Wins and Challenges – the implementation process

Before you start, here is some feedback from our pilot sites and long term ViCTOR users for your consideration..

ViCTOR Key wins:

  • A greater awareness of the deteriorating paediatric / newborn patient (e.g. acceptable and unacceptable ranges)
  • The ability to trend observations over time including from the ED to the ward or recovery to the ward.
  • Improved communication between staff, teams and a higher level of care facilities e.g. from our service to RCH
  • We knew that we were all using the same parameters and chart, from the small to the large heath service
“Most of the nursing staff that work on our ward are from an adult care based background, these charts have given us the confidence in recognising paediatric patient needs in a simple and logical way, normal limits per age range is made clear and supports us as nurses to raise concerns with doctors and ask for reviews and changers to patient treatments.”
“Use of the chart by ED and Recovery Room for assessment of the last set of observations pre-transfer to the ward have allowed more informed clinical discussions about paediatric patients being stable enough to be accepted on to the ward.”

ViCTOR Key challenges

  • Not having a clear paediatric/newborn escalation of care procedure in place, then conversely, the burden of escalation.
  • The need to continually educate staff on how to use the charts and the escalation of care procedure, including the Doctors!
  • Staff not completing the charts as intended (e.g. not plotting the dot and joining the line, not escalating when they hit a orange zone)
  • No other charts available e.g. triage notes. Its not an all in one.
“In the early stages we had increased MET calls. Our resuscitation committee took the lead and provided an opportunity to have a conversation about the framework, decision making and systems and processes. We put in place a processes review and that’s been very useful.”
“While the risk assessment is really good at identifying babies who need increased observation, it makes it very unclear as to what sort of observation is needed and for how long.”

How did you address these challenges? 

  • The escalation of care is reinforced after each audit that we do (6 – 8 weekly).
  • We use real cases from our ward/unit to identify where we could improve documentation and ultimately outcomes for out patients.
  • We use the ViCTOR implementation videos for all new staff and where necessary have 1:1 education, including the Doctors.
  • We have looked at our other charts and either redeveloped them or staff have simply got used to working with a stand-alone obs chart.

How to implement ViCTOR.

Step 1: Identify the ViCTOR charts you wish to implement.

Step 2: Watch the relevant implementation video below (1. ViCTOR / ViCTOR Urgent Care, 2. ViCTOR Newborn or 3. ViCTOR Fluids Management available upon registering) which explains how to use the charts and provides examples for education.

Step 3: For observation charts, download and review the ViCTOR Implementation checklist. For fluids charts download and review the Considerations for implementing FMC form.

Step 4: Register for the ViCTOR package and begin to engage your relevant executive teams, forms committee, health Information staff.

Step 5: Review or develop your paediatric / newborn local procedures. For examples of these click here


Implementation Video 1. ViCTOR & ViCTOR Urgent Care

Implementation Video 2. ViCTOR Newborn