Frequently asked questions
On this page you will find answers to BTF questions that are frequently asked by clinicians.
Education
Q: When will the BTF education be updated?
A: BTF education is developed in partnership with the Health Education Training Institute (HETI) and subject matter experts from LHDs and SHNs across the state. The education will be rolled out in 2023 and will include online e-learning modules and face-to-face training. All resources for the face-to-face training will be available via the Clinical Excellence Commission (CEC) BTF SharePoint site.
Q: Are all staff (clinical and non-clinical) required to complete BTF education?
A: Yes, education varies depending on your role within the organisation. Please discuss with your unit manager and/or your facility delegate responsible for BTF and DETECT training.
Q: Who do I contact regarding BTF issues within my facility?
A: Each facility and LHD or SHN has delegated Executive Sponsors and program managers or leads for Between the Flags who can be contacted for general advice or feedback.
Mental state deterioration
Q: What is a deterioration in mental state?
A: Deterioration in mental state is a negative change in a person's mood or thinking, marked by a change in behaviour, cognitive function, perception, or emotional state. Changes can be gradual or acute; they can be observed by staff, or reported by the person themselves, their carers or family.
Deterioration in a person's mental state can be related to several predisposing or precipitating factors, including mental illness, psychological or existential stress, physiological changes, cognitive impairment (including delirium), intoxication, withdrawal from substances, and responses to social context and environment. You can find more information in the National Consensus Statement.
Q: How are the BTF charts integrating mental state deterioration?
A: The first step has been to include confusion/change in behaviour to the BTF charts. This includes an assessment of the patient's behaviour in the context of their developmental age and/or baseline assessment, noting changes in their cognitive function, activity/tone, perception, or emotional state such as abnormal thinking, irritability, agitation, inconsolability and/or delirium.
In the adult eMR charts 'C' for new confusion or change in behaviour has been added to the AVPU scale to make a ACVPU scale. This has been used in the NHS National Early Warning Score (NEWS 2) for the past few years and is available in V4 onwards of the adult BTF charts in the eMR. You can find more information including videos here.
Q: What are the next steps in managing someone with mental state deterioration?
A: The next step is for clinicians to use the addition of the 'C' to the ACVPU as a springboard into delirium screening activities and more consistent, timely and uniform treatment of reversible causes. This is supported by the ACSQHC Delirium Clinical Care Standard.
The C in ACVPU provides a prompt to recognise and respond further. As of early-2022, you will work within existing local practices for next steps and what tool to use. As part of the eHealth Comprehensive Care project we have been working through risk screening and assessment. As the project moves into pilot phase we will be testing which tool works best for the workflow. We are leaning towards the 4AT.
Electronic medical record (eMR)
Q: What further changes will occur in eMR? Is that an LHD or SHN decision?
A: Version 5 of the electronic BTF charts has been developed in partnership with eHealth and in consultation with clinical experts from around the state for LHD and SHN migration.
General BTF FAQs
Q: Is there a resource or brochure that can be used to inform and engage families in understanding why and how we use BTF charts?
A: An information brochure, Between the Flags - Keeping Patients Safe - Information for patients, carers and families is available for NSW Health facilities to order via Finsbury Green (1800 515 222) stock code: NH700228. The brochure is also available in a range of languages.
Q: We are a facility external to NSW Health; are we able to use the BTF charts?
A: Yes, facilities external to NSW Health are able to use the BTF charts after requesting permission from the Clinical Excellence Commission Chief Executive.
Q: How do I get permission for my organisation to use the BTF charts?
A: Your facility/health area Chief Executive or delegate needs to write to the CEC Chief Executive requesting permission to use the charts within your facility. A copyright request form also needs to be completed. The CEC will then provide a letter of agreement outlining the terms of use.
Q: Can we customise the BTF charts for our facility?
A: Yes. Firstly, through completion of the copyright request form as listed above. All material CEC produces can be adapted with permission and appropriate acknowledgement, excluding logos and images.