Dear Mrs Mason Jane Robinson write further to your Regulation 28 report sent (0 us on 12 February 2015, and am now in a position to respond; note that tne matters of concern are as follows: Basic observalions were repeatedly unrecorded: No evidence of ongoing senior review on each shift whereby shortfalls in observations would be detected at an early stage_ Lack of written decision-making rationale in relation to the frequency of observations: No evidence of any reporting system of healthcare professionals. Taking your concerns in turn: More frequent observations including recording of the respiratory rate should have occurred in this case which would have given an accurate Early Waring Score (EWS) and prompted escalation. Currenlly all Health Care Assistants (HCAs) complete a vital signs workbook as part of their induction programme: Work has begun to introduce and embed a competency assessment for HCAs. This work be led by the Acute Response Team Load supported by Education ad Practice and CMG Heads of Nursing and will be completed by the end of October 2015, Newly Registered Nurses (including Inlernalional Nurses) have session on 'Managing the Deteriorating Patient' as part of their preceplorshlp Iinduction programme. Addilionally Sepsis management is part of (he Safely Improvement work within the Trust and both nursing and medical staff are undergoing training: The Trust is moving towards recording all observations electronically and the software purchased will automatically calculate (he EWS score and send the appropriate alerts. This software package has been programmed to ensure all observation fields, which includes respiration rate, aro mandatory requirements; A pilot will be commencing in June 2015 and is then expected to be rolled out across (he Trust throughout the following This work will be led by an Assistant Chief Nurse and is expected to be concluded by the end of 2016. There was no evidence that the nurse In charge was aware that Mrs Robinson's observations were not being taken appropriately: Work has laken place to improve both the daily Board Round and also the clinical handover process As of this work we have strengthened the role of the named nurse. Review of all patients' observation charts will now take place at the time of clinical Universlly Hospitals of Lalcester NHS Trusl Includes Genfield Hospital, Lelcaster General Hospilal and Lelcester Royal Infimary Websile: Wwuhl-t nhs_Uk Chalrman Mr Karamjit Slngh Chlef Exocutlvo Mr John Adler willl year: part

handover by the senior nurse to ensure observations have been taken, recorded accurately and escalated appropriately: The software previously described will allow nurses to record patient observations electronically using mobile devices. This process is fully audilable: In this case Staff regrettably failed complote the required documentation and follow the instructions which are written on the EWS charts. There Is clear guldance on Ihe curent Early Waming Score (EWS) charts for staff to follow when EWS scores have been calculated and actions taken should be recorded on the back of this chart: Ensuring that (his is completed is now part of the check at clinical handover time by (he named responsible llfiled nurse. As Indicated above the Trust has purchased software t0 racord palient observations moblle technology: The respiration rate is & mandatory field, The software automatically calculates the EWS score and alerls are set to besent automalically when appropriate. Thls provides fully auditable system: can confirm that there Is a reporting system for healthcare professionals when we have concerns about the standard of Iheir practise_ Improvlng Performance and Capabllity Policy a The Disciplinary policy are In place used when appropriate with referrals made professional bodies necessary: trust that this response provides You with the assurance thal you seek: If you have any further concerns please do not hesitate t0 contact me