Managing Deterioration Safety Improvement Programme


In A Nutshell:

Here in Yorkshire & Humber we have a work stream focused on improving safety in care homes. We are testing interventions that can help with early recognition of deterioration, response and communication in care homes.

Our current work focusses on improving the recognition and response to the deteriorating care home resident.

The term ‘deterioration’ can be defined as when a person moves from their normal clinical state to a worse clinical state.

To reduce the chances of this happening we focus on three main areas:

Recognition: how do we assess people to spot early signs they are deteriorating?
Response: what actions do we take when we think a person has deteriorated?
Communication: how do we communicate with the person to be sure they agree with any decision we make and how do we work effectively with other health and social care staff to get the best outcomes?

Here in Yorkshire & Humber the care home work sits as part of the Patient Safety Collaborative, which the Improvement Academy has been commissioned to deliver for the Y&H AHSN on behalf of NHS England & Improvement.

Our current work includes:

Understanding Implementation in Care Homes

In partnership with colleagues across health and social care in Yorkshire and the Humber we have been working to understand common challenges and useful approaches to implementing change ideas in their services. The key to working with care homes is to recognise the priorities and needs of care homes and building respectful, inclusive and ongoing relationships with them. Further information on the results can be found in the summary report; alternatively please contact Lizzie Sweeting.

Softer Signs in Care Homes

‘Softer signs’ tools are a relatively new approach aiming to help colleagues recognise functional and behavioural changes in patients, residents and service users as an early sign of deterioration. These ‘softer signs’ are often detectible before you start to see changes in physiological measures such as NEWS 2.

These tools are often said to capture and give credence to gut instinct, for example when you know something is wrong but find it hard to describe. There are some good tools available – RESTORE 2TM Mini tool as well as SBARD.

Advance Care Plans

An important but often overlooked aspect is understanding, capturing and acting on the wishes of patients and residents when they are nearing the end of life. Harm can be unwittingly caused when end life wishes are not known or communicated well in the team. Advance Care Plans (ACP) aim to redress this (6)

We have worked with staff from Calderdale and Huddersfield hospitals, the Clinical Network for Dementia and Older People’s Mental Health and other key stakeholders using a behaviour change approach to understand better the barriers that stop Advance Care Plans being commenced and completed.
Following two co design workshops using the ABC toolkit we developed some interventions including:

  • A core ACP document to be agreed and used in the region
  • Focus groups to better understand how patients and carers would like to be approached to commence and complete advance care planning
  • A series of videos aimed at colleagues and patients around key aspects of Advance Care Plans such as living well with frailty, capturing advance care wishes and how to recognise delirium.
  • Personalised Care and Support Plans
  • Building on our work on Advance Care Plans, we are continuing to work with the Clinical Network for Dementia and Older People’s Mental Health to broaden the use of personalised care plans beyond end of life care. Our work will focus on people in community settings, whether that be in a care home or their person’s own home.


All of our work is built upon previous experience of working across both health and social care. One of our most successful pieces of work across social care has been the implementation of safety huddles.

Safety Huddles are short discussions with the whole team aiming to reduce the harm the team are focussed on reducing harm. They can be used effectively for a variety of patient and resident harms e.g. falls, medications errors etc. We have used this highly effective approach to reduce deterioration both on acute wards and in community settings.

Despite having a focus on care homes, we appreciate that a whole systems approach is needed to reduce deterioration-associated harm in care homes. We link with other networks in the acute sector e.g. Sepsis , ED to improve system-wide pathways of care.

If you would like to work with us to improve the use of deterioration tools such as Restore2mini in your area, please contact Lizzie Sweeting

We also host two networks in our Care Homes work in order to improve adoption and spread of deterioration tools. These networks are:

Care Home Patient Safety Network

We host a quarterly meeting for all health and social care professionals who support care homes. The network provides a space where we can identify and share good practice, test ideas and share learning relevant to the care home sector and for specific at risk patient groups e.g. Learning Disabilities, Mental Health, Dementia etc.

PCN Support Network

We host a regular meeting for Primary Care Network colleagues who work with care homes. The purpose of this network is to provide support from peers across the region and an opportunity for shared learning. This is specifically for staff in ARRS roles such as; care coordinators, pharmacists, pharmacy technicians, therapists, paramedics, GPs, nurses etc.

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"The whole ward team have really embraced the safety huddle concept. We have reached the milestone of 30 days without a fall today"

Dr Alan Hart-Thomas, Clinical Director