Improving the reliability of hourly observations on Ashwell Ward

Poster uploaded

Setting: Ashwell Ward (Elderly Care), Lister Hospital, East and North Hertfordshire NHS Trust

Background: Clinical deterioration can happen at any point in a patient’s illness or care process. Many patients who suffer cardiopulmonary arrests show signs of deterioration during the 24 hours before the arrest. By closely monitoring changes in physiological observations, deteriorating patients are more likely to be identified before a serious adverse event occurs. Early identification is important to reduce mortality, avoid morbidity, length of stay and associated healthcare costs.

What matters to you? Conversations: The project team asked the team: what enables reliable observations, what are the barriers, and what are change ideas they think would work. These were themed and was included in the project’s driver diagram.

Shared purpose: The project lead included a staff nurse and a clinical support worker to help with the project. She also asked help from the ward manager and a clinical practice educator.

Project aim: To improve the reliability of observations on Ashwell ward from 29% to 40% by June 2023.

Drivers: Staff factors (motivation, work culture, staff satisfaction, competence), Appropriate escalation (reliable process), process (reliable identification of patients needing hourly observations, clinical decision making), equipment (training, software, procurement, EBE repairs), and leadership.


Outcome: The reliability of hourly observations on Ashwell Ward

Change ideas tested: Assigned observations champion during the shift, 100% staff completes NEWS2 Training, Included deteriorating patients in safety huddle, written reminders outside the bay, one-to-one conversations with staff members of concern, collaborated with the clinical practice educator (CPE) in reinforcing good practice.

Outcome: Improved reliability of hourly observations from 29% to 33%.


  • Acute
  • Acute > Patient Experience
  • Acute > Patient Safety
  • Leadership and Management
  • Leadership and Management > Quality and Performance
  • Leadership and Management > Quality and Performance > visible leadership
  • Leadership and Management > Visible leadership
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