NHS Improvement, working alongside the Royal College of Paediatrics and Child Health (RCPCH), have last week published new recommendations designed to help reduce deterioration in acutely ill children.

The purpose of the recommendations is to combat an ever increasing number of child deaths that could have been avoided had deterioration been acted upon in a timely and effective manner.

NHS Improvement have published the following statistics reinforcing the need for such recommendations:

  • In 2012, 26% of preventable deaths were related to failures in clinical monitoring, which included a failure to set up systems, a failure to respond to deterioration and a failure to act on test results;
  • In 2015, around 7% of patient safety incidents reported to the National Reporting and Learning System (NRLS) as death or severe harm were related to a failure to recognise or act on deterioration1

Whilst many hospital trusts have already put into place programmes aimed at improving hospital staff's recognition and response to deterioration, for example by implementing Early Warning Scores (a guide used by medical services to quickly determine the degree of illness of a patient); the purpose of NHS Improvement's recommendations is to implement a whole system approach to reducing harm caused by a failure to recognise and respond to children at risk of deterioration.

The recommendations include 6 core elements as follows:

  1. Improving patient safety culture;
  2. Working closely with the parents of children at risk of deterioration so that any concerns raised by parents can be investigated regardless of test results;
  3. Working at recognising deterioration at an early stage before any damage occurs or before a change in care is required;
  4. If there is deterioration, working at responding to this in a timely and efficient manner to prevent further deterioration;
  5. Where errors have been made, investigating these to make improvements for the future thereby implementing an open and consistent learning approach;
  6. Continually building up knowledge by way of education and training to ensure improvement for the future.

Of the 6 core elements, particularly important is number 2 - working closely with the parents of children at risk of deterioration. Historically, parents' concerns have often been ignored or overlooked in favour of test results; however NHS Improvement have now acknowledged that parents' concerns should in fact carry more weight than results and scores and it is hoped that this alone should lead to improvement and the prevention of deterioration in children.

All organisations that provide NHS-funded care will be expected to abide by these recommendations. They have to be implemented as soon as possible with an anticipated completion by 31 January 2017.

Similar recommendations regarding adult patient safety are already in place.