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Health Innovation Manchester has created an audit tool in Microsoft Forms that can be used by locality leads to audit uptake of deterioration tools. View the PDF for guidance and a link to this tool.

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Health Innovation Manchester Managing Deterioration Safety Improvement Programme page

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Health Innovation Manchester Managing Deterioration Safety Improvement Programme page

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Patient Safety Collaborative (GMECPSC) - Managing Deterioration - Health Innovation Manchester

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In Greater Manchester, Health Innovation Manchester Care Home Programme Team, collaborate with local health and care providers from across Greater Manchester (GM) to co-develop and deploy initiatives that aim to reduce resident deterioration and the associated harm.

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Official RESTORE2 and RESTORE2 Mini website

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Official RESTORE2 and RESTORE2 Mini website

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https://www.hantsiowhealthandcare.org.uk/your-health/schemes-and-projects/restore2

Hosted by Hampshire and Isle of Wight

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Skip to main content Skip to accessibility tools

RESTORE2TM is a physical deterioration and escalation tool for care/nursing homes.

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 resident's 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 is trademarked to Hampshire and Isle of Wight ICB to protect the standardisation of the tool. Hampshire and Isle of Wight ICB do not charge for the use of RESTORE2, or make money from any element of the tool. RESTORE2 is free to use to all health and care settings, providing no alterations are made.

Guidance from the CQC, DHSC, NHSE and PHE (31/7/20) includes reference to RESTORE2TM in their Admission and care of residents in a care home during COVID-19.The guidance states that the NHS will be supporting care home professionals to use well evaluated tools such as RESTORE2TM and NEWS2, accompanied by support and access to specific equipment such as pulse oximeters, which can also help determine whether a resident is unwell and as a way of monitoring residents with symptoms.

The British Geriatrics Society have recommended the use of RESTORE2TM in their " COVID-19: Managing the COVID-19 pandemic in care homes" (BGS 25/3/2020) which states: "If taking vital signs, care homes should use the RESTORE2TM tool..." ..."to recognise deterioration in residents, measure vital signs and communicate concerns to healthcare professionals."

Learning Disabilities Mortality Review (LeDeR) programme have recommended that NEWS2, as used in tools such as RESTORE2TM , is adapted and then adopted as a means to capture baseline and soft signs of acute deterioration in physical health for people with learning disabilities by:* Involving people with learning disabilities, their families and professional organisations. * Disseminating for use across acute, primary and community settings. 2019 Annual report of the English Learning Disabilities Mortality Review (LeDeR) programme (LeDeR 16/7/20)The report can also be downloaded from the resources zone on this webpage.

RESTORE2

RESTORE2TM makes National Early Warning Scores (NEWS2) accessible to care and nursing homes through the use of soft signs of deterioration. It includes a communication and escalation protocol developed with GP's, ambulance providers and deterioration experts specifically for care/nursing homes to support them to raise concerns and a structured communication tool (SBARD) to ensure residents get the support they need.

RESTORE2TM can be downloaded and printed in colour (A4 - 6 sheets). You can also print additional NEWS2 charts from this document .

RESTORE2TM can be ordered from NHS Creative using code CS49286 (A4 CMTK 120gsm bond paper, trim, fold twice, drill 2 holes)

£0.11p per copy for 20,000

£0.14p per copy for 10,000

£0.16p per copy for 5,000

Download here
The use of RESTORE2TM is encouraged, however users must acknowledge and comply with the following:

RESTORE2TM uses NEWS2 reproduced from the 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.

The NEWS2 charts must be reproduced in full colour and high resolution only.

RESTORE2TM and its components must not be modified/amended in any way.

RESTORE2TM is trademarked and copyright Hampshire and Isle of Wight ICB

'RESTORE2 mini' for care homes

RESTORE2TM mini is a condensed version of the full RESTORE2TM tool - ideal for introducing care and residential homes that are currently unable to measure vital signs to the concepts of soft signs and SBARD structured communication. It is designed to act as a stepping stone to the adoption of the full RESTORE2TM tool. It's also great to keep by the telephone / computer to support staff to communicate effectively.

RESTORE2TM mini can be downloaded and printed on A4 and folded to A5

RESTORE2TM mini can be ordered from NHS Creative using code CS50656 (A5 CMTK 250gsm uncoated paper £0.04p per copy (based on order of 5000)

Download here

The use of RESTORE2TM is encouraged, however users must acknowledge and comply with the following:

RESTORE2TM uses NEWS2 reproduced from the 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.

The NEWS2 charts must be reproduced in full colour and high resolution only.

RESTORE2TM and its components must not be modified/amended in any way.

RESTORE2TM is trademarked and copyright Hampshire and Isle of Wight ICB

'RESTORE2 mini' for care homes with resident ID

These versions of RESTORE2TM mini have been created for homes who want to use the mini as a legal record or as an extension sheet to the full RESTORE2TM document.

The A5 version prints on one sheet of A4 and contains a short SBARD with the resident's name, NHS number and date of birth, plus the completing person's name, signature and date of completion.

The A4 version prints double sided and contains a full SBARD (the same as in the full RESTORE2TM version) with the resident's name, NHS number and date of birth, plus the completing person's name, signature and date of completion.

Both can be used as legal records of escalation.

The use of RESTORE2TM is encouraged, however users must acknowledge and comply with the following:

RESTORE2TM uses NEWS2 reproduced from the 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.

The NEWS2 charts must be reproduced in full colour and high resolution only.

RESTORE2TM and its components must not be modified/amended in any way.

RESTORE2TM is trademarked and copyright Hampshire and Isle of Wight ICB

'RESTORE2 mini' for domiciliary care

Download here
The use of RESTORE2TM is encouraged, however users must acknowledge and comply with the following:

RESTORE2TM uses NEWS2 reproduced from the 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.

The NEWS2 charts must be reproduced in full colour and high resolution only.

RESTORE2TM and its components must not be modified/amended in any way.

RESTORE2TM is trademarked and copyright Hampshire and Isle of Wight ICB

"The tool gives me the confidence to speak to others about my concerns."
Care Home Worker

You might also be interested in...

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RESTORE2™ official :: Hampshire and Isle of Wight ICS

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Skip to main content Skip to accessibility tools RESTORE2TM is a physical deterioration and escalation tool for care/nursing homes.

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Blue Stream Academy is pleased to offer every carer throughout the UK free access to the RESTORE2mini eLearning module, created and developed alongside experts from the South West Academic Health Science Network (South West AHSN).This RESTORE2mini eLearning module helps carers to improve communication between their own setting and other health and social care providers by presenting case studies and video sequences to ensure the correct usage of SBARD. Managers can register their staff for access by emailing a staff list to mark@bluestreamacademy.com.

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Originally developed and co-produced by the NHS West Hampshire Clinical Commissioning Group, now part of the Hampshire and Isle of Wight Integrated Care System, and the Wessex Academic Health Science Network, RESTORE2mini has grown from nationally recognised deterioration methodologies such as the national early warning score (NEWS2), early recognition (Soft Signs) and structured communications (SBARD).

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Narrated Restore2Mini Training Slide Deck

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Narrated Restore2Mini Training Slide Deck

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This PowerPoint slidedeck can be used for cascading training to or within care home teams. It contains optional narrations, comprehensive slide notes, suggested timings and a QR code for feedback (data comes to Health Innovation Manchester).

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Training Video by Health Innovation Manchester

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Training Video by Health Innovation Manchester

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This video can be played in internal training sessions. This recording should be viewed in conjunction with the short Health Education England videos below.

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RESTORE2Mini Cascade training video (please see description for further videos)

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Health Education England - Soft signs of being unwell

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Health Education England - Soft signs of being unwell

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Health Education England - Recognising deterioration in people with a learning disabilities

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Health Education England - Recognising deterioration in people with a learning disabilities

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14 Recognising deterioration in people with a learning disabilities

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Health Education England - Introduction to sepsis and serious illness 

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Health Education England - Introduction to sepsis and serious illness 

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NHS England Workforce, Training and Education

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1. Introduction to sepsis and serious illness

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Health Education England - Treatment Escalation Plans and DNACPR 

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Health Education England - Treatment Escalation Plans and DNACPR 

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13 Treatment escalation plans and resuscitation

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Health Education England - Telling someone you are worried (SBARD) 

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Health Education England - Telling someone you are worried (SBARD) 

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NHS England Workforce, Training and Education

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In order to preserve the clinical integrity of the tool, users are asked to print the Restore2Mini tool in colour. If you wish to reproduce the tool within your clinical systems or develop your own digital version, please refer to this developer’s note on the Wessex AHSN website.

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In order to preserve the clinical integrity of the tool, users are asked to print the Restore2Mini tool in colour. If you wish to reproduce the tool within your clinical systems or develop your own digital version, please refer to this developer’s note on the Wessex AHSN website.

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Restore2Mini tool for use in Learning Disability settings

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Restore2Mini tool for use in Learning Disability settings

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In order to preserve the clinical integrity of the tool, users are asked to print the Restore2Mini tool in colour. If you wish to reproduce the tool within your clinical systems or develop your own digital version, please refer to this developer’s note on the Wessex AHSN website.

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Restore2Mini tool for use in Domiciliary/Home Care

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Restore2Mini tool for use in Domiciliary/Home Care

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In order to preserve the clinical integrity of the tool, users are asked to print the Restore2Mini tool in colour. If you wish to reproduce the tool within your clinical systems or develop your own digital version, please refer to this developer’s note on the Wessex AHSN website.

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In order to preserve the clinical integrity of the tool, users are asked to print the Restore2Mini tool in colour. If you wish to reproduce the tool within your clinical systems or develop your own digital version, please refer to this developer’s note on the Wessex AHSN website.

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In order to preserve the clinical integrity of the tool, users are asked to print the Restore2Mini tool in colour. If you wish to reproduce the tool within your clinical systems or develop your own digital version, please refer to this developer’s note on the Wessex AHSN website.

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Rolling out RESTORE2Mini training in Bolton

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Rolling out RESTORE2Mini training in Bolton

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Wessex AHSN Restore2 and Restore2Mini page

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Wessex AHSN Restore2 and Restore2Mini page

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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.

RESTORE2 resources can be downloaded from the Resources tab Zone at the top right of this webpage. These resources (CS49286) have been designed and created in partnership with NHS Creative and you can find out more about their work on their website.

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.

RESTORE2mini resources can be downloaded from the Resources tab Zone at the top right of this webpage. These resources (CS51690, CS51710, CS52291) have been designed and created in partnership with NHS Creative and you can find out more about their work on their website.
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 and RESTORE2mini Training Videos
Wessex PSC have recorded training sessions for RESTORE2 and RESTORE2mini which can be delivered virtually to support the implementation of these tools in your care setting.

The video presentations can be viewed on the Wessex AHSN YouTube channel at:

The Roll Out Handbook and slide decks used as the basis for these training presentations can be downloaded from the Resources Zone at the top right of this webpage.

A series of videos about implementing and using RESTORE2 in Care Home settings, together with some case study based scenarios, can be viewed via the links at the bottom of this webpage or by using the quick links here:

More videos including implementation guidance and case studies can be viewed on the Hampshire & Isle of Wight ICS RESTORE2 webpage.
Videos to support Carers to manage Deterioration in residents and clients using Soft Signs, NEWS2 and SBARD (PSCs in collaboration with Health Education England)
Wessex PSC and West of England AHSN have collaborated with West Hampshire CCG and Health Education England to produce a series of short videos (around 3 minutes each) to describe how to take measurements from residents correctly (such as blood pressure and oxygen saturation), spot the soft signs of deterioration, and prevent the spread of infection.

These videos can be used to support the implementation of RESTORE2 and RESTORE2mini in Care Homes and can be viewed via our Care Home Training Resources webpage or by using the quick link here to Health Education England's Youtube website.

The team have also collaborated to re-film 7 of the videos listed above specifically to support carers of people with a learning disability and these can also be viewed via our Care Home Training Resources webpage or by using the quick link here to Health Education England's Youtube website.
The AHSN Network
Find out how RESTORE2 is being used in care homes across England, supported by Patient Safety Collaboratives, in the AHSN report "Improving safety in care homes" which can be downloaded from the resource zone on the right of this webpage and a video presentation: Supporting safety in care homes
RESTORE2 and RESTORE2mini Tools and Implementation Resources (WHCCG/HIOW ICS)
Copies of the RESTORE2 tools, associated resources and implementation materials can be downloaded from the Hampshire & Isle of Wight ICS RESTORE2 webpage. The ICS 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)

3. 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)

4. 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)

5. 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)

6. 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)

7. 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

8. NEWS2 in out-of-hospital settings, the ambulance and the emergency department (Alison Tavaré, Anne Pullyblank, Emma Redfern, Andy Collen, Robert O Barker, Andrew Gibson - Clinical Medicine Nov 2022, 22 (6) 525-529)

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 FutureNHS 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)

RESTORE2 & RESTORE2mini resources (NATH)
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 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

RESTORE2mini e-learning package

RESTORE2 video series for those with a learning disability
West Midlands AHSN (inc. Shropshire, Herefordshire, Staffordshire, Warwickshire and, Worcester)
Guidance released on 'soft signs' of deterioration
Wessex AHSN
RESTORE2 Case studies and videos from Hampshire & Isle of Wight ICB

RESTORE2 training from NHS Dorset Quality Improvement team
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

RESTORE2mini film with Inclusion Gloucestershire
Yorkshire and Humber AHSN
Recognise Early Soft Signs, Take Observations, Respond, Escalate (RESTORE2) - NHS Sheffield CCG
RESTORE2 Endorsements
Guidance from the CQC, DHSC, NHSE and PHE (31/7/20) includes reference to RESTORE2 in their Admission and care of residents in a care home during Covid-19.The guidance states that the NHS will be supporting care home professionals to use well evaluated tools such as RESTORE2 and NEWS2, accompanied by support and access to specific equipment such as pulse oximeters, which can also help determine whether a resident is unwell and as a way of monitoring residents with symptoms.

The British Geriatrics Society have recommended the use of RESTORE2 in their " Covid-19: Managing the Covid-19 pandemic in care homes" (BGS 25/3/2020) which states: "If taking vital signs, care homes should use the RESTORE2TM tool to recognise deterioration in residents, measure vital signs and communicate concerns to healthcare professionals."

Learning Disabilities Mortality Review (LeDeR) programme have recommended that NEWS2, as used in tools such as RESTORE2 , is adapted and then adopted as a means to capture baseline and soft signs of acute deterioration in physical health for people with learning disabilities by:

* Involving people with learning disabilities, their families and professional organisations.

* Disseminating for use across acute, primary and community settings.
2019 Annual report of the English Learning Disabilities Mortality Review (LeDeR) programme (LeDeR 16/7/20) Action from Learning Report 2019/2020 (LeDeR July 2020)
These reports can also be downloaded from the resources zone on the top right of this webpage.

Spotting serious illness and sepsis in Care Homes and domiciliary settings - 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.
Blue Stream Academy
Blue Stream Academy is pleased to offer every carer throughout the UK free access to the RESTORE2mini eLearning module, created and developed alongside experts from the South West Academic Health Science Network (South West AHSN). This RESTORE2mini eLearning module helps carers to improve communication between their own setting and other health and social care providers by presenting case studies and video sequences to ensure the correct usage of SBARD.
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:

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.

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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.

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Access to view how widely adopted deterioration tools are in your locality.

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Restore2Mini is a physical deterioration and escalation tool for community settings, including care homes and domiciliary care

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Restore2Mini is a physical deterioration and escalation tool for community settings, including care homes and domiciliary care

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It is designed to support staff to:

Recognise when a person may be deteriorating or at risk of physical deterioration

Act appropriately according to the person’s care plan

Speak with the most appropriate health professional in a timely way

Provide an escalation history to health professionals to support decision making

“A tool that adds structure and a framework to what you already do as carers, and helps you to communicate any concerns better so that you can be heard by clinical staff.

"In the Care Home setting clients can often deteriorate slowly over several days and this can mean disease is more advanced when they exhibit more clinical signs.

“In addition (by) identifying soft signs early, ensuring review and intervention took place sooner, we were able to either avoid patients’ hospital admission altogether or significantly reduce the length of stay and complexity of treatment.”

Andy Cook, Chief Nurse, Interserve

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SBARD resources on the Wessex AHSN page
https://wessexahsn.org.uk/projects/273/safety-communications-inc-sbar

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Wessex PSC is helping organisations across Wessex to reduce harm related to communication failure by improving the use of safety communication techniques such as SBAR, SBARD and ATMIST.

SBARD communication tool (Situation, Background, Assessment, Recommendation, Decision)
SBARD is an easy to use, structured form of communication that enables information to be transferred accurately between individuals.

SBARD consists of standardised prompt questions in five sections to ensure that staff are sharing concise and focused information. It allows staff to communicate assertively and effectively, reducing the need for repetition and the likelihood for errors. As the structure is shared, it also helps staff anticipate the information needed by colleagues and encourages assessment skills. Using SBARD prompts staff to formulate information with the right level of detail.

SBAR was originally developed by the United States military for communication on nuclear submarines, but has been successfully used in many different healthcare settings, particularly relating to improving patient safety. Later versions used across the NHS included a 5th element "Decision", hence SBARD.

More information about SBARD can be found on the NHSE website and the ACT Academy SBAR tool can be downloaded from the resources area on the right hand side of this page.
Using SBARD in Care Settings (A Video by Wessex PSC, HIOW ICB and PHL)
When you're worried about the person you're looking after, in a Care Home or Care setting for example, it can sometimes be difficult getting people to understand what's wrong and why you're concerned. SBARD helps you to organise your thoughts before making a call so that you get the help you need.

The SBARD tool consists of standardised prompts to ensure that you share relevant information in a concise and focused way. It also helps you anticipate the information needed by colleagues and encourages assessment skills.

SBARD also helps when staff may be uncomfortable about making a recommendation i.e. those who are inexperienced or who need to communicate to senior staff. The use of SBARD prevents the hit and miss process of 'hinting and hoping'.

This video, on the top right of the screen, demonstrates the use of SBARD in a care setting and was produced in collaboration between the Wessex Patient Safety Collaborative, Hampshire and Isle of Wight Integrated Care Board and the PHL Group, with input from the Wessex PSC Patient Partners.
SBARD Templates (WPSC)
SBARD is not copyrighted and Wessex PSC have developed two templates in Word format to assist people wanting either a generic form or a template that they can customise for local use. The WPSC template originated from the RESTORE2 SBARD template whilst the NPSC version was developed and shared by West Midlands PSC.

These templates can be downloaded from the Resources Zone on the right hand side of this webpage and may be adapted to meet local needs. (Acknowledgement of source would be appreciated.)

Communication using the SBAR tool

This presentation from NHS Improving Quality introduces the SBAR tool and explains how the tool looks to improve communication in healthcare.
SBAR Communication in Care Homes (e-Learning for Healthcare)
Unplanned admissions to hospital result from a patient's condition changing in such a way that they are no longer safe to be looked after in the care facility in which they live. Hospital often becomes the default location for their care to be transferred to. These patients are often elderly, frail and have complex medical comorbidities. If the deteriorating patient is highlighted earlier to other healthcare professionals, unplanned admissions to hospital can be reduced. Therefore, communicating the correct information about patients to the correct people is imperative and SBAR communication provides a standardized tool to aid this.

This training programme is a collaborative project between Sussex Community Trust and Surrey and Sussex Healthcare NHS Trust and is funded from a grant by Health Education Kent, Surrey and Sussex with the aim of reducing admissions from hospital and improving the quality of care of patients who become unwell in care homes (with and without nursing).

SBAR Training Guide (NHSIII)

This SBAR Training Guide has been developed by the NHS Institute for Innovation and Improvement in conjunction with clinicians and other frontline staff in the NHS.

The guide will help develop an understanding of the SBAR approach and support the planning and delivery of SBAR training events - either as a classroom event, in a clinical setting, as an informal session or as part of a more structured learning curriculum.

The NHSIII SBAR Training Guide can also be downloaded from the resource zone on the right hand side of this webpage.
SBARD Training videos
A number of healthcare providers have produced training videos that show the benefits of using SBARD in clinical settings. Please find a list below:

East Midlands Emergency Medicine Educational Media
Understanding SBAR
Using SBARD in a clinical setting Royal Free Hampstead NHS Trust NHS SBAR training video
Example 1 - Using SBAR to transfer patient into ED (Ambulance Crew)View the Derbyshire Healthcare NHS Foundation Trust SBARD tool.
Example 2 - Using SBAR in the Assessments Area (HCA)
Example 3 - Using SBAR in Majors (Nurse)
Example 4 - Using SBAR in Majors (SHO)
Example 5 - Using SBAR to admit the patient to the ward (ED Reg)
Ipswich Hospital NHS Foundation Trust

Using SBARD (Derbyshire Healthcare NHS Foundation Trust and East Midlands AHSN)

When you're worried about the person you're looking after, it can sometimes be difficult making people understand what's wrong and why you're concerned. The SBARD structure helps you to organise your thoughts before you call so that you can get the help you need.

Impact of the communication and patient hand-off tool SBAR on patient safety: a systematic review (OpenBMJ)

This review found moderate evidence for improved patient safety through SBAR implementation, especially when used to structure communication over the phone. However, there is a lack of high-quality research on this widely used communication tool.

ATMIST communication tool (age, time, mechanism, injury, signs, and treatment)

Early recognition of life threatening sepsis is essential to enable the Ambulance Service to initiate life-saving therapy and issue a pre-arrival alert to the hospital's emergency department.

Crews use a systematic handover tool called ATMIST (age, time, mechanism, injury, signs, and treatment) to convey details of septic symptoms to the receiving Emergency Department which will trigger the activation of Surviving Sepsis Clinical Care Pathway upon arrival at the Emergency Department. This pathway has been demonstrated to significantly improve patient survival.

Future opportunities and priorities to further improve patient care in the community - South Central Ambulance Service http://www.scas.nhs.uk/wp-content/uploads/Clinical-Strategy.pdf - accessed December 2018.

Make or Break: Incivility in the workplace (Epsom and St Helier University Hospital NHS Trust)

See how incivility affects all of us in the NHS and how that can impact patient safety. Join the staff of Epsom and St Helier University Hospitals NHS Trust in this video as they reflect on the real-life effects of both incivility and active kindness.

The response to patient deterioration in the UK National Health Service - a survey of acute hospital policies (Bournemouth University)

The assessment of acute-illness severity in adult non-pregnant patients in the United Kingdom is based on early warning score (EWS) values that determine the urgency and nature of the response to patient deterioration. This study aimed to describe, and identify variations in, the expected clinical response outlined in 'deteriorating patient' policies/guidelines in acute NHS hospitals.

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:

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Wessex PSC is helping organisations across Wessex to reduce harm related to communication failure by improving the use of safety communication techniques such as SBAR, SBARD and ATMIST. SBARD communication tool (Situation, Background, Assessment, Recommendation, Decision) SBARD is an easy to use, structured form of communication that enables information to be transferred accurately between individuals.

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Evaluating the Use of Remote Moniroting in Care Homes

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Evaluating the Use of Remote Moniroting in Care Homes

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UCL Partners Patient Safety Collaborative, as part of the National Patient Safety Improvement Programme, worked with NHS North Central London Integrated Care System (NCL) to support adoption of an innovative digital solution Whzan Blue Box to manage deterioration in care homes residents. Using lessons learned from the pilot, the use of the Whzan Blue Box has been rolled out to 116 care homes across the North Central London. The findings are now ready. Short videos are also provided describing the application and benefits of using Whzan from a GP and care home staff perspective.  Please see the link below.
https://uclpartners.com/project/evaluating-the-use-of-remote-monitoring-in-care-homes/

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Our Patient Safety Collaborative (PSC), as part of the National Patient Safety Improvement Programme, worked with NHS North Central London Integrated Care System (NCL) to support adoption of an innovative digital solution Whzan Blue Box to manage deterioration in care homes residents.

Using lessons learned from our pilot, the use of the Whzan Blue Box has been rolled out to 116 care homes across the North Central London.

Background

Over the last few years care homes have increasingly introduced the use of digital solutions to measure resident's vital signs and calculate the National Early Warning Score (NEWS2). The use of digital technology to enable remote monitoring and consultation became critical during the COVID-19 pandemic, with system-wide uptake rapidly accelerating.

In 2019 UCLPartners Patient Safety Collaborative (PSC), as part of the National Patient Safety Improvement Programme, worked with NHS North Central London Integrated Care System (NCL) to improve the ability of non-clinically trained staff to recognise, escalate and communicate the early signs of deterioration, using an innovative digital solution Whzan Blue Box in 8 care homes.

Although the rollout of the Whzan Blue Box overall has been very successful, there were care homes where the uptake was not easy and in some where it stalled. There are various contributing factors to that, with barriers to adoption encountered at both care homes level and within the primary care service that support them.

Study findings

UCLPartners PSC team conducted a qualitative study to improve the understanding of how Whzan Blue Box has been used, what the barriers and enablers to its use were, and consider whether there is scope to expand its use to assist with the delivery of the Enhanced Health in Care Homes Framework. Insights were gathered through a set of semi-structured interviews with participants compromising GPs, care homes staff, community nursing team and residents. Study findings

Successful implementation was underpinned by a clear escalation pathway, robust communication, and clearly defined roles. Where Whzan Blue Box usage was less established, this was sometimes due to factors within the care home, such as lack of time and staffing issues. Also, the lack of engagement with Whzan Blue Box was often due to GP's concerns that they may find themselves overwhelmed with the volume of physiological data without any other clinical context and increased workload. Those who had successfully adopted Whzan Blue Box had developed solutions to these concerns.

Primarily, they ensured that a senior person within the care home, able to interpret the results in a clinical context, communicated the results to the GP and/or primary care staff. There was no expectation for the GP to sit at their desks, manning their Whzan portal - abnormal results were proactively flagged by the care home staff. When used in this context, both GPs and care home staff found Whzan Blue Box improved the quality and efficiency of their work.

Ultimately, what came across is that both sectors felt strongly that Whzan Blue Box was of benefit to residents. Care home staff were more confident to escalate concerns, and GPs liked having both vital signs data and contextual information about the resident. Stories of residents receiving more timely care in an appropriate setting were commonplace.

Read the full evaluation report.

View accompanying short videos describing the application and benefits of using Whzan Blue Box from a GP and care home staff perspective.

For more information contact Rebecca Dubben, Patient Safety Programme Manager Rebecca.Dubben@uclpartners.com

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Evaluating the use of remote monitoring in care homes - UCLPartners

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Our Patient Safety Collaborative (PSC), as part of the National Patient Safety Improvement Programme, worked with NHS North Central London Integrated Care System (NCL) to support adoption of an innovative digital solution Whzan Blue Box to manage deterioration in care homes residents. Using lessons learned from our pilot, the use of the Whzan Blue Box [...]

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This video, developed and shared by Wessex AHSN depicts a conversation between a care home and an Out of Hours service. The video shows the conversation twice, firstly without use of SBARD and then with, and demonstrates the advantages that using a structured communication tool brings in terms of effectiveness and, of course, safety.

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Empowering Care Homes Staff to Manage Deterioration in Bolton

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Empowering Care Homes Staff to Manage Deterioration in Bolton

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Oldham - Visual Pathway Guides for Care Home Staff

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Oldham - Visual Pathway Guides for Care Home Staff

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Learn about Salford's unique GP setup for care home residents

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Tameside Partnership Approach to Managing Deterioration

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Tameside Partnership Approach to Managing Deterioration

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Rolling out RESTORE2 in Manchester Locality

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Rolling out RESTORE2 in Manchester Locality