NEWS - ESSENTIAL INFORMATION The National Early Warning Score (NEWS) is a standardised assessment of acute illness across the NHS that provides a systematic approach. It measures the severity of the acute illness to aid fast and efficient responses which can result in optimal clinical outcomes. The Royal College of Nursing and the Royal College of Physicians worked together to launch NEWS across the country. Prior to it being implemented observations and assessments were all practiced differently; even on the same ward two people could have different viewpoints on the severity of a patient s condition. NEWS provides a simple technique to ensure continuity of assessment, but more importantly, a warning that a patient s condition is deteriorating. What is the role and responsibilities when completing NEWS? It is your role to ensure the NEWS assessment and chart is completed correctly so that it will work efficiently. This includes documenting the evidence and the outcome of assessment and action required, or justification if no action is taken. What are the legal requirements when completing NEWS? You have a legal requirement under the Data Protection Act to only share information necessary. NEWS is not designed for use on children, pregnant women and young people under 16. It is only designed for adults aged 16+. This is because the baseline physiological parameters differ in children and pregnancy. PEWS is discussed later. What are the main aims when completing NEWS? To assess the severity of a patient s illness and to identify if/when they require further assistance and/or their condition is deteriorating. It can identify unanticipated deterioration in their clinical condition. NEWS will track a patient s journey by providing a continuous record of their physiological status. NEWS will also: recognise when a patients clinical condition starts to deteriorate define the appropriate, timely triage and ongoing level of care required provide an assessment that is standardised in pre hospital settings define common assessment principles and a standard approach to assessment of illness severity help practitioners to decide on the frequency of monitoring give guidance as to when escalation of care is required How do I complete a NEWS assessment? NEWS monitors the following 6 physiological parameters: 1. Respiration rate 2. Oxygen saturations and if the patient is having supplementary oxygen 3. Temperature 4. Systolic BP 5. Heart rate 6. Level of consciousness 1
You will undertake these observations and record them on a NEWS observation chart. Please see example below: Once you have recorded your observations you will need to check these results against the NEWS chart below: 2
Example: A 37 year old female has been brought in following an accident on her bicycle. Her stats are: Physiological Parameter Observation result Respiration rate 23 Oxygen saturations 97 Supplementary oxygen No Temperature 35.2 Systolic BP 225 Heart rate 129 Using the top row of the chart for your score of each parameter. Then add these together you will reach patients NEW score. Physiological Parameter Observation result NEWS Respiration rate 23 2 Oxygen saturations 97 0 Supplementary oxygen No 0 Temperature 35.2 1 Systolic BP 225 3 Heart rate 129 2 Total NEWS score 8 3
Using the clinical response table below, you will know your next step in caring for this patient. As this patient has a score of more than 7 you need to follow the guidance in that section. This patient will now need continuous monitoring. The clinical response will be: Registered nurse to immediately inform the medical team caring for the patient this should be at least Specialist Registrar level. Emergency assessment by a clinical team with critical care competencies, which also includes a practitioner/s with advanced airway skills Consider transfer of clinical care to a level 2 or 3 facility, i.e. higher dependency or ITU Remember though if you have a concern about a patient you must escalate this, regardless of their score. Low, medium and high risk Scores of 1-4 indicate a low risk Scores of 5-6 indicate a medium risk Scores of 7 or more indicate a high risk In summary the NEWS system provides staff with a tool that will: Provide a continuous monitoring report 4
Alert when the patient s condition is deteriorating Guide the action that needs to be taken Provide a standardised platform for assessment Paediatric Early Warning (PEWS) Tools Infants and children admitted to hospital require regular clinical observations in order to ensure the early detection of deterioration. The Paediatric Early Warning Score (PEWS) is a specialised tool that measures the infant/child s clinical status and recommends an appropriate response. A paediatric early warning score system is: A tool to identify patients with serious physiological disturbances at risk of deterioration An objective assessment tool A tool that may give us a numeric trend in the child s condition A safety net. There are several different types of early warning scores used around the UK, some examples are: Paediatric Early Warning Score (PEWS) The PEWS is split into age groups, each particular age group has an individualised form, some trusts also use a Toddler form 1-2yrs: 0-11 months Pre-school 1-4 years School Age 5-12 years Teenager 13-18 years Children s Observation and Severity Tool (COAST) Dr Julian Sandell (Consultant in Paediatric Emergency Medicine) adapted the PEW charts. COAST is scored in relation to 6 parameters (heart rate, respiratory rate, respiratory distress, receiving oxygen, and conscious level). There are a set of COAST forms that are for infants and children being treated in Accident and Emergency Centres. The Paediatric Observation Priority Score (POPS) Wales This Welsh tool is used in primary care, secondary care and the ambulance service. It is a checklist which quickly scores (between 0-16) acutely ill children on a combination of physiological, behavioural and risk identifiers using easy collected data. It enables any staff member to assess, prioritise and treat acutely ill children. Newborn Early Warning Trigger and Track (NEWTT) Identifies those babies at risk of clinical deterioration following birth Provides a standardised observation for monitoring clinical progress Provides a visual prompt to aid identification for abnormal parameters by colour coding, e.g. red, amber, green Reduces admissions to neonatal units. 5
This workbook will be based around the PEWS form The data captured in the early warning score varies but can include any of the below: Heart rate Systolic blood pressure Conscious level Respiratory rate Temperature Oxygen saturation Capillary re-fill Respiratory effort Oxygen therapy Glasgow Coma Scale / AVPU scores The score collected will trigger certain responses, these triggers will vary from trust to trust as per local protocol. The universal trigger responses on the PEWS form are: Score Response 1 Continue Monitoring 2 Nurse in charge must review 3 Nurse in charge and Dr must review 4 Nurse in charge and Dr must review and inform Consultant 5 Nurse in charge and Consultant must review 6 Nurse in charge and Consultant must review 6
VIDEOS News scoring will help save lives: https://www.youtube.com/watch?v=u5keohs_fiu USEFUL WEBSITES RCP guide to NEWS: https://www.rcplondon.ac.uk/sites/default/files/documents/national-earlywarning-score-standardising-assessment-acute-illness-severity-nhs.pdf RCN NEWS training resource: https://tfinews.ocbmedia.com/ Royal College of Physicians: https://www.rcplondon.ac.uk/resources/national-early-warning-scorenews NHS Professionals: http://www.nhsprofessionals.nhs.uk/elearning/pages/clinical-governance.aspx NHS England: https://www.england.nhs.uk/patientsafety/re-act/design/what-works/pews-charts/ REFERENCES Innovation, N. T. (n.d.). NEWS. Retrieved 25 08, 2015, from NEWS: https://tfinews.ocbmedia.com/ Professionals, N. (n.d.). NHS Professionals. Retrieved 25 08, 2015, from NHS Professionals: http://www.nhsprofessionals.nhs.uk/elearning/pages/clinical-governance.aspx Reviewed 23/08/2016 7