Wessex PSC is working with organisations across Wessex to reduce harm related to physical deterioration
National Early Warning Score (NEWS2)
NHS England and NHS Improvement 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.
NHS England, with the support of NHS Improvement are endorsing NEWS, and aim to increase its use to 100% of acute and ambulance settings by March 2019 in order to reduce the number of patients whose conditions deteriorate whilst in hospital, and potentially save over 1800 lives a year. Read more about this initiative on the NHSE website.
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.
NEWS2 in Primary Care
Sepsis: Guidance for GPs" (RCGP 2018) notes a culture shift from accepting that sepsis is often hard to detect, to one where it is actively being assessed whenever infection is being considered as a cause for significant illness or deterioration.
The use of NEWS isn’t advocated as a replacement for clinical judgement, but physiological assessment must be undertaken when considering sepsis and/or the deteriorating patient. The RCGP note that NEWS offers a template for doing this and may be considered as a potential adjunct to the assessment process and it also offers a useful shared language for communicating concern between clinical services and clinicians.
The full document can be downloaded from the resources zone on the right hand side of this page.
Sepsis & Deterioration Webinar (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 e-learning resource from NHS Training for Innovation
This NEWS 2 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. 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.
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.
One of the actions required by the Alert is for all acute hospital trusts and ambulance trusts caring for adult patients must identify a NEWS2 champion to act as the main contact with NHS England and an active member of the NEWS2 network.
The Patients Voice
Paul's story (from West of England AHSN)
Click here to watch Paul's story who 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.
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 from organisations across Wessex.
Representation at the Network includes all grades of staff from acute, community, primary care and ambulance Trusts and also commissioners from local CCGs and Patient/Carer partners. This broad representation helps ensure that the work of the PSC remains grounded and relevant to Wessex stakeholders.
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.
Wessex All Cause Deterioration Guidance (WACDG)
The Wessex All Cause Deterioration 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.
We expect the WACDG will make a significant contribution to shaping a consistent approach to Deterioration and the use of NEWS2 across Wessex and thereby, most importantly, improving patient outcomes.
The WACDG consists of pathways for each of three care settings: Hospitals, Primary Care and Care Homes. Each pathway consists of two versions a) the Wessex Regional Guidance for that care setting and b) a matching template for local customisation to suit the needs of your own organisation if desired. Organisations may decide to use the Regional Guidance without any changes or alternatively to consider a local adaptation (still based on the Regional NEWS thresholds).
Please note that providers from non hospital settings may want to seek internal Governance approval for any patient pathway as the RCP NEWS tool has, to date, only been recommended by NHSE for use in hospitals including mental health hospitals and in ambulance services and in prison healthcare.
We are sharing the attached guidance in PDF format as read only for sharing / printing and in PowerPoint format for customising. Both these documents can be downloaded 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.
NEWS2 and Primary Care
One element of the Deterioration workstream has been to develop an aligned model of care pathways across Wessex. This includes the application of the Wessex All Cause Deterioration Guidance (details above) to the Primary Care setting.
This has led to joint working with the Wessex Local Medical Committee to help produce 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) or Dr Usha Couderc (Primary Care Lead) via email or via the contact link at the bottom of this page.
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).
NEWS2 and Care Homes (RESTORE2)
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.
This has led to joint working with the West Hampshire Clinical Commissioning Group to help produce operational guidance (RESTORE2) to support the use of NEWS2, SBAR (see below) and Soft Signs (see below) in a Care Home setting.
RESTORE2 is a physical deterioration and escalation tool for care/nursing homes based on nationally recognised methodologies including early recognition (Soft Signs - see below), the national early warning score (NEWS2) and structured communications (SBAR).
It is designed to support homes and health professionals to:
The RESTORE2 tool, associated resources and training materials can be downloaded from the West Hampshire CCG website.
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.
Soft Signs of Deterioration
An emerging area of interest is the identification and use of "soft signs" to enable the earlier recognition of physical deterioration in individuals whose physiological signs (heart rate, blood pressure, respiratory rate etc.) are not being monitored.
These soft signs include changes in behaviour, diet and habits etc. and are particularly helpful in home settings, care homes and hospital wards.
Further information about the Wessex Soft Signs work, including a taxonomy of around 120 "signs" developed by Interserve Healthcare can be obtained from Geoff Cooper (Programme Lead) via email or via the contact link at the bottom of this page.
More information about our approach to SBAR can be found on our Safety Communications webpage here
Sharing and Learning
The incorporation of Sepsis into Deterioration as a National, Regional and Local Workstream
In this Knowledge Exchange presentation here Dr Matt Inada-Kim describes progress with developing a combined Deterioration and Sepsis strategy for the NHS from his perspective as National Clinical Sepsis Advisor. (Best viewed in Chrome)
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.
Wessex Breakthrough Series (BTS) Deteriorating Patient Collaborative 2016/17
Wessex PSC worked with improvement teams from healthcare organisations across Wessex to make changes to improve the delivery of care for patients with physical deterioration. Wessex PSC provided support to these teams via methods including structured learning events, Faculty provided subject matter expertise, Improvement coaching support, webinars and site visits. Senior executives and managers from participating organisations were also involved to provide local leadership and commitment.
An Out-turn report demonstrating the impact of this Collaborative on patient care and staff capability across Wessex can be downloaded from the resources zone on the right hand side of this webpage.
Details of WPSCs earlier BTS (2015/16), and subsequent work, around Sepsis can be found on the WPSC Sepsis Webpage.
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 below: