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Recognising and Responding to Deterioration in Residents Using a Softer Signs Tool

Update 01 May 2020- Developing from the current pandemic, This training programme offered through the CCG is now available in workbook form. The training is appropriate to both new and experienced staff and is useful to providers who have already had face to face training. For more information please view this flyer or contact

The number of elderly patients admitted to hospital from care homes as an emergency has increased by 63% since 2011.  Admissions to hospital are costly and can put residents at increased risk of stress and harm. Residents care needs are increasingly complex and on average they will have six or more diagnosed conditions and seven or more prescribed medicines, placing them at greater risk of deterioration.

The NHS Vale of York CCG is committed to supporting Care Homes and Domiciliary Care organisations in providing best care to residents. The aim of this work was to reduce avoidable harm, enhance clinical outcomes and improve the experience of deteriorating residents in care homes or their own home. To achieve this focus was placed on improving recognition (softer signs and NEWS2), response and communication.

By using softer observational signs It has been found that nursing assistants in care homes identified changes in residents up to 5 days before clinical observations were taken by spotting “ behavioural and functional status changes”[i],  identifying deterioration early has the potential of reducing harm, improving quality and reduction in hospital visits.

The face to face training programme delivered by the CCGs project team and is providing positive impact  in the care home and domiciliary care settings  The training develops care staff skills and knowledge in recognising deterioration how to respond to change. Training also includes communication skills and how to use the SBAR (situation, background, assessment and recommendations) tool to help care staff  relay accurate, relevant and timely information to other health and care services including GPs and District Nurses.

Care staff are supported to use the tools and how to embed this change in to practice.

You can find out more information by reading the 'guide for friends, relatives and people receiving health & social care' booklet here.

For further information please contact Kay Ford, Project Nurse at

[i] Boockvar K1, Brodie HD, Lachs M, J Am Geriatr Soc. 2000 Sep;48(9):1086-91. Nursing assistants detect behaviour changes in nursing home residents that precede acute illness: development and validation of an illness warning instrument.

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