Wessex PSC is working with organisations across Wessex to reduce harm related to physical deterioration.
The Managing Deterioration Safety Improvement Programme (ManDetSIP) *
The ManDetSIP aims to reduce deterioration-associated harm by improving the prevention, identification, escalation and response to physical deterioration, through better system co-ordination and as part of safe and reliable pathways of care.
ManDetSIP focuses on managing deterioration at a system-wide level across both health and social care through Managing Deterioration and Care Homes Patient Safety Networks.
Programme aims
• To support the adoption and spread of the COVID Oximetry@home and COVID Virtual Ward remote
monitoring models across England
• To support the spread and adoption of the acute Paediatric Early Warning Score (PEWS) and a system-wide paediatric observations tracker for children across all appropriate care settings in England
• To support an increase in the spread and adoption of deterioration management tools (e.g. NEWS2, RESTORE2, RESTORE2mini, SBARD etc.), reliable personalised care and support planning (PCSP), and approaches encompassing end of life care principles, to support learning disabilities, mental health and dementia care management in relation to deterioration in at least 80% of all appropriate non-acute settings across health and social care.
*NB This webpage relates to our Managing (Physical) Deterioration workstream, information about our Sepsis specific work, including access to the Suspicion of Sepsis Insights Dashboard, can be found on our Sepsis Webpage.
PEWS (Paediatric Early Warning Score)
Children can deteriorate rapidly when they become unwell and the need for a validated national PEWS is vital. It has long been recognised that a standardised approach to managing deterioration is important for both staff and patients and that a systems approach to reliable care across care settings is a fundamental pillar of quality.
The Paediatric Early Warning Score (PEWS) and System wide Paediatric Observations Tracker (SPOT) sits within the Managing Deterioration Safety Improvement Programme (ManDetSIP) and focuses on improvement in deterioration management in the care of children.
The programme consists of a three-phase strategy aimed at creating a consistent approach to the care of children across 3 care settings:
In February 2021, Wessex PSC joined with Oxford and KSS AHSN in a joint bid to be part of the national inpatient pilot. Within Wessex we had 2 of the 3 sites which undertook the usability testing which started in November 2021. Since then 2 mores sites have started to test using both paper and digital systems. Further implementation will follow the patient flow, so initially across inpatient settings and ED, working closely with the national System-Wide Paediatric Observations Tracking (SPOT) Delivery Board then testing a primary care system wide observations approach. Wessex PSC has worked closely with Thames Valley and Wessex Paediatric Operational Delivery Network and will continue to do this until the end of June 2022.
You can view how the implementation of PEWS is going on our Case Studies page (CV13 & CV14).
Deterioration and NEWS related resources (AHSN Network)
Organisations including AHSNs have produced resources to aid staff in dealing with deterioration in their patients and residents. All these resources are available on the AHSN network website.
NEWS2: Additional implementation guidance (RCP - 6 April 2020)
Since it's publication in December 2017 some elements of implementing NEWS2 in hospitals have proven more challenging and clinicians have raised a number of questions. To support clinicians to deliver best consistent practice, the RCP has published this additional implementation guidance to provide clarification.
The guidance notes that the trigger (threshold) for escalation is normally set at a single score of 3, or a composite score of 5 and 7. However, this threshold can be adapted for individual patients following clinical assessment.
Additional guidance is provided around:
The guidance document is downloadable from the resources zone on the right of this webpage.
NEWS2 and deterioration in Covid-19 (RCP - 14 April 2020)
NEWS2 should be used when managing patients with Covid-19. The use of NEWS2 will ensure that patients who are deteriorating, or at risk of deteriorating, will have a timely initial assessment by a competent clinical decision maker. NEWS2 should supplement clinical judgement in assessing the patient’s condition.
The NEWS2 scoring system for oxygen supplementation is binary (yes/no). In patients with Covid-19 infection, once hospitalised and treated with oxygen, their oxygen requirement might increase rapidly if their respiratory function deteriorates but this may not result in any significant increase in the NEWS2 score. Therefore, in patients with Covid-19, all staff should be aware that ANY increase in oxygen requirements should trigger an escalation call to a competent clinical decision maker. This should be accompanied by an initial increase in observations to at least hourly until a clinical review happens, if this has not already happened as a result of NEWS2.
More information about NEWS2 and deterioration in Covid-19 can be found on the RCP website.
National Early Warning Score (NEWS2) (April 2018)
NHS England (NHSE) and NHS Improvement (NHSI) have endorsed a single early warning score – the National Early Warning Score (NEWS) – for use in acute and ambulance settings. NEWS is a tool developed by the Royal College of Physicians which improves the detection and response to clinical deterioration in adult patients and is a key element of patient safety and improving patient outcomes. Read more about the NEWS tool on the RCP website.
The intention is to increase the use of NEWS2 to 100% of acute and ambulance settings by March 2019 in order to save over 1800 lives a year. Read more about this initiative on the NHSE website.
NB: The NEWS should not be used in children (ie aged <16 years) or in women who are pregnant, because the physiological response to acute illness can be modified in children and by pregnancy.
The NEWS may be unreliable in patients with spinal cord injury (especially tetraplegia or high-level paraplegia), owing to functional disturbances of the autonomic nervous system. Use with caution.
NEWS2 e-learning resource from OCB Media
This NEWS2 e-learning resource provides an opportunity to learn about the implementation and use of the National Early Warning Score system which has been introduced across the NHS.
Here you will be able to access online training in how to fill in the forms and effectively operate the NEWS2 system.
You will also be able to access downloadable forms and information notices as well as a facility to print out a personal certificate showing that you have successfully completed the training.
The Patients Voice/s
Paul's story (from West of England AHSN)
Click here to watch Paul's story about how he made a quick and full recovery from sepsis as a result of NEWS (the National Early Warning Score) being communicated at every handover of care.
Julie's story (from patientstories.org.uk)
Click here to watch Julie's story about her treatment following a road traffic accident whilst on a cycling holiday following which she experienced two further emergency admissions to hospital due to acute cellulitis and sepsis.
Geoff's story (from Oxford University Hospital)
Click here to watch the experience of a patient at Oxford University Hospitals who was treated for life-threatening sepsis told from the point of view of both the patient and his family.
More information about Wessex PSCs work on patient enegagement can be found on our Working with our patients and public web page here.
Wessex Deterioration Workstream
The Wessex PSC Deterioration Workstream includes supporting a Regional Deterioration Network and producing tools to assist with the management of physical deterioration and structured communications in all care settings across Wessex.
Wessex Regional Deterioration Network
The Wessex Deterioration Network is currently working with NHS organisations across Wessex to improve the delivery of care to patients experiencing physical deterioration. The Network meets quarterly and is open to staff and patient/carer partners and includes all grades of staff from acute, community, primary care and ambulance Trusts and also commissioners from local CCGs and Patient/Carer partners.
The Deterioration Network is co-ordinated by Geoff Cooper who is the Programme Lead and Improvement Coach for the Wessex PSC Deterioration Workstream. The Clinical Lead for the Network is Dr Matt Inada-Kim who is a consultant acute physician at Hampshire Hospitals NHS FT, NHS(E) National Clinical Advisor on sepsis, co-chair of the National AHSN sepsis cluster, Lead for sepsis and deterioration at Wessex PSC and attends the NHS Cross System Sepsis Programme Board.
All Cause Clinical & Organisational Response to Deterioration (ACCORD)
The Wessex All Cause Clinical & Organisational Response to Deterioration (ACCORD) Guidance was co-designed by the Wessex PSC Deterioration Network to encourage the development of a consistent language and approach to the management of physical deterioration across Wessex, and to help ensure that escalation pathways within and between healthcare organisations are aligned to a common understanding and set of thresholds.
ACCORD consists of pathways for each of three care settings: Hospitals, Primary Care and Care Homes. Each pathway includes the Wessex Regional Guidance for that care setting and a matching template for local adaption if desired. The ACCORD documentation can be downloaded in pdf and ppt format from the Resource zone on the right hand side of this web page.
Organisations from outside Wessex are very welcome to use this methodology to support their own approaches*. If you have any questions, or you would like further information please get in touch with the Patient Safety team using the link at the bottom of this web page.
*Wessex PSC advises that all care providers conduct a robust internal governance review prior to use of any clinical escalation tool, including the WACDG, to ensure that the clinical thresholds and escalation actions are appropriate for the care settings in their organisation.
Reviewing the Clinical & Organisational Response to Deterioration (RECORD)
RECORD takes a Quality Improvement “Measurement for Improvement” approach to support the implementation of NEWS2 by describing elements of a methodology for evaluating the effectiveness of the recognition of, and response to, patient deterioration.
Based on the Portsmouth Hospitals NHS Trust Time to ACT project data collection tool and developed by the Regional Network of Sepsis / Deterioration leads it sets out a process for reviewing the clinical response, and patient outcomes, arising from the use of NEWS2. As such it looks beyond quantifiable process measures around “are we using NEWS2” to the qualitative outcome measures around “how well are we using NEWS2”.
In addition to the review criteria contained within the Portsmouth Hospital’s “Time to Act” tool the RECORD documentation poses questions for those wanting to develop their own review methodologies. What constitutes a Medical Review, when observations should be considered "late" and whether to exclude patients with identified Treatment Escalation Plans are some of the issues addressed.
The RECORD guidance can be downloaded from the resource zone on the right hand side of this webpage. More information about the design and potential use of RECORD can be obtained from the Programme lead via the contact link at the bottom of this webpage.
Wessex Patient Transfer Summary (WPTS)
The Wessex Patient Transfer Summary (WPTS) is a Primary Care referral form developed to standardise the referral process, once a clinical decision is made for escalation of care from Primary Care to another provider. The WPTS was developed from some initial work undertaken by Dr.Hein le Roux (Clinical Lead for West of England AHSN) and was further developed by Wessex Patient Safety Collaborative (WPSC) with support from the Wessex Primary Care Forum and its constituent GPs, CCGs and patient representatives.
The aim of the WPTS is to support and improve transfer of care from Primary Care to another provider, through standardising the referral process and use of a common language to improve patient outcome and reduce mortality. Two nationally accredited assessment tools (National Early Warning Score 2 [NEWS 2] and the Clinical Frailty Scale) are included alongside an aide memoire for escalation guidance.
The WPTS proforma can be downloaded from the resources zone on the right side of this webpage.
Introducing NEWS2 into Care Homes
Another element of developing an aligned model of care pathways across Wessex includes the application of the Wessex All Cause Deterioration Guidance (details above) to the Care Home setting.
Joint working with the West Hampshire Clinical Commissioning Group has led to the production of operational guidance (RESTORE2) to support the use of NEWS2, SBAR (see below) and Soft Signs in a Care Home setting.
More information about the work of Wessex PSC in the Care Home Sector as well as links to the RESTORE2 tool and the Interserve Soft Signs Taxonomy can be found on the Wessex PSC Enhanced Health in Care Homes webpage.
NEWS2 in Primary Care
The Royal College of GPs position statement regarding assessing patient at risk of deterioration (RCGP 2020) can be downloaded from their Clinical Policies webpage.
An introduction to NEWS2 from NHS England
This video clip from NHS England features Professor Bryan Williams (University College London Hospitals) discussing the development of NEWS2, the benefits of a standardised system, and how it can be used to identify acute deterioration in adult patients.
The National Deterioration Forum on the NHS Future Collaboration Platform
FutureNHS is an online platform designed to empower people to co-develop, share, connect and work together. The platform supports users to access and exchange knowledge and information on transformation, across health and social care.
NEWS2 Calculation App
The official NEWS2 Calculation App has now been released on both the iOS and Android stores as a joint development between the Royal College of Physicians (RCP) and the North West London Collaboration for Leadership in Applied Heath Research and Care (NWL CLAHRC).
The app is available for free and can be found as follows:
iOS – visit the Apple App Store and search for ‘NEWS2′
Android – visit the Google Play store and search for ‘NEWS2’ or use the following link here
NHSI Resource Alert (April 2018)
A resource alert has been issued to support providers to adopt the revised National Early Warning Score (NEWS2) to detect deterioration in adult patients. Read more about this alert on the NHSI website and the alert can be downloaded from the resources zone on the right hand side of this page.
*New Resource pack to support the early adoption of NEWS2 - NHSI Jan 2019
In partnership with NHS England, Health Education England and the Royal College of Physicians (RCP), NHSI have published the NEWS2 resource pack. Developed with clinical input, the pack provides access to tools and resources which support planning and delivery of NEWS2 implementation, and illustrates practical examples of how it is being implemented across the country. The resource pack can be downloaded from the resources zone on the right hand side of this page.
Deterioration (including Sepsis) Resources
Oxford AHSN Deterioration Programme Resources include many useful Deterioration and Sepsis related resources including access to the monthly Sepsis Bulletin (a Bodleian Library resource).
NEWS2: supporting the physician’s role in leading on the deteriorating patient
The mismanagement of deterioration is the most common area of systemic failure in avoidable patient death across the NHS and poor communication is the leading root cause of adverse events in healthcare. 90% of cardiac arrests are preceeded by a deterioration in vital signs. When a deteriorating patient’s worsening condition is not clear to clinical staff, it can lead to serious problems, complications, and death.
In a discussion piece for the RCP Dr Matt Inada-Kim argues that the next great advance will not be a cure, but a change in the way we work as a system, more from this article on the RCP here.
Recognising and responding to critically unwell patients (Healthcare Safety Investigation Branch - May 2019)
Problems in recognising and responding to deteriorating patients continues to be a major source of severe harm and preventable death in hospitals. Previous research has shown that up to a quarter of preventable deaths are related to failures in clinical monitoring.
Following a reference event involving a 58-year-old woman who deteriorated and died within 24-hours of presenting at hospital two weeks after having surgery, the HSIB made safety recommendations to The Royal College of Physicians (RCP) and NHS England and NHS Improvement that the Royal College of Physicians NEWS advisory group continues to evaluate the implementation and use of NEWS2, including but not limited to:
Further information and copies of the report can be downloaded from the HSIB website
Using NEWS2 in out of hours primary care (NHSI Nov 2018)
Click here to view a case study of how an out of hours primary care provider in the north west sought to improve their recognition and response to patients at risk of sepsis through the use of the national early warning score (NEWS2).
A community perspective (RCGP, WLMC & WPSC)
Watch a recording of an adult community focused webinar on Sepsis & Deterioration delivered by the Royal College of GPs (RCGP) in collaboration with Wessex LMC and Wessex PSC on 17th October 2018 presented by Dr Matt Inada-Kim.
Matt is the National Clinical Advisor Sepsis (NHS England) and Deterioration (NHS Improvement), Clinical Lead for Deterioration and Sepsis, Wessex Patient Safety Collaborative and Consultant Acute Physician / Sepsis Lead at the Hampshire Hospitals NHS Foundation Trust.
Introducing NEWS into GP Surgeries (BBC South 28 Oct 2017)
Click here to watch a BBC story which includes interviews with Dr Nigel Watson (Wessex LMC) and Dr Matt Inada-Kim (Wessex PSC) about how the NEWS tool is being introduced into GP surgeries. (Best viewed in Chrome.)
NEWS2 and Primary Care (Wessex Local Medical Committee and Wessex PSC)
One element of the Deterioration workstream has been to develop the application of the Wessex All Cause Deterioration Guidance (details above) to the Primary Care setting.
Joint working with the Wessex Local Medical Committee has resulted in the production of an educational resource (a Lunch & Learn Presentation) to support the use of NEWS2 in the development of a Primary Care pathway for Physical Deterioration.
Further information on this workstream can be obtained from Geoff Cooper (Programme Lead) via email or via the contact link at the bottom of this page.
When time is life - Ergonomics to improve time-critical sepsis care
Click here to read about a Human Factors and Ergonomics approach to improving early recognition and potentially life-saving treatment of sepsis in the emergency department.
The project by Oxford AHSN sought to understand better the remaining barriers to more rapid recognition, assessment and treatment by applying a formal Human Factors (HF) approach to analysing and redesigning the ED sepsis patient pathway.
An hour on Sepsis
In this Knowledge Exchange presentation here Dr Matt Inada-Kim talks about Sepsis from his perspective as National Clinical Sepsis Advisor. (Best viewed in Chrome)
NEWS 2: An opportunity to standardise the management of deterioration and sepsis
In this BMJ opinion article here Dr Matt Inada Kim (National Clinical Advisor for Sepsis and Deterioration - NHS England and NHS Improvement) and Dr Emmanuel Nsutebu (Sepsis Lead at the Tropical and Infectious Disease Unit of the Royal Liverpool Hospital) consider the effect of unnecessary variation in critical processes across the NHS.
A guide for identifying "Suspicion of Sepsis" using Hospital Episode Statistics
Wessex PSC is also working closely with Oxford AHSN on the topic of Sepsis and have developed "A guide for identifying "Suspicion of Sepsis" using Hospital Episode Statistics". Their paper published in BMJ Open (Inada Kim et al., 2017) can be downloaded from the resource zone on the right hand side of this webpage.
The response to patient deterioration in the UK National Health Service – a survey of acute hospital policies (Bournemouth University)
The assessment of acute-illness severity in adult non-pregnant patients in the United Kingdom is based on early warning score (EWS) values that determine the urgency and nature of the response to patient deterioration. This study aimed to describe, and identify variations in, the expected clinical response outlined in ‘deteriorating patient’ policies/guidelines in acute NHS hospitals.
If you have any questions about the Wessex Patient Safety Collaborative's Deterioration workstream or any other aspects of the Wessex PSC, please contact us via the link
Resources
The Managing Deterioration Safety Improvement Programme (NHSEI)
National Early Warning Score (NEWS) 2 - Additional guidance (RCP 6 April 2020)
All Cause Clinical & Organisational Response to Deterioration (ACCORD) [pdf]
All Cause Clinical & Organisational Response to Deterioration (ACCORD) [pptx]
Reviewing the Clinical & Organisational Response to Deterioration (RECORD) [docx format]
Reviewing the Clinical & Organisational Response to Deterioration (RECORD) [pdf format]
Wessex Patient Transfer Summary (WPSC - Feb 2019)
Improve the recognition and response to deterioration (NSIP - 06/2019)
Resources to support the adoption of NEWS2 (NHSI Jan 2019)
The 9 Principles of the Wessex Patient Safety Collaborative Deterioration Project
The Sepsis and Transfers of Care Collaborative (BTS1 2015/16) Outturn Report
The (Physically) Deteriorating Patient Collaborative (BTS2 2016/17) Outturn Report
