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Tom Walvin

University of Plymouth, UK

The aim of this chapter is to introduce the reader to the methods that may be used when escalating concerns about a patient.

By the end of this chapter, the reader will be able to:

Describe the role of the nursing associate in escalating concerns about a patient

Use a structured method to escalate concerns

Discuss the challenges of communication when escalating concerns about a patient

1 What does ‘SBAR’ stand for?Situation, Background, Assessment, ReactionSafety, Background, Assessment, Ring for HelpScene, Background, Assessment, RespondSituation, Background, Assessment, Recommendation

2 In an acute hospital in the United Kingdom, which number can be called to summon emergency medical help for a patient?999922229993333

3 If concerned about a patient after completing an assessment, which healthcare professional could the nursing associate first escalate concerns to for clinical decision‐making and advice?Junior doctorSpeciality registrarRegistered nurseContinue to manage the patient yourself

4 What does ABCDE stand for in the context of deteriorating patient care?Airway, Breathing, Circulation, Deformity, EscalateAirway, Breathing, Circulation, Disability, EscalateAirway, Breathing, Circulation, Deformity, ExamineAirway, Breathing, Circulation, Disability, Exposure

5 Where can detailed information about the patient’s admission assessment, tests and initial diagnosis be found?Medical notesNursing handover sheetNursing care record summaryAmbulance clinical record

The Nursing and Midwifery Council (NMC) educational standards require nursing associates to both understand how to escalate concerns to other appropriate healthcare professionals for expert help and how to recognise when a person’s health has deteriorated and escalate as needed (Nursing & Midwifery Council 2018a).

This chapter will develop understanding of both of these by introducing different methods for escalating concerns about patients, discussing how to escalate effectively and describing the pitfalls in communication so that these can be avoided. The NMC Code (Nursing & Midwifery Council 2018b) also contains requirements with regards to deteriorating patients and escalation. The nursing associate is required to maintain effective communication with colleagues, to make a timely referral to another practitioner when any action, care or treatment is required and to arrange, wherever possible, for emergency care to be accessed and provided promptly.