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

Reacting and Responding (3)

Update 27 January 2021- Developing from the current pandemic, This training programme offered through the CCG is now also available in workbook form, including one designed for those supporting individuals with learning difficulties and autism.  To access the workbook please follow this link and this link for the LD and autism specific workbook. 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 see contact details at the bottom of the page.

The slides that accompany the training can be found through this link. There is also bespoke training for adults with learning disabilities or autism which can be found through this link.

Carrying out clinical observations can support clinical decision making and  these valuable skills can be learnt in any care home setting. Training on why and how to take blood pressure, pulse, temperature and oxygen levels (using pulse oximeters) is available  virtually and  face to face. There is also a supporting workbook which can be found here. The workbook  accompanies the practical element of the training.  Following training the trainees will need to be observed as competent within the workplace.

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 Sam Varo 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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