Restore 2

🩺 RESTORE2 – Recognise Early Soft Signs of Deterioration

Overview

RESTORE2 is a tool used in care homes to help staff recognise when a resident may be becoming unwell and to respond quickly and appropriately.
It stands for:
Recognise early soft signs
Take observations
Respond
Escalate

RESTORE2 helps staff:

  • Identify early changes in residents’ health.
  • Take key observations (vital signs).
  • Communicate concerns clearly using the SBARD structure.
  • Get the right help at the right time for the best outcome.

🔍 Recognising Soft Signs

Care home staff are often the first to notice small changes in residents.
Watch for:

  • Shortness of breath or fast breathing
  • Reduced appetite or fluid intake
  • New or worsening confusion
  • Increased sleepiness or agitation
  • Pale, cold, or mottled skin
  • Reduced mobility or “off legs”
  • Concerns from family or other carers

If you notice any of these signs, record them and take a full set of observations.

📏 Taking Observations (Vital Signs)

You’ll need to measure:

  • Breathing rate
  • Oxygen levels (SpO₂)
  • Blood pressure
  • Heart rate (pulse)
  • Temperature
  • Level of alertness (ACVPU scale)

These are used to calculate a NEWS2 score (National Early Warning Score) — a standard tool across the NHS that helps show how unwell someone may be.

 

🚨 Escalation – Getting the Right Help

Depending on the NEWS score and your concern:

  • 0–2: Monitor closely and repeat observations
  • 3–4: Inform senior staff and consider GP review
  • 5–6: Urgent GP assessment or NHS 111
  • 7+: Dial 999 (emergency admission may be needed)

Always consider the resident’s Treatment Escalation Plan (TEP) or DNACPR decision when deciding next steps.

 

🗣️ SBARD Communication Tool

When you contact a GP or other clinician, use the SBARD structure to communicate clearly:

S – Situation: Who you are and why you’re calling
B – Background: Medical history and recent changes
A – Assessment: What you think is happening
R – Recommendation: What action you’re asking for
D – Decision: What’s been agreed and next steps

 

💬 Training and Resources

 

✅ Key Points

  • Know what’s normal for each resident.
  • Act on your concerns — even if the NEWS is normal.
  • Use SBARD when escalating to professionals.
  • RESTORE2 helps deliver the right care, at the right time, in the right place.