Patients who are admitted into hospital with acute care needs have a right to receive reliable harm-free care. The recognition of clinical deterioration relies largely on nurses taking and recording vital signs, identifying where these are abnormal, communicating findings to skilled clinical personnel and ensuring appropriate interventions are given in a timely manner. Lack of recognition of physiological changes may lead to a delay in care, an extended hospital stay, ICU admission or even a premature death. Failure to rescue occurs when a patient’s deterioration is not recognised and they suffer harm from a potentially treatable condition. Nurses are accountable for ensuring accurate clinical observations are recorded and acted upon (Figure 3.1), even if delegated to a non-registered healthcare professional.¹ Training, education and support for the healthcare team is essential in the delivery of harm-free care.

In 2007 NICE recommended the use of ‘aggregated weighted track and trigger systems’.² These are early warning systems (EWS) that consider a number of different clinical observations, generating an overall score to help evaluate risk of deterioration. The score gained is used to identify low, medium and high scoring groups, thereby determining frequency of observations and the need for review by the medical team and/or outreach. A number of EWS have been used across the UK, leading to a significant variation in trigger levels, and therefore a potential lack of understanding by clinical staff moving across the country to work in different clinical environments. A standardised National Early Warning Score (NEWS) developed by The Royal College of Physicians,³