OPBG scenarios
Scenario no.1
2
OPBG scenarios • • • • •
3 Scenario no.1 Clinical assessment 8:00 a.m. Heart rate 145 Respiratory rate 46 Blood pressure 94/p Oxygen saturation 97% O2 administration 40 % FM Rerspiratory work moderate Capillary refilling 2 sec OPBG scenarios
4 Scenario no. 1 BPEWS score 8:00 a.m. BPEWS sub-score Heart rate 145 1 Respiratory rate 46 1 Blood pressure 94/p 0 Oxygen saturation 97 0 O2 administration 40% FM 2 Respiratory work moderate 1 Capillary refilling 2 sec 0 BPEWS score 5 OPBG scenarios
5 Recommendations in response to the score Bedside PEWS score 5 - 6 Initial recommendations Parameter monitoring 1 - 2 hrs Nursing re-evaluation < 4 hrs Re-evaluation by the operating unit physician < 4 hrs Re-evaluation by the physician on duty < 4 hrs Similar patients 1 - 2 OPBG scenarios
6 Scenario no. 1 Clinical assessment 10:00 a.m. Heart rate 151 Respiratory rate 50 Blood pressure 92/p Oxygen saturation 96% O2 administration 40 % FM Respiratory work moderate Capillary refilling 2 sec OPBG scenarios
7 Scenario no. 1 BPEWS score 10:00 a.m. BPEWS sub-score Heart rate 151 2 Respiratory rate 50 1 Blood pressure 92/p 0 Oxygen saturation 96 0 O2 administration 40 % FM 2 Respiratory work moderate 1 Capillary refilling 2 sec 0 BPEWS score 6 OPBG scenarios
8 Recommendations in response to the score Bedside PEWS score 5 - 6 Subsequent recommendations Parameter monitoring 1 – 2 every hour Nursing re-evaluation < 8 every hour Re-evaluation by the operating unit physician < 8 every hour Re-evaluation by the physician on duty < 8 every hour Similar patients 1 – 2 OPBG scenarios
9 Scenario no. 1 Clinical assessment 12:00 noon Heart rate 160 Respiratory rate 60 Blood pressure 88/p Oxygen saturation 95% O2 administration 40 % FM Respiratory work moderate Capillary refilling 3 sec Temperature 38.0 OPBG scenarios
10 Scenario no. 1 BPEWS score 12:00 noon BPEWS sub-score Heart rate 160 2 Respiratory rate 60 2 Blood pressure 88/p 1 Oxygen saturation 95% 0 O2 administration 40 % FM 2 Respiratory work moderate 1 Capillary refilling 3 sec 4 BPEWS score 12 OPBG scenarios
11 Recommendations in response to the score Bedside PEWS Score > 8 Initial recommendations Parameter monitoring 15 min Nursing re-evaluation < 15 min Medical evaluation < 15 min Continuous monitoring Continuous Resuscitation consultation To be considered Similar patients None OPBG scenarios
Gradual changes
12
OPBG scenarios
Scenario no. 2
13
OPBG scenarios • • • • • •
14 Scenario no. 2 Clinical Assessment 5:50 a.m. Heart rate 123 Respiratory rate 22 Blood pressure 100 Oxygen saturation 100% O2 administration TO 3 L/min Respiratory work Normal Capillary work 3 sec OPBG scenarios
15 Scenario no. 2 BPEWS score 5:50 a.m. BPEWS sub-score Heart rate 123 1 Respiratory rate 22 0 Blood pressure 100 0 Oxygen saturation 100% 0 O2 administration TO 3 L/min 2 Respiratory work Normal 0 Capillary refilling 3 sec 4 BPEWS score 7 OPBG scenarios
16 Recommendations in response to the score Bedside PEWS score 7 - 8 Initial recommendations Parameter monitoring 15 - 60 min Nursing re-evaluation < 2 hrs Medical evaluation <2 hrs Continuous monitoring (ECG, O2Sat) To be considered Resuscitation consultation To be considered Similar patients 0 – 1 OPBG scenarios
17 Scenario 2 Clinical assessment 9:00 a.m. Heart rate 130 Respiratory rate 30 Blood pressure 132 Oxygen saturation 100% O2 administration TO 5 L/min Respiratory work Moderate Capillary refilling 5 sec OPBG scenarios
18 Scenario no. 2 BPEWS score 9:00 a.m. BPEWS sub-score Heart rate 130 2 Respiratory rate 30 1 Blood pressure 132/83 1 Oxygen saturation 100% 0 O2 administration TO 5 L/min 2 Respiratory work Moderate 2 Capillary refilling 5 sec 4 BPEWS score 12 OPBG scenarios
19 Recommendations in response to the score Bedside PEWS Score > 8 Initial recommendations Parameter monitoring 15 min Nursing re-evaluation < 15 min Medical evaluation < 15 min Continuous monitoring Continuous Resuscitation consultation To be considered Similar patients None OPBG scenarios
Gradual changes
5- <12yr
20
OPBG scenarios
Scenario no. 3
21
OPBG scenarios • • •
•
•
22 Scenario no. 3 Clinical assessment 8:00 a.m. Heart rate 114 Respiratory rate 70 Blood pressure 108 Oxygen saturation 97% O2 administration 5 l/min Respiratory work Moderate Capillary refilling 2 OPBG scenarios
23 Scenario no. 3 BPEWS score 8:00 a.m. BPEWS sub-score Heart rate 114 1 Respiratory rate 70 4 Blood pressure 108 0 Oxygen saturation 97 0 O2 administration 5 l/m 4 Respiratory work Moderate 2 Capillare refilling 2 0 BPEWS score 11 OPBG scenarios
24 Recommendations in response to the score Bedside PEWS Score > 8 Initial recommendations Parameter monitoring 15 min Nursing re-evaluation < 15 min Medical evaluation < 15 min Continuous monitoring Continuous Resuscitation consultation To be assessed Similar patients None OPBG scenarios
25 Scenario no. 3 Clinical assessment 12:00 noon Heart rate 115 Respiratory rate 75 Blood pressure 86 Oxygen saturation 96% O2 administration 5 l/min Respiratory work Moderate Capillary refilling 2 OPBG scenarios
26 Scenario no. 3 BPEWS score 12:00 noon BPEWS sub-score Heart rate 115 1 Respiratory rate 75 4 Blood pressure 86 1 Oxygen saturation 96 0 O2 administration 5 l/min 4 Respiratory work Moderate 2 Capillary refilling 2 0 BPEWS score 12 OPBG scenarios
27 Recommendations in response to the score Bedside PEWS score >8 Subsequent recommendations Parameter monitoring 15-60 min Nursing re-evaluation < 2 hrs Re-evaluation by the operating unit physician < 2 hrs Continuous monitoring (ECG, SaO2) Continuous Resuscitation consultation To be re-evaluated Similar patients 0 OPBG scenarios
28 Scenario no. 3 Clinical assessment 12:00 midnight Heart rate 140 Respiratory rate 88 Blood pressure 91 Oxygen saturation 96% O2 administration 5 L/min Respiratory work Moderate Capillary refilling 2 State of consciusness Agitated OPBG scenarios
29 Scenario no. 3 BPEWS score 12:00 midnight BPEWS sub-score Heart rate 140 2 Respiratory rate 88 4 Blood pressure 91 0 Oxygen saturation 96% 0 O2 administration 5 L/min 4 Respiratory work Moderate 2 Capillary refilling 2 0 BPEWS score 12 OPBG scenarios
30 Recommendations in response to the score Bedside PEWS score >8 Subsequent recommendations Parameter monitoring 15-60 min Nursing re-evaluation < 2 hrs Re-evaluation by the operating unit physician < 2 hrs Continuous monitoring (ECG, SaO2) Continuous Resuscitation consultation To be re-evaluated Similar patients 0 OPBG scenarios
31 Scenario no. 3 Clinical assessment 4:00 a.m. Heart rate 126 Respiratory rate 60 Blood pressure 109 Oxygen saturation 94% O2 administration 5 L/min Respiratory work Moderate Capillary refilling 2 OPBG scenarios
32 Scenario 3 Punteggio BPEWS 4:00 a.m. BPEWS sub-score Heart rate 126 1 Respiratory rate 60 4 Blood pressure 109 0 Oxygen saturation 94% 1 O2 administration 5 L/min 4 Respiratory work Moderate 2 Capillary refilling 2 0 BPEWS score 12 OPBG scenarios
33 Recommendations in response to the score Bedside PEWS score >8 Subsequent recommendations Parameter monitoring 15-60 min Nursing re-evaluation < 2 hrs Re-evaluation by the operating unit physician < 2 hrs Continuous monitoring (ECG, SaO2) Continuous Resuscitation consultation To be re-evaluated Similar patients 0 OPBG scenarios
34 Scenario no. 3 Clinical assessment 6:00 a.m. Heart rate 126 Respiratory rate 92 Blood pressure 102 Oxygen saturation 90% O2 administration 5 L/min Respiratory work Severe Capillary refilling 2 OPBG scenarios
35 Scenario no. 3 BPEWS score 6:00 a.m. BPEWS sub-score Heart rate 126 1 Respiratory rate 92 4 Blood pressure 102 0 Oxygen saturation 90% 2 O2 administration 5 L/min 4 Respiratory work Severe 4 Capillary refilling 2 0 BPEWS score 15 OPBG scenarios
36 Recommendations in response to the score Bedside PEWS score >8 Subsequent recommendations Parameter monitoring 15-60 min Nursing re-evaluation < 2 hrs Re-evaluation by the operating unit physician < 2 hrs Continuous monitoring (ECG, SaO2) Continuous Resuscitation consultation To be re-evaluated Similar patients 0 OPBG scenarios
Gradual changes
37
OPBG scenarios 5-
<12yr
