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Expert advice

How to spot the ‘soft signs’ of deterioration in older people attending the ED

Neal Aplin warns against an over-reliance on the National Early Warning Score

Deterioration in patients can be spotted very early on by nurses who are trained to recognise the signs

Why do emergency nurses need to know about the soft signs of deterioration?

Emergency nurses play a vital role in recognising the early signs of deterioration and enabling prompt interventions to improve care for older patients in urgent care settings.

I work as an advanced clinical practitioner on a community ward caring for older people where staff, including therapy staff, have been trained to recognise the soft signs of deterioration. These subtle changes in a patient can have a huge effect on outcomes, yet not all emergency nurses receive training in them.

How is deterioration commonly


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