RESTORE2

RESTORE2 (Soft Signs, NEWS2 and SBAR/D)

RESTORE2 is a physical deterioration and escalation tool for care/nursing homes based on nationally recognised methodologies including early recognition (Soft Signs), the national early warning score (NEWS2) and structured communications (SBARD).

RESTORE2 was co-produced by West Hampshire CCG and Wessex Patient Safety Collaborative. 

It is designed to support homes and health professionals to:

• Recognise when a resident may be deteriorating or at risk of physical deterioration
  
• Act appropriately according to the residents care plan to protect and manage the resident
  
• Obtain a complete set of physical observations to inform escalation and conversations with health professionals
  
• Speak with the most appropriate health professional in a timely way to get the right support
  
• Provide a concise escalation history to health professionals to support their professional decision making.
  

RESTORE2 uses NEWS2 reproduced from: Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP, 2017.

RESTORE2mini (Soft Signs and SBAR/D)

RESTORE2 has also been adapted for use by Care Homes wanting to use a "Soft Signs" approach as a pre-diagnostic indicator of concern" to facilitate earlier treatment and avoid unnecessary transfers to hospital. 

Named RESTORE2mini the Soft Signs based tool has also been adapted for use in care settings including Care Homes, Domiciliary/Home care and Learning Disability.

Implementation Support

Please contact us if you would like to discuss the use of RESTORE2 and RESTORE2mini in your organisation or care setting using the contact link at the bottom of this webpage. 

As a co-producer of RESTORE2, Wessex PSC is able to provide advice and support to organisations in Wessex considering or implementing RESTORE2 and RESTORE2mini. 

We also have experience in advising organisations from outside Wessex, nationally and internationally, and may be able to help directly, or to provide contact details for local support networks (including the list of AHSNs across England lower down this webpage).

Users of RESTORE2 and RESTORE2mini are also able to join the RESTORE2 Project Advisory Group where members are able to share experiences, learning, challenges and successes as part of an active Community of Practice.

Training Resources

Free resources to support the use of RESTORE2  and RESTORE2mini can be downloaded from the Resources Zone at the top right of this webpage. Other related resources including RESTORE2, Soft Signs, the National Early Warning Score (NEWS2), the SBARD communication tool, End of Life considerations and virtual (video-based) staff training) can also be found on our Resources for Care Homes webpage, our Domiciliary Care webpage and our Learning Disability webpage.

More information about the SBARD Communication Tool, including some downloadable resources, can be viewed on our Safety Communications webpage. 

RESTORE2 Training Presentation Video

RESTORE2mini Training Presentation Video

RESTORE2 Conversations

Kingfisher Nursing Home - Restore2

1 RESTORE2 What Is It

2 RESTORE2 Primary Care

3 RESTORE2 Why Use It

4 RESTORE2 How to Roll Out

5 RESTORE2 Case Studies

RESTORE2 and RESTORE2mini Tools and Implementation Resources (WHCCG)

Copies of the RESTORE2 tools, associated resources and implementation materials can be downloaded from the Hampshire, Southampton and Isle of Wight CCG RESTORE2 webpage. The CCG website contains full information about using RESTORE2 and ordering printed copies of any materials. 

Developers note: NHS West Hampshire CCG is keen to work with suppliers interested in developing digital versions of RESTORE2 and RESTORE2mini. Information and contact details for anyone interested in developing a digital product are provided at the bottom of this webpage.

Literature Review

This list is constantly being updated  - please let us know if you are aware of any links we can add.

1. Organisations standardise the pathway to manage rising GP workload and facilitate early identification of deterioration, resulting in a 8.4 per cent reduction in 999 calls (HSJ Value Awards 2020)

2. Detecting deterioration: Delivering RESTORE2 training to care homes (SW AHSN 7/7/20) 

Association between National Early Warning Scores in primary care and clinical outcomes: an observational study in UK primary and secondary care (Lauren J Scott, Niamh M Redmond, Alison Tavaré, Hannah Little, Seema Srivastava and Anne Pullyblank - British Journal of General Practice 2020) 

3. Using the National Early Warning Score (NEWS) outside acute hospital settings: a qualitative study of staff experiences in the West of England (Emer Brangan, Jonathan Banks, Heather Brant, Anne Pullyblank, Hein Le Roux, Sabi Redwood - BMJ Open 2018)

4. Nurses' worry or concern and early recognition of deteriorating patients on general wards in acute care hospitals: a systematic review (Gooske Douw, Lisette Schoonhoven, Tineke Holwerda, Getty Huisman-de Waal, Arthur R H van Zanten, Theo van Achterberg, Johannes G van der Hoeven – PubMed.Gov May 2015)

5. Can Routinely Collected, Patient-Reported Wellness Predict National Early Warning Scores? A Multilevel Modeling Approach (Abigail Albutt, Jane OʼHara, Mark Conner, Rebecca Lawton - PubMed.Gov 21 Feb 2020)

6. A study to introduce National Early Warning Scores (NEWS) in care homes: Influence on decision-making and referral processes. Hodgson, P., Greaves, J., Cook, G., Fraser, A., & Bainbridge, L. (2022). Nursing Open, 9, 519–526

The National Deterioration forum

The National Deterioration forum provides a live interactive platform for network members to engage with each other, sharing challenges and best practice in the management of Physical Deterioration of all conditions across the NHS. The National Deterioration Forum is a membership based forum accessed via the Future NHS platform.

AHSN and PSC Networks promoting RESTORE2 across the UK

This list is constantly being updated  - please let us know if you are aware of any links we can add.

East Midlands AHSN

Managing Deterioration (including RESTORE2)

Eastern AHSN (Cambridgeshire, Norfolk, Suffolk, North East, Mid and South Essex, Herts and Eastern Beds)

Supporting the acute sector and care homes

Health Innovation Manchester

Digital Care Homes

Kent, Surrey & Sussex AHSN

Managing Deterioration

Listen to a care home manager in Kent talking about rolling Restore2 out here

Innovation Agency - AHSN for the NW Coast (Inc Cheshire, Merseyside, Lancashire and South Cumbria)

RESTORE2 for care settings

Oxford AHSN (Oxfordshire, Buckinghamshire and Berkshire)

Implementing RESTORE2 in care homes

South West AHSN (inc. Somerset, Devon and Cornwall)

RESTORE2 Recognising and Escalating Deterioration

Detecting deterioration: Delivering RESTORE2™ training to care homes

West Midlands AHSN (inc. Shropshire, Herefordshire, Staffordshire, Warwickshire and, Worcester)

Guidance released on 'soft signs' of deterioration

Wessex AHSN

RESTORE2Case studies and videos from West Hampshire CCG (now Southampton, Hampshire & Isle of Wight CCG)

West of England AHSN (inc Somerset, Gloucestershire and Wiltshire)

RESTORE2 Training resources for care providers

A case study: RESTORE2 in residential care

Resources, booking links, videos, and more for care staff in the West of England

Yorkshire and Humber AHSN 

Recognise Early Soft Signs, Take Observations, Respond, Escalate (RESTORE2) – NHS Sheffield CCG

RESTORE2 Endorsements

Carers working in a residential care home, or professional or family carers supporting someone in their own home, can access a number of tools including RESTORE2 and Soft Signs from the AHSN network to help recognise physical deterioration and take the appropriate actions.

The Scottish Government have endorsed the use of RESTORE2 in their National Clinical and Practice Guidance for Adult Care Homes in Scotland during the COVID-19 Pandemic (May 2020) stating that the RESTORE2 tool (Annex 2) may be useful in identifying new illness in older residents. Page one of the tool can help assess changes in the residents condition. 

RESTORE2 Awards

RESTORE2 is based on NEWS2 and has been a key element of the process of implementing NEWS2 within Care Homes, initially across Wessex and subsequently nationally via the AHSN network.

Since its release in 2018 RESTORE2 has attracted a number of Awards including the:

2019 Parliamentary Award for Excellence in July 2019, (with NHSE Acknowledgement) 

2019 Sir Peter Carr Partnership Award in November 2019

2020 HSJ 'System or Commissioner Led Service Redesign Initiative’ Value Award in September 2020 and the 

2020 HSJ 'Deteriorating Patients & Rapid response Systems'  Patient Safety Award in November 2020

2021 Whilst not winning an Award in 2021 the RESTORE2mini Learning Disability project was shortlisted for both the ‘Learning Disabilities Initiative of the Year’ award and the ‘Videos to support the training of carers to identify deterioration and communicate concern’ award for the 2021 HSJ Patient Safety Awards. 

Read more about the National and Regional recognition for the work by West Hampshire CCG and Wessex PSC with RESTORE2 on the Hampshire, Southampton and Isle of Wight CCG webpage. 

RESTORE2 Video resources (WPSC & WHCCG)

A series of 6 videos produced by WPSC and WHCCG about implementing and using RESTORE2 in Care Home settings together with some case study based scenarios can be viewed below.

Video 1: An introduction to RESTORE2

Video 2: What is RESTORE2?

Video 3: Why use RESTORE2?

Video 4: Some scenarios based on RESTORE2

Video 5: GP information about RESTORE2

Video 6: Implementation advice about rolling out RESTORE2

Developers note regarding digitalising RESTORE2 and RESTORE2mini

We understand that a number of organisations across the country are exploring the creation of digital versions of the nationally recognised RESTORE2 tool. This has been brought to the forefront of consciousness in light of the recent Covid-19 pandemic, the impact of the virus within care/nursing homes and the speed at which solutions need to be developed to support this vital area of healthcare.

NHS West Hampshire CCG is keen to work with developers to ensure that all care/nursing homes have access to a digital version of RESTORE2 and RESTORE2mini as quickly as possible. When considering this it is important to recognise RESTORE2 has been trademarked by NHS West Hampshire CCG in order to ensure consistency across discrete implementations. This consistency applies to both the look and feel of the tool as well as the clinical pathways that will be impacted by a transition to a digital platform. 

NHS West Hampshire CCG, with the help of Wessex AHSN, has developed a Market Specification for both RESTORE2 and RESTORE2mini. This Market Specification will enable organisations to develop digital solutions that remain familiar for those using the existing RESTORE2 and RESTORE2mini tools across the UK, whilst ensuring the clinical safety of patient pathways after the transition to a digital platform. Through establishing this specification, it is anticipated that care providers will adopt digital versions of the RESTORE2 tool more rapidly due to the assurance it provides.

Organisations should not progress their own independent adaptations of the RESTORE2 tool without the express permission of NHS West Hampshire CCG. If you have any queries, please direct them to West Hampshire CCG.

Further information on this workstream can be obtained via the contact link at the bottom of this page.