Exam Pass Notes

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A Simple Safety Memory Aid

• Notice the warning words
• Stay within role
• Use the local route
• Record the facts
• Hand over clearly
• Close the loop

Recognise

• Chest pain with sweating, vomiting, light-headedness, breathlessness or pain radiating to the arm, jaw, neck, back or abdomen may require urgent action.
• Breathing difficulty includes inability to speak full sentences, sudden worsening breathlessness, blue lips, choking, gasping, noisy breathing or visible chest retraction.
• Collapse, unconsciousness, difficulty waking or prolonged drowsiness must not be managed as routine cases.
• Patients may downplay serious symptoms or request a GP appointment first; such requests should not override clear urgent warning signs.

Respond

• Use the local urgent escalation route as soon as concerning wording appears.
• Do not diagnose or clinically triage from reception, care navigation or call-handling roles.
• Do not give clinical reassurance or advise a person it is safe to wait when urgent wording is present.
• Escalate uncertainty instead of trying to resolve potentially unsafe symptoms yourself.

Record and Handover

• Record exact words, time, contact route, patient location and a safe call-back number.
• Record action taken, including who accepted responsibility and which urgent route was used.
• Document complications such as refusal, failed call-back, disconnection, online delay or remaining uncertainty.
• Keep urgent wording visible rather than reducing it to vague phrases like "unwell" or "wants advice".

Practice Systems

• Staff need visible prompts, clear scripts, named urgent clinical contacts and backup routes.
• Online requests and routine queues must be monitored so urgent wording is not missed.
• Failed-contact rules should state what to do when calls drop, patients leave or urgent ownership is delayed.
• Near misses should inform learning and system improvement, not only individual reminders.