A number nobody counted
Educational use only. Not clinically reviewed64-year-old man for calm chart reading, measurement, discrepancy recording, escalation, and handoff practice. About 7 simulated minutes.
What you will practise
- Read the trend as a distribution, not a trajectory.
- Recognize that counting is what changed.
- Record the discrepancy without resolving it.
- Escalate on the counted value, with the chart alongside it.
- Review the boundaries and their certainty.
- Hand off a record that disagrees with itself.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Cretikos MA, Bellomo R, Hillman K, et al. Respiratory rate: the neglected vital sign. Med J Aust. 2008;188(11):657-659. A respiratory rate above 27 per minute was the strongest predictor of in-hospital cardiac arrest; more than half of serious adverse events had a rate above 24 identifiable up to 24 hours beforehand at greater than 95% specificity; respiratory rate was documented in only about 30% of ward patients before an early-warning score was introduced.
- Palmer J, et al. How registered nurses measure and record respiratory rate: an integrative review. J Clin Nurs. 2023. Documents over-representation of the values 16, 18, and 20 in charted respiratory rates and rates recorded without being counted.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.