When a Nursing Expert Witness Report Reveals Missed Escalations

Why Nursing Observations Are Under Legal Scrutiny

In today’s clinical negligence litigation landscape, accurate and timely nursing documentation is more than best practice—it's a legal imperative. At Apex Experts, our nurse expert witnesses are frequently instructed in cases where a failure to escalate deteriorating conditions has led to patient harm and liability.

This article is drawn from a redacted expert witness report, based on a real case, where lapses in early warning score (EWS) management and documentation formed the core of the claim. The findings, though nearly a decade old, remain critical in 2025 in light of the latest NICE guidance, regulatory reforms, and evolving digital health standards.

The Case at a Glance: Deterioration, Documentation, and Duty

The patient in question presented with clinical indicators of sepsis. Over a 48-hour period, the National Early Warning Score 2 (NEWS2) system recorded scores consistently ranging from 5 to 7—suggesting the need for immediate medical review. However, there was:

• No evidence of escalation to medical staff;

• Gaps in nursing entries over several shifts;

• No consultant notes until after clinical deterioration.

  
  

Our expert concluded that the nursing team did not meet the required legal standard of care, as defined by the tests set out in Bolam v Friern Hospital Management Committee (1957) and refined in Bolitho v City & Hackney HA (1996). The absence of escalation and documentation significantly contributed to the patient’s decline.

Clinical Failures with Legal Implications

1. Ignored Escalation Protocols - Raised EWS results with no response are not mere oversights—they are breaches of clinical duty under NEWS2 escalation policies.

2. Incomplete Nursing Records - The report cited a breach of the Nursing & Midwifery Council (NMC) Code, which requires comprehensive, contemporaneous documentation as evidence of safe practice.

3. Systemic Handover Failures - Lack of evidence of communication between nursing and medical teams reflected a failure to meet interdisciplinary care expectations, breaching NHS England’s 2023 Safety Improvement Standards.

Why This Still Matters in 2025

The issues raised in this case mirror themes consistently flagged by the Healthcare Safety Investigation Branch (HSIB). With healthcare systems facing post-pandemic staff shortages, rising litigation, and digitisation mandates, there’s now zero tolerance for lapses in EWS documentation and escalation.

Poor record-keeping is no longer a technical fault—it’s seen as a barrier to safe, defensible care. Legal professionals are increasingly using real-time audit trails and metadata from EHRs to assess claims of breach and causation.

How a Nursing Expert Witness Report Strengthens Legal Claims

Our expert panel is trained in CPR Part 35 compliance and brings deep sector insight into standards of nursing care. In this case, our expert:

• Interpreted the clinical context within the Bolam/Bolitho legal framework;

• Assessed trust policies against national best practice;

• Provided opinion on causation and systemic versus individual failure.

Whether acting for claimant or defence, this objectivity is what sets apart reliable expert testimony in nursing litigation.

At Apex Experts we Provide:

• Independent expert witness reports in nursing, AHP and medical cases

• Clinical negligence assessments (including breach & causation)

• Medical records sorting and pagination

• Training for legal teams on interpreting nursing evidence

  
  

With over 200 regulated clinicians in our Expert Directory, Apex Experts is the trusted name in high-quality, court-compliant reporting.