The document discusses the implementation of the Restore2 tool, which uses National Early Warning Scores (NEWS2) to enhance communication and timely intervention in care and nursing home settings. It highlights the benefits of recognizing 'soft signs' of deterioration in residents, resulting in improved escalation of concerns and quicker responses from healthcare providers. The evidence suggests that using the tool has led to earlier interventions, reduced 999 calls, and better outcomes for residents, while further analysis is needed to assess its full impact.

1. A common language across healthcare:
Using National Early Warning Scores through
RESTORE2 in Care/Nursing home settings
#ipcnurse

2. The Triad of Clinical Outcomes
Enable staff to communicate concisely with clinical
decision makers to get an effective response

3. Recognise
Soft Signs
Take
Observations
Get the right
help early
Get your message
across
Calculate
NEWS2
Soft signs provide relevant
prompts for staff and an entry
point into NEWS observations
Observations are
recorded on a
standard colour NEWS
chart – a common
language across
healthcareA communication
and escalation
pathway to get the
right help early
A Structured Communication Tool to
ensure that your concerns are heard

4. Making NEWS accessible

5. Recognise
Soft Signs

6. Take NEWS2
Observations
Get your
message across
Get the right
help early
Recognise
Soft Signs

7. Qualitative Outcomes “we could see she was deteriorating and she
received the help she needed quickly. We had
the evidence that she was not well. It’s easy
when you have the evidence”
“you just seem to get a quicker response
because you give better information”
“amazing and really useful . I live by it daily”
“ it makes it easier for staff to check and keep
on to top of things“
“things get followed through and dealt with ”
• 100% of respondents said that the tool had helped
them achieve earlier escalation of their concerns
• 100% of respondents said that the tool had helped to
achieve earlier intervention from GP’s, Out of Hours or
the Ambulance Service
• 25% of staff who escalated residents using the tool
would not have done so without it
0% 20% 40% 60% 80% 100%
Easy to Record Findings
Clear Guidance on Clinical Response
Helped Trigger a Timely Response
Healped Referral
Re-inforced Clinical Concerns
Gave Confidence to Raise Concerns
Yes
No

8. Outcomes Improved understanding of ‘normal’ NEWS of residents
• Data from residents in care, nursing and
dementia homes show that most (more
than 80%) have a NEWS2 score of 0 or 1.
Some residents will have elevated scores as
part of their normal underlying pathology
but this is the exception to the rule
0%
20%
40%
60%
80%
100%
0 1 2 3 4 5 6 7 8 9
NEWS2 Score
Dementia Residents
0%
20%
40%
60%
80%
100%
0 1 2 3 4 5 6 7 8 9
NEWS2 Score
Care Homes
0%
20%
40%
60%
80%
100%
0 1 2 3 4 5 6 7 8 9
News2 Score
Nursing

9. • Resident admitted for respite care
following a fall and treatment for rib pain
and a chest infection
Home does have a
reference point for
normal physiology0
Case Study RESTORE2 in a Nursing Home
NEWS
Nursing Home

10. • 2 days after admission staff and the
residents family noticed small changes
with the residents “soft signs”
increased lethargy
breathlessness
3
Case Study RESTORE2 in a Nursing Home
NEWS
off food
looking pale
Nursing Home – Out of Hours GP
Clear story to tell GP
service with
physiology

11. • OOH reviewed but the resident deteriorated further that evening.
Following GP review and liaison with the hospital team admission
was recommended for assessment and oxygen administration
5
Case Study RESTORE2 in a Nursing Home
NEWS
clear, quantifiable
evidence of
deterioration
Nursing Home – OOHGP – Ambulance Service - Hospital
clearer handoff
between services
transferable records
of physiology

12. • The resident was discharged from
hospital following treatment for
chest sepsis & pulmonary oedema
after 4 days , returned to the nursing
home for further respite and home 2
weeks later
Case Study RESTORE2 in a Nursing Home
‘the home staff felt
the RESTORE2 tool
enhanced their
confidence in being
able to request a GP
review and
communicating the
reasons for this’
Nursing Home – OOHGP – Ambulance – Hospital – Nursing Home - Home
‘the incident has also highlighted
to the care home staff the
importance of soft signs and how
changes can be an early indicator
of deterioration’

13. Data Analysis 999 calls
999 Calls* % change
(July 2016-June 2017 versus February 2018-January 2019)
All Homes Nursing Homes
Residential / Care
Homes
Combined Care with
Nursing Homes
NEWS/RESTORE2 15.91% 8.36% 31.13% 26.15%
No Deterioration tool 11.35% 1.54% 14.11% **insufficient data
• *5,686 999 calls from care/residential and nursing homes between April 2016 and January 2019
• Data Caveats; data is based on initial analysis, data quality from ambulance service feeds is variable, data is not
adjusted for other initiatives implemented across the system e.g. frailty teams, hydrate, sepsis awareness, small dataset
categories are comparatively small, – frailty, hydrate, safety huddles etc. increasing acuity of residents and bed
occupancy not adjusted for
• Project caveats; selection bias – some homes may be more proactive but a large proportion were supported to
implement NEWS/RESTORE2 because of serious safeguarding, quality or leadership concerns, improved outcomes are
dependent on wrap around community services and EOL planning as well as early identification of deterioration,
Homes in safeguarding or approached because of leadership concerns, RESTORE2 is free to download and, therefore,
some homes classed as not using RESTORE2 may actually be.

14. Data Analysis 999 calls
0
1
2
3
4
5
6
7
8
9
Apr-16
May-16
Jun-16
Jul-16
Aug-16
Sep-16
Oct-16
Nov-16
Dec-16
Jan-17
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
Feb-18
Mar-18
Apr-18
May-18
Jun-18
Jul-18
Aug-18
Sep-18
Oct-18
Nov-18
Dec-18
Jan-19
Numberof999Calls&Conveyances
ENG_BAR 999
Conveyances
ENG_BAR 999
Calls
Mean 999 Calls
No deterioration tool NEWS RESTORE2
0
20
40
Apr-16
May-16
Jun-16
Jul-16
Aug-16
Sep-16
Oct-16
Nov-16
Dec-16
Jan-17
Feb-17
Mar-17
Apr-17
May-17
Jun-17
Jul-17
Aug-17
Sep-17
Oct-17
Nov-17
Dec-17
Jan-18
Feb-18
Mar-18
Apr-18
May-18
Jun-18
Jul-18
Aug-18
Sep-18
Oct-18
Nov-18
Dec-18
Jan-19
Feb-19
NoofVisits
ENG_BAR Urgent
Home Visits
73%
Conveyance
rate
81%
Conveyance
rate

15. Conclusions
• NEWS requires an entry point for use in the community and Soft Signs provides this
• Soft Signs are not specific enough to be used in isolation but they are intuitive to care home staff
• Any format requires a structure communication tool as an adjunct to support effective dialogue
• Case study evidence supports:
• Earlier recognition and escalation of concerns
• Better communication and response to concerns once raised
• Avoided hospital admissions for some residents and shorter length of stay for others
• Lives saved
• However – further quantitative analysis is needed around GP workload, 999 conveyances and
hospital length of stay
• Outcomes are variable and multi-factorial; dependant on leadership, relationships with primary
care services and anticipatory care planning
• As proof of concept, NEWS can work in community settings to improve recognition of physical
deterioration

16. • RESTORE2 is free for any healthcare provider to use
• Details and support matthew.richardson2@nhs.net
• Available to print at www.westhampshireccg.nhs.uk/restore-2
• or order from NHS Creative using code CS47008
“We have been using NEWS since last year. I recently started using on our residential side too. Having a NEWS tool
provides confidence to staff whilst having conversations with out of hours, 999/GPs. It is really great to see having
something that is used nationwide to assure staff/us that we are on the same page.”
“There have been various success stories where staff correctly scored the resident and summoned the correct services
in timely manner to achieve positive outcomes for the individual.”