Patient Assessment, Observations and Escalation

This course covers how to recognise and respond to a deteriorating adult patient using structured assessment, NEWS2 and clear escalation. It explains why observations are missed and escalation is delayed, what to do when you are worried, and how regulators view concerns about failure to recognise deterioration. It ends with a guided reflection and a remediation plan.

What you will learn

• Carry out a structured ABCDE assessment of an acutely unwell adult and record the findings clearly.
• Calculate a NEWS2 score from a set of observations and state the clinical response it triggers.
• Escalate concerns using SBAR, and continue to escalate when the response is not adequate.
• Explain the human and system factors that lead to missed observations and delayed escalation.
• Describe what regulators expect in terms of insight and remediation after a concern about recognising deterioration.
• Write a structured reflection and a remediation plan with verifiable evidence.

Course content

1. Why deterioration is missed (2 min)
2. Structured assessment: the ABCDE approach (3 min)
3. NEWS2: scoring and response (3 min)
4. Escalating clearly and persistently (4 min)
5. Why observations and escalation fail (1 min)
6. What regulators expect: insight and remediation (2 min)
7. Case study: a weak and a strong reflection (3 min)
8. Building your remediation plan (1 min)
9. Knowledge check (10 questions, 10 min)
10. Guided reflection (15 min)

Standards and guidance covered

• NMC: The Code (2015, updated 2018), including the sections on assessing need, acting without delay if there is a risk to safety, working within the limits of your competence and keeping accurate records
• NMC: Future nurse: Standards of proficiency for registered nurses, including the platform on assessing needs and planning care
• GMC: Good Medical Practice (2024), including the duties to assess, provide or arrange prompt treatment, and work within your competence
• HCPC: Standards of conduct, performance and ethics (2024) and the standards of proficiency for paramedics and physiotherapists
• Royal College of Physicians: National Early Warning Score (NEWS) 2 (2017)
• Resuscitation Council UK: Guidelines on in-hospital resuscitation and the ABCDE approach

Certificate

Courses are free to study. When you pass the knowledge check (80%) and complete your reflection, you can buy a verified certificate showing your CPD time, with a unique ID and QR code that anyone can check on our verification page.

Related guides

Patient safety

When to Escalate a Deteriorating Patient: Observations, Assessment and Escalation for Nurses

When to escalate a deteriorating patient: NEWS2 triggers, ABCDE assessment, SBAR calls and what to do if no one comes. A practical guide for UK nurses.

12 min read

Practitioner Insight is an independent education provider. It is not affiliated with or endorsed by the GMC, MPTS, NMC, HCPC, GPhC or any NHS organisation, and this information is not legal advice. If you have been referred to a regulator, speak to your defence organisation, trade union or legal representative.