The taking of patient observations forms a fundamental part of the assessment process (Churpek et al. [43]; see also Chapter c02: Admissions and assessment). The findings and results will help to determine the level of care a patient requires and to establish whether an intervention is needed to prevent the patient deteriorating (Uppanisakorn et al. [201]).

Adult patients in acute hospital settings should have:

Caring for acutely unwell patients can be daunting and challenging; however, early detection of changes in observations helps to identify patients who are at risk of clinical deterioration. Early detection may provide an opportunity to intervene and avoid further deterioration (Adam et al. [2], Tait et al. [194]). Various early warning scores have been created and used across UK hospitals to assist with the identification of critically ill patients and improve patient safety (Farenden et al. [63]). However, in 2012, and with the view of facilitating a standardized approach, the Royal College of Physicians (RCP) introduced a physiological scoring system called the National Early Warning Score (NEWS). This simple scoring system relies on healthcare staff performing patient observations (respiratory rate, heart rate, blood pressure, peripheral oxygen saturation, temperature and fluid balance) and informing medical staff and/or critical outreach teams of deviations from the norm (Keep et al. [91]). The total score helps to identify not just patients who are at risk and require immediate assessment but also those who are being safely managed, supporting clinical decision making and improving patient outcomes (NICE [142]).

More recently, in December 2017, the RCP updated its 2012 NEWS and published NEWS 2 (Figure 14.1) with the aim of improving the recognition of clinical deterioration in adults due to sepsis and hypercapnic respiratory failure (NICE [142]). The updated version now includes a new oxygen saturation scoring system for such patients and recognizes the patient's level of consciousness as an important sign of clinical deterioration (RCP [171]). A final score of 5 or more identifies patients who require further assessment and early intervention, and this can help to prevent further clinical deterioration and potentially death (NICE [142]). Once a patient ‘triggers’, they are usually referred to critical care outreach teams or medical emergency teams, who are available in most hospitals to provide support to staff, assess the patient, initiate any required interventions, and avert or assist in critical care admissions (NICE [142], RCP [171]).

Initially, the implementation of NEWS in 2012 was targeted at UK hospital wards and emergency departments; however, since then, other clinical settings, such as ambulance services and general practices, have also embraced its use. In addition, NEWS is currently used across the world to assist health services to identify acutely unwell patients, improve patient outcomes and ultimately save lives (Blows [21], Lee et al. [101], NICE [142], RCP [171], Wilkinson et al. [215]).

The use of NEWS has been shown to help nurses improve and focus their recognition of patients who may need further support and monitoring; therefore, it is important that time is taken to accurately calculate the score and act accordingly (Adam et al. [2], Peate and Wild [157]). Obtaining an accurate measure of a patient's condition relies not just on an early warning score but also on clinical judgement and a holistic assessment (Farenden et al. [63], NICE [142]).

A tool that assists with structuring and standardizing communication when reporting concerns is the Situation‐Background‐Assessment‐Recommendation (SBAR) tool (Figure 14.2). SBAR is an easy‐to‐remember mechanism that is useful for framing any conversation, especially critical ones. It aims to focus the clinician's immediate attention on the presenting problem (Adam et al. [2], Wilkinson et al. [215]), and it allows the person raising the concern to communicate key, succinct points and to highlight expected actions. It provides an easy and focused way to communicate key points and enables the person raising the concern to express what action is expected to result from the conversation (Müller et al. [122]).

Physiological observations will be assessed and recorded appropriately. Any actual or potential deterioration will be recognized early and communicated to the necessary teams (RCP [171]).