Platform 3: Assessing Needs and Planning Care in Adult Nursing

Scope and weight

Fourteen questions at 1.5 minutes each is about 21 minutes. Platform 3 questions tend to give a short case with observations or screening results and ask for the next step. Many of them are decisions about escalation, which are scored by a published framework. If you know the frameworks, the questions become mechanical. If you do not, they become guesses between plausible options.

What is tested

• The nursing process. Assess, plan, implement and evaluate, applied to a holistic assessment.
• Acute deterioration. ABCDE assessment, NEWS2 scoring and escalation, sepsis screening and the first-hour actions.
• Symptom and risk tools. Pain assessment tools, MUST for malnutrition, Waterlow or Braden for pressure ulcers, falls risk and post-fall review, VTE risk assessment.
• Cognition and frailty. Delirium and dementia screening (4AT, AMTS), the Clinical Frailty Scale and comprehensive geriatric assessment.
• Mental health risk. Self-harm, suicide and agitation risk assessment.
• Long-term conditions. Care planning in diabetes, COPD, asthma, heart failure, chronic kidney disease and stroke, including GCS and FAST.
• Person-centred planning. Goals, shared decision-making, capacity during care planning and learning disability reasonable adjustments.
• Palliative and discharge needs. End-of-life needs assessment and discharge assessment.

Local points to anchor your answers

• NEWS2 bands. Respiratory rate 12 to 20 scores 0; 9 to 11 scores 1; 21 to 24 scores 2; 8 or below or 25 or above scores 3. SpO2 on scale 1: 96% or above 0, 94% to 95% 1, 92% to 93% 2, 91% or below 3. Supplemental oxygen scores 2. New confusion, or any response other than alert, scores 3. The bands are from the RCP summary; confirm point values on the RCP chart.
• Clinical concern overrides the score. A nurse worried about a patient with a low aggregate should still escalate.
• Scale 2. SpO2 target 88% to 92% is for confirmed hypercapnic respiratory failure and is used only on a qualified clinician's instruction.
• Sepsis. Suspected infection with NEWS2 of 5 or more means consider sepsis and arrange urgent assessment by a team competent in sepsis management. Antibiotic timings under NICE NG253 are a confirm-at-source item.
• MUST. 0 low risk, 1 medium, 2 or more high. Combines BMI, unplanned weight loss and acute disease effect. Confirm at source.
• Glasgow Coma Scale. Eye 1 to 4, verbal 1 to 5, motor 1 to 6, total 3 to 15. A score of 8 or below indicates severe impairment and airway risk. Confirm at source.

Three typical traps

1. Scoring one parameter and stopping. A patient may have a low aggregate but a single parameter at 3, which triggers urgent clinician review. Always check for a single red score before you read the total.
2. Waiting to re-measure when the situation is urgent. If a patient has a high score, the correct answer escalates now. Another set of observations in an hour is usually a distractor.
3. Applying the wrong target scale. Oxygen saturation scale 2 is not the default for every patient with lung disease. The question must say that hypercapnic respiratory failure is confirmed and that a clinician has directed it.

How the questions are framed

Platform 3 stems commonly give a set of observations, a short history and a screening result. You may need to total a NEWS2 score from the figures given, decide whether the patient is stable, or choose which assessment tool applies to the problem described. Others ask which part of an assessment to do first, or which finding on a care plan is most important to act on. The numbers are usually simple. The difficulty is applying the correct band and the correct response.

What the exam asks about each group

• Acute deterioration. Score, then escalate at the right level. Know the difference between routine review, urgent clinician review and emergency assessment, and who is called in each case.
• Sepsis. Recognise that suspected infection plus a high score needs urgent senior assessment, and that time matters. Do not wait for a laboratory result before escalating.
• Screening tools. Choose the tool that matches the risk: MUST for nutrition, Waterlow or Braden for pressure ulcers, 4AT for delirium, the Clinical Frailty Scale for frailty, VTE assessment on admission.
• Neurological assessment. Use FAST for suspected stroke and the Glasgow Coma Scale for level of consciousness, and act on a falling score.
• Mental health risk. Ask directly about self-harm or suicidal thoughts, assess immediate risk and follow the local pathway.
• Care planning. Choose goals with the person, review them, and include capacity and reasonable adjustments where they apply, including health passports for people with a learning disability.
• Palliative and discharge needs. Identify end-of-life needs early, involve the person and family, and start discharge planning at admission.

When an item gives you a number, do the arithmetic on the note board even if it looks easy. A misread band is the commonest way to lose these marks.

How to revise it

1. Memorise the NEWS2 chart by writing it out from memory until you make no errors, then score ten invented sets of observations.
2. Link each tool to its trigger: MUST on admission, Waterlow on admission and change, VTE assessment on admission, 4AT for suspected delirium.
3. Practise ABCDE as a sequence with a first action for each letter.
4. Use long-term conditions as care-plan templates: assess, goals, monitoring, self-management, review.
5. Finish with timed mixed sets that combine this domain with Platform 4, since assessment leads directly to care.

See the high-yield list for oxygen targets and sepsis points.