Exam Pass Notes

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A Simple Safety Memory Aid

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

Recognise

• Deterioration means the person is getting worse, is less able to cope, or is not their usual self.
• Warning words include new confusion, drowsiness, slurred speech, not making sense, breathlessness, blue lips or noisy breathing.
• Sudden weakness, inability to stand, inability to drink, reduced urine output, severe pain, rigors, mottled skin or clamminess require concern.
• Repeated contact can indicate worsening symptoms or that previous advice has not helped.
• Babies, children, frail adults, care-home residents, recently discharged patients and people who cannot communicate clearly often need earlier escalation.

Respond

• Use the local urgent escalation route as soon as concerning deterioration is evident.
• Do not diagnose or clinically triage from reception, care navigation or call-handling roles.
• Do not give clinical reassurance or say it is safe to wait when symptoms are worsening.
• Escalate uncertainty rather than attempting to resolve unsafe symptoms yourself.

Record and Handover

• Record exact words, time, contact route, patient location and safe call-back details.
• Record change over time, noting what is new, worse or different from usual.
• Record action taken, including who accepted ownership 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 such as "unwell", "weakness query" or "wants advice".

Practice Systems

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