15-0648 Form QEWS Standard+Pediatric+Observation+Chart 5+to+11yrs
15-0648 Form QEWS Standard+Pediatric+Observation+Chart 5+to+11yrs
15-0648 Form QEWS Standard+Pediatric+Observation+Chart 5+to+11yrs
5 - 11 YEARS
R (Recommendation) 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
Altered Calling Criteria Weight (kgs) Height (cms) Head Circumference (cms) ON HOW TO MAKE A CALL TO ESCALATE CARE FOR YOUR PATIENT
OTHER CHARTS IN USE Neurological Observations RBS Monitoring Sheet Growth Chart
Neurovascular Pain Scoring / Epidural Other CHECK THE HEALTH CARE RECORD FOR AN END OF LIFE CARE PLAN WHICH MAY ALTER
24 Hrs Intake & Output Chart DNAR Sheet Other THE MANAGEMENT OF YOUR PATIENT
PRESCRIBED FREQUENCY OF OBSERVATIONS
Observations must be performed routinely at least 4 hourly, unless advised below YELLOW ZONE RESPONSE
Date: Additional YELLOW ZONE Criteria
Time: Partially obstructed airway New, increasing or uncontrolled pain
Frequency Required Moderate Respiratory Effort / Distress Sternal Capillary Refill 3sec
5 - 11 Years 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
Signature Consider the following:
What is usual for your patient and are there documented ALTERATIONS TO CALLING CRITERIA?
ALTERATIONS TO CALLING CRITERIA Does the trend in observations suggest deterioration?
MUST BE REVIEWED WITHIN 48 HOURS OR EARLIER IF CLINICALLY INDICATED Is there more than one Yellow Zone observation or additional criterion?
Any alterations MUST be signed by a Resident/Specialist and countersigned by Consultant Are you concerned about your patient?
Document rationale for altering CALLING CRITERIA in the patients health care record
Date:
IF A CLINICAL REVIEW IS CALLED:
1. Reassess your patient and escalate according to your local DPRS if the call is not attended within 30 minutes
Time: or you are becoming more concerned
Frequency Required 2. Document an ABCDE assessment, reason for escalation, treatment and outcome in your patients health
care record
Respiratory Rate 3. Inform the consultant in-charge that a call was made as soon as it is practicable
60 60
55
50
55
50
Qatar Early Warning System (QEWS)
per minute)
Respiratory Rate
45 45 Standard Pediatric Observation Chart
40 40
35 35
30 30
25 25 Altered Calling Criteria
(Breaths
20 20 Date Date
AIRWAY/BREATHING
15 15 Time Time
10 10
5 5 Level of LoC
Consciousness CS = Conscious, CF = Confused, S = Stupor, U = Unconscious
Normal Normal
Distress
Mild Mild Rt Rt
Resp
Moderate Moderate Lt Lt
DISABILITY
Pupil
Size
Severe Severe
100 100 1 2 3 4 5 6 7 8
(in any amount of O2)
95 95
90 90 Rt Rt
Reaction
2
Pupil
SpO
85 85 Lt Lt
80 80 B = Brisk, S = Sluggish, N = No Response, NA = Not Applicable
75 75
70 70 Glasgow Coma
Scale Score GCS
Probe Change
15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15
Probe Change
L/min or % L/min or %
41 41
BINDING MARGIN - NO WRITING
Oxygen
Device Device
Key: RA = Room Air, NC = Nasal Cannula, FM = Simple facemask, NRBM = Non Re-breather Mask, VM = Venturi Mask, TC = Trach Collar,
40.5 40.5
CPAP = Continuous Positive Airway Pressure, BiPAP = Bi-level Positive Airway Pressure
40 40
39.5 39.5
5 - 11 Years Chart
t 180 180 39 39
38.5 38.5
Temperature (oC)
170 170
160 160 38 38
37.5 37.5
EXPOSURE
150
(Apical)(Beats per minute)
150
140 140 37 37
130 130 36.5 36.5
Heart Rate
120 120 36 36
110 110 35.5 35.5
100 100 35 35
90 90 34.5 34.5
80 80 34 34
70
70
60 60 Route Route
CIRCULATION
130 130
Systolic Blood Pressure is trigger
EYE
Difficulty feeding or eating Unable to talk or cry
70 70 Unable to feed or eat 2 To pain
60 60 Respiratory rate in the red zone
1 No Response
50 50 Respiratory Rate Mildly increased Respiratory rate in the yellow zone
Decreasing (exhaustion) 5 Smiles, coos appropriately
40 40 4
VERBAL
None / minimal Moderate recession Severe recession Appropriate cry
3
30 30 Tracheal tug Gasping Inappropriate cry or scream
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MOTOR
Apnoeic Episodes None Abnormal pauses in breathing Apnoeic episodes
3 Decorticate flexion
Rapid Response Clinical Review Oxygen No oxygen requirement Mild hypoxaemia, corrected by oxygen Hypoxaemia, may not be 2 Decorticate extension
Increasing oxygen requirement corrected by oxygen 1 No Response