CARES Escalation Record Instructions for use: The form should be used when faced with an incident or urgent health need to support the assessment and decision making process Routine observations should be completed by care/nursing Home staff – prior to calling GP/111/999/CPAT. By completing the form it can become apparent which service would be able to provide the most appropriate response. This form should be given to whichever service the resident is handed over to. Care Home details Details of call Name of care home: Date: Address: Name of caller: Time of call: Time call returned: Contact number: Patients details Details of GP: Patients name: Is there a DOLS in place: YES / NO Date of Birth: Is there a DNAR in place: YES / NO CONCERN ACTION RESPONSE EXAMINATION SHARED INFORMATION What is the concern regarding the patient? List symptoms: Provide detail of patient’s Past Medical History /Diagnosis (relevant to current event): Ensure you have care notes to hand CONCERN Allergies: What actions have you taken to manage the patient’s condition? ACTION What were the notifiable affects from these actions? RESPONSE
CARES Escalation Record Instructions for use: The form should be used when faced with an incident or urgent health need to support the assessment and decision making process – Routine observations should be completed by care/nursing Home staff prior to calling GP/111/999/CPAT. By completing the form it can become apparent which service would be able to provide the most appropriate response. This form should be given to whichever service the resident is handed over to. Details of call Date: Name of caller: Time of call: Time call returned: Care Home details Name of care home: Address: Contact number: Patients details Patients name: Date of Birth: Details of GP: Is there a DOLS in place: Is there a DNAR in place: YES / NO YES / NO CONCERN ACTION RESPONSE EXAMINATION SHARED INFORMATION CONCERN What is the concern regarding the patient? List symptoms: Provide detail of patient’s Past Medical History /Diagnosis (relevant to current event): Ensure you have care notes to hand Allergies: ACTION What actions have you taken to manage the patient’s condition? RESPONSE What were the notifiable affects from these actions?
CARES%20Escalation%20Record.docx