falls
Policy (2008) the Doctor may request on-going observations using the Glasgow Coma Scale.

3. Staff training in the use of the PARS System.

Staff attending the UK Resuscitation Council Immediate Life Support course will be given instruction
and explanation on the use of the PARS in WMHPT. Ward managers will be responsible that all staff
who will take observations are aware of the PARS system and the importance of informing the nurse in
charge of any raised PARS.

4. Record and audit of the use of PARS.

When a PARS is calculated and the result is an emergency 999 patient transfer, the PARS score must
be recorded on the WMHPT “Transfer and Record form for Medical Emergencies and Cardiac Arrests”
(Worcestershire MHPT Resuscitation policy, 2008). The use of the PARS for emergency transfers can
then be audited by the Resuscitation Officers.

5. References.

Critical Care Outreach Service Operational Policy. 2006. Worcestershire Acute Hospitals NHS Trust.

Do Not Attempt Resuscitation Policy, 2009. Worcestershire NHS.

Falls Policy. 2008. Worcestershire MHPT

In Hospital Cardiac Arrest Prevention, Treatment guidelines. Version 3. 2004. Cardiac Arrest
Prevention Advisory Panel.

Patient at Risk Guideline, 2007, Worcestershire PCT.

Rapid Tranquilisation of Acutely Disturbed Patients. 2007, Worcestershire MHPT.

Resuscitation Policy. 2008. Worcestershire MHPT.

Resuscitation Policy. 2008. Worcestershire PCT.

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 Appendix One: WMHPT Observations chart – including PARS

UNIT NO:

SURNAME:
(BLOCK LETTERS)
OBSERVATION CHART AND
PATIENT AT RISK SCORE FIRST
NAMES:

Date

M M M M M M M M M M M M M M M M M M M M M
12 hourly E E E E E E E E E E E E E E E E E E E E E

4 hourly 2 10 18 2 10 18 2 10 18 2 10 18 2 10 18 2 10 18 2 10 18
6 14 22 6 14 22 6 14 22 6 14 22 6 14 22 6 14 22 6 14 22
Other
Frequencies
41.5
41.0 300
40.5 290
TEMPERATURE (°CELSIUS)

40.0 280
39.5 270
39.0 260
38.5 250

BLOOD PRESSURE mmHg

38.0 240
37.5 230
37.0 220

36.5 210
36.0 200
35.5 190
180 35.0 180
170 34.5 170
PULSE PER MINUTE

160 34.0 160

150 33.5 150
140 33.0 140
130 32.5 130
120 32.0 120
110 31.5 110
100 31.0 100
90 30.5 90
RESPIRATION PER MINUTE

80 30.0 80
70 29.5 70
60 29.0 60
50 28.5 50
40 28.0 40
30 30
20 20
10 10

AVPU
O²
Sats
Urine
See
PARS
Over

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 NOTE: This page will be displayed on reverse side of observation chart.

PATIENT AT RISK SCORE

Score 3 2 1 0 1 2 3

Systolic Blood Pressure 161-

<80 81-89 90-110 111-160 >190
(mmHg) 190

111-
Heart Rate <40 41-60 61-110
130
131-150 >150

Respiratory Rate <5 6-9 10-20 21-30 >30

Awake
Responds
Conscious Level Voice Awake Voice Unresponsive
to Pain
Pain A V U
P
Unresponsive

Urine output (if measured) <0.5ml/kg/h

37.8°- 38.1°-
Temperature <34° 34°-35.9° 36°-37.7°
38° 39.5°
>39.5°

Notes: Any abnormal measurement should trigger the calculation of the score. Points are
allocated according to the reading: i.e. temperature of 35.3 = 2; heart rate of 67 = 0. Once a
full set of observations have been made a total score is calculated.

Score 4 or above Immediate review by Doctor (if on site) or phone for a 999 emergency
ambulance to transfer the patient (as per local policy) Ring A&E to
advise of imminent transfer.

Score 3 Call for urgent Doctor review within 1 hour.

Score 2 Increase frequency of observations and inform Nurse in Charge/Senior

Nurse or Clinical Coordinator. Minimum frequency of observations
hourly for scores of 2 and above.

Score 0 or 1 Continue observations at current frequency.

‘This guidance does not override the individual responsibilities of the health care professional
to make appropriate decisions according to the circumstances of the individual patient in
consultation with the patient and or carer. However, if the health care professional chooses to
deviate from this guideline the reason for deviation and subsequent action taken must be
documented.’

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