Monitoring health and wellbeing is a vital part of delivering safe, person-centred care. Basic health observations can help identify changes in an individual’s condition, support early recognition of deterioration, and enable timely intervention when concerns arise.
This section brings together guidance, tools and resources to support care providers in recognising deterioration including carrying out soft sign observation, basic health observations, maintaining skin integrity, monitoring nutrition and hydration, and implementing effective governance and quality assurance processes. The resources below are designed to support good practice, improve communication with healthcare professionals, and promote positive outcomes for the people you support.
Governance and Quality Assurance
Effective governance arrangements help ensure observations are undertaken consistently, recorded accurately and used appropriately to support safe, high-quality care. Providers should ensure staff are trained and competent in basic soft sign observations, equipment is maintained (where used), and observations form part of wider quality assurance and risk management processes, with appropriate escalations.
As people are living longer and often with more complex health needs, recognising deterioration is becoming a core part of delivering safe care. Health observations are not just about using equipment such as blood pressure monitors, thermometers or pulse oximeters. They also involve recognising soft signs of deterioration, understanding a person’s usual presentation, and knowing when and how to escalate concerns. Even where providers do not routinely undertake ‘health’ observations, all staff should be able to identify changes in an individual’s wellbeing and respond appropriately.
The following content talks through the different resources and guidance available for the whole journey for managing recognising changes.
Recognising and Escalating Deterioration
Recognising deterioration early is a key component of safe care delivery. Changes in behaviour, mobility, appetite, hydration, cognition, mood, alertness or physical observations may indicate that an individual’s health is deteriorating.
Providers should ensure staff understand how to identify concerns, record observations accurately and escalate concerns in line with organisational procedures and local healthcare pathways.
Key resources for recognising and escalating deterioration
Basic Health Observations
Basic health observations provide objective information about an individual’s physical health and wellbeing. Observations can support early identification of deterioration and provide important information when escalating concerns to healthcare professionals.
Common observations include:
- Temperature
- Pulse (heart rate)
- Blood pressure
- Oxygen saturation levels
- Respiratory rate
- Level of alertness and responsiveness
Observations should always be considered alongside the person’s usual baseline, preferences, health conditions and presenting signs and symptoms.
Key resources for basic health observations
- Basic Health Observations for Managers Toolkit
- Basic Health Observations Assurance Checklist
- Example Competency Checklist for Electronic Blood Pressure, Pulse Oximetry and Infrared Thermometer
- Blood Pressure Demonstration Video
- Health Education England: How to Measure Temperature
- Health Education England: Measuring Oxygen Saturation
- Pulse Oximeters in Care Homes guidance
RESTORE2™ and NEWS2
RESTORE2™ (Recognise Early soft Signs, Take Observations, Respond, Escalate) supports care staff to recognise and respond to deterioration by combining physical observations with the identification of soft signs of deterioration. The tool supports structured communication and escalation when concerns arise and incorporates NEWS2 (National Early Warning Score) observations where appropriate.
Using a recognised approach helps care teams communicate clearly with healthcare professionals and supports timely clinical decision-making.
Key resources for RESTORE2™ and NEWS2
- Visit the official RESTORE2™ website
- Visit the official RESTORE2™ Training and resources
- RESTORE2™ Escalation Process for Care Homes in East and North Hertfordshire
- RESTORE2™ Escalation Process for Care Homes in Herts Valley
- RESTORE2™ Measuring Tool
- NEWS2
Some digital care systems have RESTORE2™ and NEWS2 tools built into their platforms. Where these functions are available, providers should ensure staff understand how to use them effectively and how they fit within existing care processes. Using integrated digital tools can support timely recognition of deterioration, structured escalation of concerns and accurate recording of observations and outcomes.
Skin Integrity and Pressure Ulcer Prevention
Supporting skin integrity and preventing pressure damage are important aspects of delivering safe care. Providers should use current evidence-based approaches to pressure ulcer prevention and risk assessment and ensure appropriate monitoring, documentation and escalation processes are in place.
Resources
Nutrition and Hydration
Good nutrition and hydration are essential for maintaining health, wellbeing and independence. Screening and monitoring can help identify individuals who may be at risk of malnutrition or dehydration and ensure timely intervention and support.
Resources
Training and Development
Staff undertaking observations should receive appropriate training and support to ensure they can carry out observations competently, recognise deterioration and escalate concerns appropriately.
HCPA provides learning opportunities to support workforce development and improve confidence in delivering safe, effective care.
Visit the HCPA Training Zone
Effective health observations and early recognition of deterioration contribute to safer care, improved communication with healthcare professionals and better outcomes for people receiving support. By implementing robust governance arrangements, ensuring staff competence, using recognised tools such as RESTORE2™, and making use of current guidance and resources, providers can strengthen practice and support the delivery of safe, effective and person-centred care.