Failure to recognise and appropriately rescue the deteriorating patient is a global issue which has the potential to cause serious harm to patients. Such recognition and rescue of a deteriorating patient requires both technical and non-technical skills and there are multiple points for potential failure. The taking and recording of vital observations is one of the cornerstones of recognising deterioration. However, such observations are often delegated to students and the least experienced staff. This paper explores the teaching and assessment of under-graduate nursing students to recognise and arrange the rescue of a deteriorating patient within the first 16 weeks of their course. The paper describes the development of an integrated Objective Structured Clinical Examination (OSCE) and the subsequent evaluation of this using survey data, student performance results and unobtrusive methods. The results suggest that it is possible to use an integrated OSCE to assess students even at such an early stage in their course. Although data from other Higher Education Institutions in the UK suggests that integrated OSCEs at such an early stage are rare. The appropriate teaching of vital observations, structured hand off and reporting enable students to contribute to safer care and to adhere to the maxim "First Do No Harm".

Background: The manual recording of blood pressure is widely accepted to be more accurate than the recording of blood pressure using an automated device. Despite this many western healthcare systems have moved almost entirely to the automated recording of this important vital sign using oscillometric devices. Such devices may either fail to record the patient's blood pressure in persistent hypotension or may give inaccurate readings in people with arteriosclerotic or atherosclerotic changes. This paper explores the importance of manual blood pressure recording, the availability of aneroid sphygmomanometers in UK hospitals and the maintenance of the skills of the workforce following initial nurse education. Methods: Using a survey of nursing students to explore what opportunities they have to practice manual blood pressures in the clinical setting, the paper explores the maintenance of skills following initial nurse education. The paper also describes the results of data collection, using unobtrusive methods, regarding the availability of aneroid sphygmomanometers in general and specialist hospital facilities in Northern England (UK). Data using both methods were collected in the spring of 2014. Results: The results suggest that despite most hospitals having some aneriod sphygmomanometers available (mean was 1 device for every 6 beds in acute, 1 device for every 3 beds in specialist hospitals and 1 device for every 12 beds in mental health) they were rarely used in clinical practice with only 35% of students reporting that they had undertaken a manual blood pressure in a clinical setting during the first year of their course. In addition, some hospitals had no aneroid devices and several others had no central record of location and regular calibration of such devices. Conclusions: The suggested infrequent use of aneroid devices raises a concern that nurses skills in manual blood pressure recording may be subject to decay over time. Given the importance of these skills in patient safety and, in ensuring accurate and effective care, failure to ensure adequate equipment and opportunities for skill maintenance could result in practitioners and hospitals being open to negligence claims