Setting standards for assessment of ward patients at risk of deterioration

Improving the care of critically ill patients is a key objective of the Department of Health (DoH, 2000). Research findings and anecdotal evidence suggest that the key indicators of developing critical illness (respiratory rate and fluid balance) are being missed on busy general medical and surgical wards. In order to address this issue, the East Somerset NHS Trust critical care outreach team, in collaboration with ward staff, created the Amber Project. This project aimed to identify clearly patients who were at risk of deterioration and provide qualified nurses with a clear framework and minimum standard for assessment and observation. The project ran from June to September 2003. Results indicated that on the ward using the amber system the frequency of patient observations increased compared to those found on two other general wards. Nursing staff reported feeling more confident with regard to assessment and prioritizing care. Junior medical staff, physiotherapy and nursing staff reported that multiprofessional communication had improved, resulting in identification and treatment of critically ill patients. The authors suggest that the Amber Project, which incorporates the use of a "track and trigger" warning system, has been an effective initiative in identifying patients at risk of developing critical illness on general wards. Its positive impact on the performance and confidence of qualified nurses working in difficult environments has resulted in the extension of the project to all other wards in the hospital.