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


Picture: iStock

Essential facts

The National Early Warning Score (NEWS) was developed by the Royal College of Physician’s 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 2017. The updated version improves escalation to higher levels of clincal care in patients with chronic hypoxaemia, and includes acute delirium or confusion within assessments.

What’s new

Every hospital, ambulance and acute mental health 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 whose conditions deteriorate while in hospital could be reduced, with the potential to save 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, 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 between one and four, leads an assessment by a registered nurse; a medium score, of five or 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 likely patient transfer to a high-dependency unit.

Expert comment

Ed Freshwater, chair of the Royal College of Nursing Mental Health Forum

‘The use of a common assessment tool should improve communications between professionals and lead to welcome improvements in outcomes. People who have severe mental illness have a lower life expectancy than the general population, and much of this is attributable to poorer physical health.

'Efforts to improve outcomes for people with severe and/or acute mental illness should be embraced, but there are likely to be some teething troubles as time will have to be found for new procedures in an already overstretched environment. Nurses will need support from their employers to ensure clinical skills are up to date so that accurate information is recorded, the signs of a deteriorating patient recognised and further action taken.

'The introduction of a new procedure is only part of the solution and as long as there are deficiencies in staffing numbers and training, the laudable goals will not be realised.’

 

Find out more

RCNi article

Nursing Management (2015) Early warning scores: a sign of deterioration in patients and systems 

 

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