Admissions: Adult Deterioration Detection System (ADDS) & Neurovascular Observations

This article provides a step-by-step guide to recording, monitoring, and managing patient Observations in an admitted care setting using MediRecords. It will show you how to view and add new Observations, chart results over time, and respond appropriately to clinical alerts such as Emergency Call, Increased Surveillance, and Senior Nurse Review. You’ll also learn how to edit or remove Observations to ensure records stay accurate and up to date, supporting safe and timely clinical decision-making.

Within Admissions, three types of Observation & Charting tools are available:

• Fluid Balance – monitor a patient’s fluid intake and output to assess hydration, organ function, and detect signs of overload or dehydration. For information on Fluid Balance Charting, please see this link. 

• ADDS (Adult Deterioration Detection System) – track vital signs to identify early clinical deterioration and trigger appropriate escalation.

• Neurovascular – check circulation, movement, and sensation in limbs to detect issues such as impaired blood flow or nerve injury.

Contents:

1. Viewing Observations
2. Adding ADDS Observations
3. Escalation: Increased Surveillance
4. Escalation: Senior Nurse Review
5. Escalation: Emergency Call
6. Charting ADDS Observations
7. Adding Neurovascular Observations
8. Deleting ADDS or Neurovascular Observations

Viewing Observations

1. Go to the MediRecords Menu and click on Admissions.
   
    
2. This will take you to the Admissions grid. Click on the Patient Name.
   
    
3. After clicking on the patient's name, you will be shown the Observations Tab. Under Charting, this is where you can record record ADDS, Fluid Balance, and Neurovascular Observations.

Adding ADDS Observations

1. Click on Admissions, then click on the Patient Name, or Find Patient.
   
    
2. This will route you to Charting/ADDS (Adult Deterioration Detection System).
3. To add an Observation click on the (+) plus icon
   
    
4. Fill out the necessary details then click the Tick/Check icon 
   
   
    
5. When saving the Observation, depending on the information you have entered, you may also receive an additional window; Emergency Call, Increased Surveillance, and/or Senior Nurse Review. If you receive one of these windows, you will need to input the required data before you will be able to finalise the Observation. Information on this is included below.

Colour-Coded Alerts

ADDS Observations are displayed within the chart using a colour-coding system:

Purple - Emergency Call - triggered by life-threatening signs. Requires immediate resuscitation and advanced life support within 10 minutes.

Red - High Priority Review - for critical but not arrest-level deterioration. A doctor must review the patient within 15-30 minutes.

Orange - Senior Nurse Review - for moderate concerns. The senior nurse and doctor review is required, and care may be escalated if deterioration continues.

Yellow - Increased Surveillance - for early warning signs. Involves closer monitoring, pain/fluid/blood management, and more frequent vital sign checks to detect worsening conditions early.

Escalation: Increased Surveillance

Note: The Increased Surveillance Window will appear only when required due to response criteria. Provide details needed and click Save.

Escalation: Senior Nurse Review

The Senior Nurse Review Window will appear only when required due to response criteria. Provide details needed and click Save.

Escalation: Emergency Call

The Emergency Call Window will appear with the actions required. Provide details needed and click Save.

Charting ADDS Observations

The ADDS Chart page is the graphical display of the ADDS Observations, plotted at each point of time. This provides at a glance, the trend of each Observation measurement as they relate to one another.

To Chart your ADDS Observations, follow the instructions below:

1. From the patient's Admission, expand the Charting menu, and click ADDS.
   
   
    
2. Click the Charts toggle at the top of the window to switch to the Chart view
   
   
    

3. The Observations will then be displayed within a Chart format, with each Observation represented within the timeline.
   
    

    

Adding Neurovascular Observations

1. Click on Admissions, then click on the Patient Name, or Find Patient.
   
    
2. Open the Neurovascular option under the Charting menu.
   
   
    
3. Select a type of Neurovascular Observation to create using the toggles above the chart. You may choose from Left Upper Limb, Right Upper Limb, Left Lower Limb, and Right Lower Limb to switch between charts.
   
   
    
4. Click the (+) plus icon above the next empty column.
   
   
    
5. Enter values for the following fields as required:
   • Colour
   • Warmth
   • Capillary Refill
   • Pulse
   • Swelling
   • Bruising
   • Sensation
   • Radial Nerve
   • Ulnar Nerve
   • Median Nerve
   • Movement
   • Radial Nerve
   • Ulnar Nerve
   • Median Nerve
   • Date Applied
   • Condition

   • Pain Score

     Note: You must enter a value for at least one field to save the Neurovascular Observation, but you do not need to fill every field. 
      

6. When you have entered all required information, the tick icon will become available. Click this to save.
   

Deleting Observations

1. To delete an Observation click on the ellipses icon above the Observation you wish to delete. The Delete option will be displayed.
   
    
2. A Reason to Delete Window will display. Enter Comments, and click Save.  
   
    
3. The Observation will be disabled and shown in grey with red lines through the information, indicating that it has been deleted.