• Lack of awareness of the signs and symptoms that could signal deterioration, and the role of vigilant
monitoring in early detection
• Vital signs not monitored consistently, or not monitored at all
• Changes in vital signs not detected
• Lack of recognition of the implications of changes in vital signs
• Uncertainty about when to trigger assistance, resulting in delays in notifying medical staff of signs of
deterioration
• Delays by medical staff in responding to notification, or provision of an inappropriate response
• Inconsistent skills of ward medical and nursing staff on how to manage the deteriorating patients
• A delay or not seeking supervision or advice in a timely manner
• Ineffective communication and handover of critically ill patients.