Information for GP’s on the implementation of a track and trigger observation scoring system within Community Nursing Services
NHS BwD Community Matron Team has devised a new way of monitoring acutely unwell patients in the Community. Track and Trigger systems involve periodic clinical observations of specified patient vital signs (the ‘track’) which prompts a pre determined graded response (the ‘trigger’) for seeking more experienced clinical support and for increasing the intensity of care and monitoring. Track and Trigger systems have become well established in secondary care in the management of acutely unwell adults. Indeed, their use is advocated by the National Institute of Clinical Excellence, the NHS Litigation Authority and the National Patient Safety Agency.
National and local drivers promote admissions avoidance strategies, supported by the Community Matrons, whereby many patients undergoing acute exacerbation of their long term conditions can be intensively monitored and managed in their own home or residential setting. To facilitate this and to promote equitable, standardised care across Blackburn with Darwen, a Track and Trigger system was specifically designed for use with patients in their own home or residential setting. By monitoring specified clinical observations (respiratory rate, temperature, pulse, systolic blood pressure, level of alertness and blood oxygen levels), deteriorating patients are identified and monitored more frequently. More experienced nursing or medical support is requested if the patients clinical observations fall outside a pre determined range. The tool was piloted for 6 months with patients on the Darwen Community Matron neighbourhood caseload, who were visited frequently by the Matrons and community staff nurses. Quantitative evaluation of the pilot data demonstrated that the Track and Trigger system promotes comprehensive measurement of patient observations and appropriate escalation of management, in terms of frequency and seniority of review. Qualitative evaluation demonstrated that the Community Matrons and community nurses found the tool valuable as a support and guide in their clinical decision making.
The Track and Trigger system is currently being rolled out to all Community Matron patients in Blackburn with Darwen, with a plan to extend its use to all patients on the community nursing caseload.
If you would like more information about the Track and Trigger system in Blackburn with Darwen, please contact Claire Downes, Community Matron and Project Lead on 07967644557 or Jane Pemberton Head of Community Nursing on 01254 282768.
