Policy briefing

Updated National Early Warning Score

In December 2017, the Royal College of Physicians updated the National Early Warning Score to improve identification of acutely ill patients

In December 2017, the Royal College of Physicians updated the National Early Warning Score to improve identification of acutely ill patients


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Essential facts

The National Early Warning Score (NEWS) was developed by the Royal College of Physicians to improve the identification of acutely ill patients, including those with sepsis. A score is allocated to six physiological measurements, already recorded in routine practice, to gain an aggregate overall score.

The original NEWS was published in 2012, with a new version, NEWS2, launched in December. The updated version improves escalation in patients with chronic hypoxaemia and includes acute delirium or confusion in assessments. The recording of physiological parameters has been reordered to align with the Resuscitation Council (UK) ABCDE sequence.

What’s new

Every hospital and ambulance service in England has been asked to use the NEWS system by March next year (2019). Already used by 70% of hospitals, increasing this further will mean NHS staff who move between trusts are using a consistent set of measures for diagnosing patients. Through standardisation of the NEWS, the number of patients who deteriorate while in hospital could be reduced, potentially saving more than 1,800 lives a year, NHS England says.

Where NEWS is used

The NEWS can be used in all patients over 16 years old, except pregnant women, and across all healthcare settings. It is particularly useful when patients are transferred from one setting to another to ensure there is a clear understanding of the patient’s clinical state, risk of deterioration and prognosis. Clinical judgement should always be used, even if the NEWS is normal.

Paramedics have been told that NEWS should be used for all pre-hospital patients who are ill or at risk of deteriorating, including those suspected of having sepsis. But it should not be used as the sole criteria for prioritisation of patients being admitted to hospital via ambulance services.

Implications for nurses

Under the system, patients are assessed on breathing rate, pulse rate, systolic blood pressure, temperature, level of consciousness or new confusion and oxygen saturation. The results are plotted on a NEWS chart which gives a score for each measure. The combined number then shows the level of clinical care needed and the risk of deterioration.

A low score of one to four leads an assessment by a registered nurse, a medium score of between five and six would prompt an urgent review from an acute clinician, such as a ward-based doctor, and a high score of seven or more would see an emergency assessment by a critical care team and a likely patient transfer to a high dependency unit.

Expert comment

Janet Youd, chair of the RCN Emergency Care Association and emergency nurse consultant at Calderdale and Huddersfield NHS Foundation Trust

‘Most emergency nurses will be familiar with NEWS, which is a useful and good prompt to consider things like sepsis and clinical deterioration.

‘There are reported incidents where if NEWS had been used, it may have prompted an earlier senior review, and possibly led to a better patient outcome.

‘It’s also good that ambulance staff will be using it. They will be able to give us pre-arrival alerts about acutely ill patients and we will all be talking the same language. ‘However, it shouldn’t be relied on in isolation, clinical judgement should always be used. I have seen patients deteriorate, but their parameters remain within normal range, using NEWS alone would have given false reassurance.

‘It is a shame that there isn’t a national early warning system for children, as there is huge regional variation in the systems used.’

 

Further information

RCNi article

Fox A, Elliot N (2015) Early warning scores: a sign of deterioration in patients and systems. Nursing Management

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