PHDU Audit Form
Please start data collection when High Dependency Care begins.
Patient ID (e.g. Poole 1):
Age (Months & years):
Postcode:
Source of admission: (Immediately prior to “qualifying” as a HDU patient – Circle appropriately)
Home/GP/A&E/OPD/HDU(Funded)/HDU(Unfunded)/NNU/PICU/Theatre/AICU/Ward/DGH
ward/Other (Specify)
Date & Time (24 hr clock) of onset of HD Care episode:
Area HDU care provided (Circle appropriately): Ward/AICU/PICU/HDU (Funded)/HDU (Unfunded)
Date & Time (24 hr clock) HD Care ended:
Outcome (Circle appropriately): Stayed in same area/HDU transfer/PICU transfer/DIED/Other
If outcome death: Treatment withdrawn/Treatment Limited/Failed CPR
Was the patient discussed with PICU: Yes/No
Outcome of discussion with PICU: Advice only/Accepted/Refused/AICU admission
Transfer team: PICU/NNU/Local/Other PICU teams (e.g. CATS)
DIAGNOSES
Primary Diagnosis: ………………………………………………………………………..
Diagnostic Category:
Cardiovascular
Renal
Endocrine
Sepsis
Poisoning / Ingestion
Respiratory
Metabolic
Neurological
Gastrointestinal
Trauma
Secondary Diagnosis: ...............................................................................................
Co-morbidities: Prematurity (gestation)
Neurological
Other (specify)
Chromosomal
Cardiovascular
Respiratory
Undiagnosed Syndrome
Intensity of HDU care: Please tick all the interventions received during the time patient received HDU
care
HRG1 Interventions (High Dependency Care Basic)
62
CVP Monitoring
50
Continuous ECG Monitoring
73
Oxygen therapy plus continuous pulse oximetry
55
Nasopharyngeal airway
13
Tracheostomy (cared by nursing staff)
57
Upper airway obstruction requiring nebulised adrenaline
59
Severe asthma (IV bronchodilator / >1 nebuliser an hour for 4 hours)
70
DKA requiring continuous insulin infusion
PICF 1
Bolus IV fluids (40ml/kg) in addition to maintenance fluids
HRG2 Interventions (High Dependency Care Advanced)
51
Invasive ventilation via endotracheal tube
52
Invasive ventilation via tracheostomy tube
53
Non-invasive ventilation / CPAP
58
Apnoea requiring Intervention (>3 in 24 hours or IPPV)
06
Vasoactive infusion (inotrope, vasodilator, prostaglandin)
64
CPR in last 24 hours
60
Arterial line monitoring
Other
74
Isolation / Cubicle and/or requiring 1:1 care
PICF2
>10% Burns
PICF3
Poisoning / Ingestion requiring IV therapy or ECG monitoring
PICF4
Airway at risk
PICF5
GCS < 12
PICF6
Prolonged (>20 mins) or recurrent convulsions
PICF7
Post complex surgery (detail)
PICF8
OTHER (detail)
Please send forms to Carolyne Boyles, PICU, D Level, Southampton General Hospital, Southampton, SO16 6YD