Unit 2.4: Escalation and Deteriorating Patients

• Topic 01

  NEWS2 Parameters and Thresholds

  45 questions
• Topic 02

  SBAR Escalation to Medical Teams

  48 questions
• Topic 03

  Rapid Response and Critical Care Outreach

  45 questions
• Topic 04

  Documentation of Deterioration and Response

  45 questions

A few questions from this unit, with the answer and a full explanation. The complete bank is available when you start practising.

1. A nurse is worried about escalating a deteriorating patient to the on-call consultant because they feel they might be overstepping. Which aspect of the NMC Code most directly addresses this concern?

   • A
     NMC Code Section 4 requires nurses to act within their competence; escalating to consultants is outside nursing competence unless explicitly trained
   • B
     NMC Code Section 17 requires nurses to raise concerns immediately when a patient is at risk, regardless of hierarchy — this duty applies to all levels of the clinical team including consultants
     Correct answer
   • C
     NMC Code Section 8.3 permits advocacy but only when the nurse has tried two previous escalation attempts through junior members of the team
   • D
     NMC Code Section 20 requires nurses to uphold professional standards in all settings, which includes respecting the clinical hierarchy before direct consultant contact
   Explanation

   NMC Code Section 17 is clear that raising concerns about patient safety is an immediate, ongoing professional obligation that applies at all levels of the clinical hierarchy. There is no requirement that the nurse exhaust a specific number of escalation attempts before contacting a senior clinician. If patient safety is at risk and immediate escalation to the consultant is the appropriate action, the nurse is both professionally authorised and obligated to make that call. Concerns about hierarchy should never delay patient safety escalation.

2. A 68-year-old patient is admitted with a productive cough. Their observations are: respiratory rate 24, SpO2 93% on 2L oxygen (Scale 1), systolic BP 102 mmHg, heart rate 108, temperature 38.9°C, alert. What is the aggregate NEWS2 score, and which two clinical pathways should the nurse initiate simultaneously?

   • A
     Aggregate score 9 — respiratory rate 2, SpO2 2, supplemental oxygen 2, systolic BP 1, heart rate 1, temperature 1, consciousness 0 — the nurse should initiate urgent CCO/escalation and sepsis screening (score ≥5 triggers sepsis screening)
     Correct answer
   • B
     Aggregate score 7 — respiratory rate 2, SpO2 1, supplemental oxygen 2, systolic BP 1, heart rate 1, temperature 0, consciousness 0 — the nurse should call the crash team and start the Sepsis Six
   • C
     Aggregate score 9 — all parameters correctly scored — the nurse should monitor hourly and wait for the medical team's review before initiating sepsis screening
   • D
     Aggregate score 9 — correctly scored — the nurse should initiate sepsis screening but wait for NEWS2 to reach 10 before involving the CCO team
   Explanation

   Parameter scores: respiratory rate 24 = 2 (21–24); SpO2 93% Scale 1 = 2 (92–93%); supplemental oxygen 2L = 2; systolic BP 102 = 1 (101–110); heart rate 108 = 1 (91–110); temperature 38.9°C = 1 (38.1–39.0); alert = 0. Total = 2+2+2+1+1+1+0 = 9. At score 9 (high risk), the nurse must initiate immediate CCO/MET review and continuous monitoring. Simultaneously, a score of ≥5 triggers sepsis screening — both pathways must be activated without delay. A crash call is not appropriate as the patient has not arrested.

3. A nurse activates a MET call for a patient with respiratory deterioration. When the team arrives, what structured communication tool should the nurse use to hand over the patient?

   • A
     SBAR (Situation, Background, Assessment, Recommendation)
     Correct answer
   • B
     An unstructured verbal report, as the team can gather their own information on assessment
   • C
     The DNACPR form, as this is the most relevant document in a deterioration handover
   • D
     The NEWS2 chart only, as numerical data provides the most objective handover to a clinical team
   Explanation

   When the rapid response or MET team arrives, the ward nurse should use SBAR to provide a structured, concise handover: Situation (who the patient is and the immediate concern), Background (relevant history), Assessment (current NEWS2 score and clinical picture), and Recommendation (what the nurse believes is needed). SBAR ensures the team rapidly receives the most critical information in a predictable format, facilitating immediate and appropriate clinical action.