Download Guidelines for the use of Zuclopenthixol Acetate (Clopixol Acuphase

 Guidelines for the use of Zuclopenthixol Acetate (Clopixol
Acuphase®) injection
Version 1
Guidelines for the use of Zuclopenthixol
Acetate (Clopixol Acuphase®) injection
SUMMARY POLICY CODE REPLACES POLICY CODE (IF APPLICAPLE AUTHOR Naeema Majothi, Clinical Pharmacist Saira Mould, Senior Clinical Pharmacist TRUST BOARD SUB-COMMITTEE WHICH APPROVED ORIGINAL
VERSION
(Name of Committee)
DRUG AND THERAPEUTICS COMMITTEE
DATE OF APPROVAL 8th July 2014
DATE OF NEXT REVIEW
Q2 FY15/16
CURRENT VERSION PLACED ON INTRANET
DATE
CHAIR(S) OF APPROVING COMMITTEE SIGNATURE(S)
TITLE(S) Deputy Chair, DTC DATE 8th July 2014 Guidelines for the use of Zuclopenthixol acetate (Clopixol Acuphase®) Version 1. Date: April 2014
Authors: Naeema Majothi Clinical Pharmacist, Saira Mould Sr Clinical Pharmacist
Page 1 Guidelines for the use of Zuclopenthixol Acetate (Clopixol
Acuphase®) injection
For In-Patient Use Only
This guideline should be read in conjunction with Trust Policy CP04:
(Rapid Tranquillisation Adults and Older Adults)
Aim of the Guideline:
The aim of this guideline is to provide information to prescribers and mental health practitioners to
ensure that Zuclopenthixol acetate (Clopixol Acuphase®) injection is prescribed and administered safely
and effectively to adult and elderly service users within Oxford Health NHS Foundation Trust.
Background:
Zuclopenthixol Acetate (Clopixol Acuphase®) is a parenteral antipsychotic which can be prescribed for
“the initial treatment of acute psychoses including mania and exacerbation of chronic psychoses,
particularly where a rapid onset of action and duration of effect of 2-3 days is desirable”.
As per Trust Policy CP04 (Rapid Tranquillisation Adults and Older Adults), zuclopenthixol acetate
should never be considered as a first-line drug for rapid tranquillisation as the onset of action will not be
rapid enough in these circumstances.
A Cochrane review published in 2012 advised that the evidence for zuclopenthixol acetate rapidly
calming and sedating patients was poor and recommended caution in using zuclopenthixol acetate in
psychiatric emergencies.
In addition, the administration of an oil based injection carries significant risk in highly agitated,
struggling patients as there is a chance of accidental administration into a vein.
Zuclopenthixol acetate should not be given to patients who are struggling excessively to resist injection
who cannot be suitably restrained due to the risk of intravasation and oil embolus.
Zuclopenthixol acetate may be of best use where there is a history of administration to good clinical
effect or there is an advance directive in place.
Zuclopenthixol acetate is not recommended for use in the Community because it has a relatively long
duration of action (72 hours) and requires a period of physical health monitoring.
Mental Health Act Consideration:
Where “Consent to Treatment” forms (T2 or T3) are in place for a service user, due consideration must
be given to whether the use of zuclopenthixol acetate is covered under the Mental Health Act. The
Responsible Clinician (RC) may need to complete a Section 62 form prior to prescribing and
administration of zuclopenthixol acetate.
Medicines that may be required to treat potential side effects of zuclopenthixol acetate e.g. procyclidine
oral or injection should also be included on the Section 62 form if they are not already included on a T2
or T3 form.
Guidelines for the use of Zuclopenthixol acetate (Clopixol Acuphase®) Version 1. Date: April 2014
Authors: Naeema Majothi Clinical Pharmacist, Saira Mould Sr Clinical Pharmacist
Page 2 Prescribing standards:
Zuclopenthixol acetate may only be prescribed by or under the advice of a Consultant Psychiatrist.
The prescribing decision must be documented in the patient’s electronic progress notes.
Zuclopenthixol acetate should only be prescribed if any of the following circumstances applies:
¾
After an acutely psychotic or manic patient has required repeated injections of short acting
antipsychotic drugs, such as haloperidol or olanzapine or sedative drugs such as lorazepam as
per Trust Guideline CP04.
¾
When there is an advance directive for the use of zuclopenthixol acetate
¾
When there is a documented history that the patient experienced a good clinical effect and
good tolerability.
Zuclopenthixol acetate should not be administered:
¾
In an attempt to “hasten” the antipsychotic effect of other prescribed antipsychotics.
¾
As a test dose for zuclopenthixol decanoate
¾
At the same time as other parenteral antipsychotics or benzodiazepines (see NOTE) as this
may lead to over sedation, which may be difficult to reverse.
Zuclopenthixol acetate should only be administered when enough time has elapsed to assess the full
response to previously injected drugs. Allow a minimum of 60 minutes after intramuscular injections.
NOTE: Administration of parenteral benzodiazepines in addition to zuclopenthixol acetate may be
appropriate in some circumstances:
E.g.
¾
Where the sedative effect of a benzodiazepine is desirable in the period of time before the
zuclopenthixol acetate has a chance to take effect and this is part of a management plan
agreed by the treating Consultant.
¾
Where there is documented evidence that the patient has experienced a good clinical effect
from the combination of parenteral benzodiazepines and zuclopenthixol acetate and has
demonstrated tolerability to the combination,
Flumazenil is available on all Mental Health Units in case there is a need to reverse the effects of
benzodiazepines (see CP04).
A single dose should be prescribed on the “Medication to be given once only” section of the Trust drug
chart.
The prescribing of other parenteral antipsychotics to be administered as required (prn) should be
ceased for the duration of action of the zuclopenthixol acetate.
The Multi-disciplinary team should consider withholding other antipsychotics for the duration of action of
the zuclopenthixol acetate (72 hours).
Intramuscular and oral procyclidine should be prescribed in case of the occurrence of treatment
emergent extrapyramidal side effects e.g. acute dystonic reaction or pseudo-parkinsonism.
Guidelines for the use of Zuclopenthixol acetate (Clopixol Acuphase®) Version 1. Date: April 2014
Authors: Naeema Majothi Clinical Pharmacist, Saira Mould Sr Clinical Pharmacist
Page 3 IM procyclidine should not be administered as prophylaxis at the same time as zuclopenthixol acetate
administration, to “prevent” the occurrence of dystonic reactions as it has a significantly shorter half-life
than zuclopenthixol acetate.
Zuclopenthixol acetate must not be prescribed as a course, and after an initial dose has been
administered, an assessment of the service user by the prescribing doctor must be carried out prior to
prescription and administration of any further doses.
Therefore faxed orders or verbal orders for zuclopenthixol acetate are not acceptable.
Care must be taken not to confuse zuclopentixol acetate (Clopixol Acuphase®) with
zuclopenthixol decanoate as the latter is the long acting injection used in the maintenance
treatment of schizophrenia.
ALWAYS PRESCRIBE AS ZUCLOPENTHIXOL ACETATE
ALWAYS CHECK THE PACKAGING AS CLOPIXOL ACUPHASE®, CLOPIXOL
INJECTION® AND CLOPIXOL CONC ®INJECTION LOOK VERY SIMILAR
Prescribing Precautions:
Zuclopenthixol acetate should never be prescribed for the following:
¾
Patients who accept oral medication prescribed to relieve agitation or aggression / manage
psychosis e.g., antipsychotics
¾
Patients who are neuroleptic naïve
¾
Patients who are sensitive to extrapyramidal symptoms (EPS)
¾
Patients who are pregnant
¾
Patients who are unconscious
¾
Patients who have advanced hepatic or renal impairment
¾
Patients with a history of seizures or epilepsy
¾
Patients with cardiac disease
This group includes but is not exclusive to those with QT prolongation, recent acute myocardial
infarction, significant bradycardia (<50 beats per minute), uncompensated heart failure or
cardiac arrhythmias.
Hypokalaemia, hypomagnesia and those with a genetic risk of cardiac arrhythmia may also be
at risk of cardiac side effects.
Licensed use:
Zuclopenthixol acetate is licensed for initial treatment of acute psychoses including mania and
exacerbation of chronic psychoses, particularly where a rapid onset of action and duration of effect of 23 days is desirable.
Zuclopenthixol Acetate is not licensed for use in children and adolescents.
Dose:
¾
Adults: 50mg-150mg of Zuclopenthixol Acetate (1-3ml) can be prescribed. Repeat if necessary
after two or three days. Some patients may need an additional injection between 1 and 2 days
after the first injection.
Guidelines for the use of Zuclopenthixol acetate (Clopixol Acuphase®) Version 1. Date: April 2014
Authors: Naeema Majothi Clinical Pharmacist, Saira Mould Sr Clinical Pharmacist
Page 4 ¾
Elderly: The dosage may need to be reduced in the elderly owing to reduced rates of
metabolism and elimination. Maximum dosage per injection should be 100mg
¾
Zuclopenthixol Acetate is not intended for long term use and duration of treatment should not
be more than two weeks. For all patients the accumulated dosage must not exceed 400mg in a
2 week period and the number of injections should not exceed four. During this two week period
a treatment plan must be made to manage the service user beyond this period.
¾
Zuclopenthixol Acetate should not be viewed as a course of treatment.
Administration:
Zuclopenthixol acetate is to be administered by deep intramuscular injection, into the upper outer
buttock or lateral thigh.
Onset and duration of Action:
The sedative effects usually begin to be seen 2 hours after the injection and peak at around 36 hours.
The effects usually last for up to 72 hours although full elimination of the drug may take 7 days.
Adverse Reactions:
Consult the specific product characteristics for full list of adverse reactions and prescribing
information.
Common:
¾
Drowsiness
¾
Movement disorders ( akathisia, dystonia, parkinsonian symptoms)
¾
Raised Prolactin
¾
Constipation
Less Common
¾
Tachycardia
¾
Urinary retention
¾
Prolong QT interval
¾
Neuroleptic malignant syndrome (NMS)
Physical Health Monitoring Standards
Due to the extended release profile of zuclopenthixol acetate observations should be continued for 72
hours. Complete physical health monitoring as per guidance in Appendix 2.
Documentation:
In addition to a clear zuclopenthixol acetate prescription, prescribers should document instructions for
the use of zuclopenthixol acetate and the physical monitoring of zuclopenthixol acetate in the patient’s
electronic progress notes.
Guidelines for the use of Zuclopenthixol acetate (Clopixol Acuphase®) Version 1. Date: April 2014
Authors: Naeema Majothi Clinical Pharmacist, Saira Mould Sr Clinical Pharmacist
Page 5 In addition to documenting administration of zuclopenthixol acetate on the prescription chart, nursing
staff must document service-user response to zuclopenthixol acetate, recording any adverse events
and the actions taken as well as the level of response to the medication.
Physical health monitoring should be carried out in accordance with the guidance in Appendix 2 and
recorded on a M-EWS Modified Early Warning Scoring System) form as per Trust Policy. If there is any
deterioration in the condition of the service user, nursing staff must contact medical staff and actions
taken should be documented in the service user’s electronic progress notes.
In the event that the administration of Acuphase has to be carried out under restraint, post-incident
review must be recorded in the patient’s electronic progress notes. Appropriate records should be kept
of any post-incident staff and/or patient debriefing.
Other relevant polices and guidance:
•
National institute for Health and Clinical Excellence (NICE). Violence – The short term
management of disturbed/ violent behaviour in in-patient psychiatric setting and emergency
departments. Guidelines No 25, 2005
•
CP04 Rapid Tranquilisation (Adults and Older Adults). December 2011.
•
MM01 Medicines Management Policy
•
Risk Note 11:Seclusion reviews and physical health care: Risk
References:
•
Summary of Product Characteristics, Clopixol Acuphase Injection, Lundbeck Ltd. (Accessed
10/4/14)
•
National institute for Health and Clinical Excellence (NICE). Violence – The short term
management of disturbed/ violent behaviour in in-patient psychiatric setting and emergency
departments. Guidelines No 25, 2005. (Accessed 10/4/14)
•
D.Taylor et al. The Maudsley Prescribing Guidelines in Psychiatry 11th Edition, Wiley-Blackwell,
2012.
•
Sussex Partnerships NHS Trust ;Guidelines for the use of zuclopenthixol acetate (Clopixol
Acuphase®) injection Version 2 – amended appendix – January 2012
•
Jakody K et al. Zuclopenthixol acetate for acute schizophrenia and similar serious mental
illness (Review). The Cochrane Library 2012, Issue 4
Thanks:
Many Thanks to Dr Ashley Rule for his advice in preparing this document.
Guidelines for the use of Zuclopenthixol acetate (Clopixol Acuphase®) Version 1. Date: April 2014
Authors: Naeema Majothi Clinical Pharmacist, Saira Mould Sr Clinical Pharmacist
Page 6 Appendix 1: Treatment Algorithm & Guidance for the use of Zuclopenthixol acetate (Clopixol
Acuphase®) in Adults and Older Adults (18+)
This algorithm should be implemented in any of the following situations :
•
Use of repeated doses of short acting parenteral antipsychotics e.g. haloperidol, olanzapine,
aripiprazole and/or benzodiazepines has been unsuccessful.
•
An antipsychotic with a duration of action of 2-3 days is required.
•
The patient has a documented history of previous good response to the use of zuclopenthixol
acetate.
The need to continue following this algorithm should be under constant review and a return to managing
acute agitation using oral medication, if necessary, should be undertaken at the earliest opportunity.
Doctor to review patient and previous psychotropic management
Assess symptoms and need for antipsychotic treatment with 2-3 day effect.
Discuss with Consultant.
Document plan in patient’s progress notes
Prescribe Zuclopenthixol acetate 50-150mg as ONCE only dose 1, 2, 3, 4, 5
Competent registered nurse to administer zuclopenthixol acetate injection.6, 7
Complete physical monitoring for 72 hours.9
Refer any concerns to doctor and document in patient’s progress notes.
When monitoring form complete (M-EWS), upload into patient’s electronic health record.
Doctor to review the patient and assess need for further prescription of zuclopenthixol acetate.
Discuss with Consultant and repeat dose if necessary after two or three days.
Document plan in patient’s progress notes
Total dose must not be greater than 400mg in 2 a week period and the number of injection should not exceed
FOUR.
Maintain Physical Health Monitoring and upload completed M-EWS forms into patient’s electronic health
Guidance and Precautions
1. Check BNF/SPC for zuclopenthixol acetate for dosing.
2. Maximum dose in older adults is 100mg per injection.
3.
Zuclopenthixol acetate should never be prescribed for the following:
Appendix 2: Physical Health Monitoring Record ¾ Patients who accept oral medication to treat agitation or psychosis e.g. antipsychotics
¾ Patients whoAcetate
are neuroleptic
naïve
Zuclopenthixol
Physical
Health Monitoring Form
¾ Patients who are sensitive to extrapyramidal symptoms (EPS)
¾ Patients who are pregnant
¾ Patients who are unconscious
¾ Patients who have advanced hepatic or renal impairment
¾ Patients with cardiac disease e.g. QT prolongation, recent MI, heart failure, cardiac arrhythmia,
bradycardia (see SPC for further information)
¾ Patients with a history of seizures or epilepsy
4. Ensure that the appropriate Mental Health Act paperwork has been completed e.g. Section 62, to enable
legal administration of zuclopenthixol acetate and any other prescribed medications e.g. procyclidine,
benzodiazepines.
5. Caution: Always prescribe as ZUCLOPENTHIXOL ACETATE to avoid confusion with zuclopenthixol
decanoate (Clopixol depot injection). Ensure that the correct product is chosen –NOTE SIMILAR
PACKAGING TO OTHER IM & DEPOT PREPARATIONS.
6. Ensure both oral and I/M procyclidine are prescribed in case of treatment emergent dystonia and other
EPS.
Do not administer IM procyclidine for prophylaxis
Appendix 2 7. Zuclopenthixol acetate should not be given to patients who are struggling excessively to resist injection who
Guidelines
for the
use of Zuclopenthixol
Acuphase®)
1. Consider
Date: Apriladministering
2014
cannot
be suitably
restrained dueacetate
to risk(Clopixol
of intra-vasation
& oil Version
embolus.
IM
Authors:lorazepam
Naeema Majothi
Clinical
Pharmacist,
Saira
Mould
Sr
Clinical
Pharmacist
& waiting until the patient is calmer before administering zuclopenthixol acetate
8. Unless planned co-administration of benzodiazepine, check that 60 minutes have elapsed since
administration of the last antipsychotic or benzodiazepine intra muscular injection
9. See Appendix 2 for monitoring
Page 7 Monitoring Guideline for the Use of Zuclopenthixol Acetate
Oxford Health NHS Foundation Trust uses M-EWS (Modified Early Warning Scoring System) to monitor the
physical health of patients.
Where zuclopenthixol acetate is prescribed and administered, the M-EWS must be used to record the
following clinical observations:
•
blood pressure (BP),
•
pulse,
•
temperature
•
respiration rate
•
Sp02
Monitoring should be carried out at the following time intervals after administration of zuclopenthixol
acetate and recorded on the M-EWS form.
15 minutes
6 hours
28 hours
52 hours
30 minutes
8 hours
32 hours
56 hours
1 hours
12 hours
36 hours
60 hours
2 hours
16 hours
40 hours
64 hours
3 hours
20 hours
44 hours
68 hours
4 hours
24 hours
48 hours
72 hours
In the event that physical monitoring of a patient cannot be carried out e.g. due to aggression, AVPU
scoring must be used until it is possible to carry out the required monitoring.
Alert
Voice
Pain
Unresponsive
Once completed, the monitoring information must be uploaded into the patient’s electronic health record.
Guidance on the use of M-EWS and AVPU can be accessed via the following link:
MONITORING
M-EWS forms can be accessed by following the link:
M-EWS V5
Extra-pyramidal symptoms
Patients administered zuclopenthixol acetate must also be monitored for the emergence of extrapyramidal
symptoms such as acute dystonia, akathisia and pseudo-parkinsonism which can be managed with oral
anticholinergic agents e.g. procyclidine, or parenteral anticholinergics e.g. IM procyclidine in an emergency.
Guidelines for the use of Zuclopenthixol acetate (Clopixol Acuphase®) Version 1. Date: April 2014
Authors: Naeema Majothi Clinical Pharmacist, Saira Mould Sr Clinical Pharmacist
Page 8 Name:...........................................Date of Birth:............................
ID Number / NHS number………../................
(Affix label)
Baseline clinical observations & calculation of M-EWS to be recorded every 12 hours for the first 72 hours
after admission (More frequently if score rating indicates or recommended by doctor) Baseline
observations include; Respirations, Pulse Oximetry, Pulse, Manual BP, Conscious Level, Blood glucose and
weight.
Observations should be recommenced in the following situations:
rapid tranquilisation or physical intervention; falls; seizures; the commencement of new/increased medication;
signs of recent confusion or agitation; or if staff, carers or the service user states that they suspect the patient
maybe becoming physically unwell.
If unable to carry out an observation record:
R = refused
A = absent
Modified –Early Warning Score (M-EWS)
Scores Grading Response Action Plan for the Adult Patient at Risk
Observation Score 0-1
Continue observations as before & inform nurse
in charge
Yes
Potential for deterioration
Inform nurse in charge that patient has triggered
a M-EWS
Check and record observations minimum interval
4 hourly (Nurse in charge to decide frequency)
If there is single observation score rating of 3
provide supportive measures -Table 1
Nurse in charge to decide to contact medical
team
No
Observation Score 2-3
Yes
No
Observation Score 4 or above
(single observation rating 3)
Table 1
Example recommendations:
Yes
Patient deteriorating & at risk of critical illness
Inform nurse in charge & medical staff of patient
deterioration, report & document using the
SBARD format.
Review & rescore assessment of patient within
30 minutes
Provide supportive measures –Table 1
Supportive measures to consider
A. Maintain a patent airway, suction if required, give oxygen if emergency
B. Monitor saturations. Sit patient up (not if unconscious or BP low)
C. Monitor ECG. Check urine output, fluid balance and for haemorrhage
D. Check pupil reaction, conscious level, blood glucose. If unconscious place in lateral position
E. If in pain give analgesia. If Pyrexia present - cool & give antipyretic. If hypothermic - warm
Document all actions & a clear management plan following a review, including when the next review should occur
IF PATIENT DETERIORATES AND YOU ARE UNABLE TO GET IMMEDIATE MEDICAL AID, TELEPHONE 9999.
IF YOUR PATIENT IS NOT BREATHING and NO SIGNS OF LIFE TELEPHONE 9999 & PROVIDE BASIC LIFE SUPPORT
S
B
A
Situation:
I am (name) a RMN with (X team/ward); I am calling about (patient X);
I am calling because I am concerned they are unwell (e.g. they have difficulty breathing, chest pain )
Background:
Patient (X) has been under our team since (X) date with (X) problem
They have been receiving (X) medicines/intervention, Their medical history is (X)
Their condition has changed in the last (X )mins/hours
Assessment:
I think the problem is (X):
Airway –clear/partially/completely obstructed
Breathing – Colour, RR, Sp02, noises such as coughing wheezing, sputum, use of accessory muscles
Circulation – Pulse, BP, CR, sweaty/clammy, pain, bleeding, nausea+/-vomiting
Disability – AVPU, GCS, pupil reaction, confused/ disorientated, blood glucose,
Exposure – rashes/injuries, temperature
M-EWS score is (X)
OR: I am not sure what the problem is but I am concerned
R
Recommendation:
D
Decision:
I have done (X)
I need you to; See the patient (when?)/Consider prescribing (X) drug/Make a referral to/Advise me what to do next (When?)
AND is there anything I can do in the meantime?
So we have agreed that I will (X) AND/OR you will (X)
January 2014 M-EWS V5
Author: Resuscitation Service
1
Name:...........................................Date of Birth:............................
ID Number / NHS number………../................
(Affix label)
Date
Time (24hour)
Respiratory Rate
≥ 30
3
21-29
2
17-20
0
12-16
0
10-11
1
9
2
≤8
3
Respirations
97-100
0
94-96
0
≤ 93
3
Oxygen Saturation
0
Voice
V
1
Pain
P
2
U
3
Conscious Level
40
3
39
3
38
3
37.5
2
37
0
35
1
Unresponsive
Temperature
(36.1 – 37.4 °C)
Conscious Level
40
39
38
37.5
36- 37
35
34
Temperature
34
3
Temperature
TOTAL MEWS
TOTAL MEWS
Signature/Initials
January 2014 M-EWS V5
Pulse
(51-100)
SPO2
A
Author: Resuscitation Service
2
Conscious
Level
If outside of normal parameters (4-7mmol/L) seek medical advice
Temperature
(36.1 – 37.4 °C)
Conscious
Level
SYSTOLIC Blood Pressure
(100 -139)
Pulse
51 -100)
Oxygen Y/N
130>
3
120
3
110
2
100
1
90
0
80
0
70
0
60
0
50
1
≤40
3
Pulse
≥ 200
3
190
3
180
3
170
3
160
3
150
3
140
3
130
3
120
3
110
3
100
3
90
2
80
0
70
0
60
0
50
2
40
3
Systolic BP
Diastolic BP
Blood Glucose
level
DIASTOLIC Blood Pressure
(60 -89)
SPO2
Respirations
(12 - 20)
≥ 30
21-29
17-20
12-16
10-11
9
≤8
Respirations
97-100
94 - 96
≤ 93
Oxygen
Saturation
Oxygen Y/N
130 >
120
110
100
90
80
70
60
50
≤40
Pulse
≥ 200
3
190
2
180
2
170
2
160
1
150
1
140
1
130
0
120
0
110
0
100
0
90
1
80
1
70
3
60
3
50
3
40
3
Systolic BP
Diastolic BP
Blood Glucose
Level
FILL IN THE ACTUAL VALUE IN MMOL/L (No score )
Alert
Name:...........................................Date of Birth:............................
ID Number / NHS number………../................
(Affix label)
Glasgow Coma Scale (GCS)
Best motor
response
Verbal
response
Eyes
open
DATE
TIME (24HOUR)
Spontaneously
To speech
To pain
None
Orientated
Sentences
Words
Sounds
None
Obey
Commands
Localise pain
Normal flexion
Abnormal flexion
Extension
None
Total GCS
4
3
2
1
5
4
3
2
1
6
5
4
3
2
1
Pupil
guide
3mm
4mm
5mm
- no reaction
6mm
S sluggish
7mm
8mm
C closed
Limb Movements
Pupils
1mm
2mm
Response:
+reacts
L Size (mm)
Response
R Size (mm)
Response
A
r
m
s
L
e
g
s
Normal power
Mild weakness
Severe weakness
Spastic flexion
Extension
None
Normal power
Mild weakness
Severe weakness
Spastic flexion
Extension
None
Record findings for RIGHT ('R') and LEFT ('L') separately if different
ACTIONS
GCS of 8 or less - severe injury - urgent 999
GCS of 9 - 12 moderate injury - urgent 999
GCS of 13 - 14 minor injury - urgent medical review
GCS of 15 minor injury - monitor observations
January 2014 M-EWS V5
Author: Resuscitation Service
3
Name:...........................................Date of Birth:............................
ID Number / NHS number………../................
(Affix label)
WEIGHT CHART
BMI………………………………………. (kg/m2) on admission
Measure and record weight in kg. Choose day to weigh and preferably before breakfast
Start by plotting the admission weight in the first column between the centre two ‘-00’ points. This will enable you to
record future weight loss or gain without running quickly out of chart space
Weight
KGS
-00
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
Date
9
8
7
6
5
4
3
2
1
-00
9
8
7
6
5
4
3
2
1
-00
9
8
7
6
5
4
3
2
1
-00
WM
Initials
Comments
January 2014 M-EWS V5
Author: Resuscitation Service
4