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Date
Time
Respiratory
Rate
(breaths / min)
O2 Saturation
(%)
O2 Flow Rate
(L / min)
Blood
Pressure
(mmHg)
Heart Rate
(beats / min)
Temperature
(C)
Consciousness
Pain Score
None (0) Worst (10)
09/2010
ADDS
Scores
6/3/2013
20:00
37
36
3135
2130
920
58
4
93
9092
8589
84
>5
15
<1
Write 200
190s
180s
170s
160s
150s
140s
130s
120s
110s
100s
90s
80s
70s
60s
50s
40s
Write 140
130s
120s
110s
100s
90s
80s
70s
60s
50s
40s
30s
38.6
38.038.5
36.137.9
35.136.0
34.135.0
34.0
Alert
To Voice
To Pain
Unresp.
800
120799
80119
79
Write
Respiratory Rate
O2 Saturation
O2 Flow Rate
Systolic BP
Heart Rate
Temperature
4 Hour Urine Output
Consciousness
TOTAL ADDS
I Interventiont
E.g. A
250
37
36
3135
2130
920
58
4
93
9092
8589
84
>5
15
<1
Write 200
190s
180s
170s
160s
150s
140s
130s
120s
110s
100s
90s
80s
70s
60s
50s
40s
Write 140
130s
120s
110s
100s
90s
80s
70s
60s
50s
40s
30s
38.6
38.038.5
36.137.9
35.136.0
34.135.0
34.0
Alert
To Voice
To Pain
Unresp.
800
120799
80119
79
1
0
1
1
1
0
0
0
4
DRAFT - NOT
FOR USE
URN:
Family Name: Barber
Modifications in use
Family name:
Given Name: Frederick
Given names:
Date of Birth: 2/3/1931
Date of birth: Sex:
If any observation is in a shaded area, add up the Total ADDS Score and take the
action required for that score.
Score 0
Score 1
Score 2
Score 3
Emergency call
Actions Required
Total ADDS Score 13
E.g. A
Write
4
1
0
1
1
1
1
0
0
5
20:30
DRAFT - NOT
FOR USE
DRAFT - NOT
FOR USE
MRN: 0598371
URN:
Family Name: Barber
Family
name:
Given
Name: Frederick
Datenames:
of Birth: 2/3/1931
Given
Facility:
x M
Insulin Infusion
Anticoagulant
Neurology
Fluid Balance
Neurovascular
Review requested
Date
Reason
Other
ADDS
Review undertaken
ENT
Bones / Joints
Management
Management changed
Specify:
to
Heart Rate
to
Temperature
to
Consciousness
to
to
Designation
Additional Observations
Date
Signature
Time
Blood Glucose Level
(mmol / L)
Date
Weight
Time
//
(kg)
Bowels
Interventions
Urinalysis
Specific gravity
pH
Leukocytes
Blood
Nitrite
Ketones
Bilirubin
Urobilinogen
Protein
Glucose
Designation
Signature
Systolic BP
//
Skin
ADDS CHART
O2 Flow Rate
to
Emergency
Specify:
No change, observe
If abnormal observations are to be tolerated for the patients clinical condition, write the acceptable ranges (where
the ADDS Score will be 0) below. Modifications must be reviewed at least every 72 hours.
Doctors name (please print)
to
Respiratory Rate
Registrar
Neurology
Modifications
Time
Ward doctor
Circulation
Whenever an observation falls within a shaded area, you must enter the ADDS Score for that vital
sign in the appropriate row of the ADDS Scores table, unless a modification has been made (see
below).
Breathing
When graphing observations, place a dot () in the centre of the box which includes the current
observation in its range of values and connect it to the previous dot with a straight line. For blood
pressure, use the symbols indicated on the chart.
Time
Airway
If you administer
an intervention,
record here and
note letter in
Intervention row
over page in
appropriate time
column.
Date
//
to
Clinical Reviews
General Instructions
O2 Saturation
x M