ViCTOR - Keeping kids safe in their zones
Victorian Children's Tool for Observation & Response
Session plan
• Introduction to new observation
charts
• New Escalation of care process
• Implications for Nursing at RCH
• Charts & forms
• Next steps
• Go live day
Keeping Kids Safe
• Why this system is important
• Where this is happening
• How ViCTOR works
1 – 4 year old Observation and Response Chart: RESPIRATORY
Service
Normal Range (white
area)
RATE
Clinical review trigger MET or CODE trigger point
point (high)
RCH *trial chart
20 – 40
41
High 56 / Low 16
Eastern Health
21 – 30
31
High 36 / Low 11
Barwon Health
20 – 40
41
Highest 60 / Lowest 15
* 3 tier escalation
Bendigo Health
21 - 35
36
Highest 41 / Low 14
The Alfred
21 – 49
50
High 60 / Low 15
Austin Health
20 – 40
41
Highest 60 / Lowest 20
* 3 tier escalation
NSW
20 – 40
41
Highest 60 / Lowest 15
* 3 tier escalation
SA
20 – 34
35
Highest 40 / Lowest 12
* 3 tier escalation
4
Paediatric Clinical Network Initiative
Examples of Track and Trigger in VIC
WHAT DOES IT MEAN FOR ME
AS AN RCH NURSE?
Practice using the new charts
• Using the new charts, practice charting
the following observations on an age
appropriate chart
• Review & make a decision about what
actions you are going to make
• Justify your decision to the group (prepare to
document your decision)
Scenario 1:
12 year old presents with suspected right hand
fracture post collision in football match
Temp
37.7
HR
117
O2
99% RA
BP
122/67
RR
20
AVPU = Alert Scoring 8/10 pain
Scenario 2:
3 year old post elective Tonsillectomy
Temp 38.0
HR
140
O2
96% RA
RR
24
BP
100 / 63
AVPU = Alert Scoring 6/10 pain
Scenario 3:
8 month old, Ex 24/40. Elective admission for
closure of colostomy
Admission day Observations
Temp 37.0
HR 122
O2 100% RA
BP 102/55
RR 26
AVPU = Alert
Which pain scale should be used?
Scenario 3 / Day 3 Observations
Temp
38.5
HR
160
O2
97% RA
RR
65
BP
122/ 76
AVPU = Alert
Which pain scale should be used?
Scenario 3 / Day 4 Observations
Temp
38.5
HR
200
O2
95% 2L NP
RR
72
BP
85/44
AVPU=Verbal
Which pain scale should be used?
Other implications
Utilize the following additional charts:
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Neurological Observation Chart (new)
Pain Observation Charts (PCA & Epidural)
Upper Limb Observation Chart
Lower Limb Observation Chart
Remember
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•
•
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•
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•
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Plot the dot, join the line to show the trend
Escalation of Care
Plan Frequency of observations
AVPU (LoC)
Special considerations for PICU / OT / ED
Modify & Justify
Beware of ‘copying and pasting’ modifications
Temperature modifiable in <3 mths
What do I have to know?
1. ViCTOR – observation charts
• 5 charts
• Observation procedure
2. Medical Emergency Response Procedure
• Escalation of Care & Modification flowchart
3. Code Blue
• Coming soon
• 48 Flemington Road response
RCH Launch
Wednesday 7th January, 2015
• Go live at 12 noon
• Transition to new charts between
0900-1200 hours
• Roving clinical support crew available
Resources
• Medical emergency response
procedure
• Escalation of Care Flowchart
• Observation & continuous monitoring
of Children CG
• ViCTOR observation charts x 5
Acknowledgments
Questions?