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Objectives
Objectives
Describe the process of applying the NEWS2 tool in a clinical environment.
Recognise the NEWS2 scoring system and how to apply this to a patient in a clinical environment.
Demonstrate the use of the tool using the case studies provided.
Understand the thresholds, triggers, pathways and escalation to appropriate care following application of the tool.
Understand the need for system wide standardisation.
What is NEWS2?
What is NEWS2?
NEWS is a tool developed by the Royal College of Physicians which improves the detection and response to clinical deterioration in adult patients and is a key element of patient safety and improving patient outcomes.
The original version of the national early warning score (NEWS) was released in 2012, A revised version (NEWS2) was released in 2018 with the expectation that all NHS organisation embed the use of NEWS2 into practice by March 2019.
Formal endorsement: NEWS 2 has now received formal endorsement from NHS England and NHS Improvement to become the early warning system for identifying acutely ill patients (including those with sepsis). This will allow standardisation across the health service and improve the ability to identify deteriorating patients between different the care providers.
When to use NEWS2
When to use NEWS2
NHS England's aim is for all acute hospital trusts and ambulance trusts is to fully adopt NEWS2 for adult patients by March 2019.
This alert has been jointly issued by NHS England, NHS Improvement and Royal College of Physicians to highlight the existing resources to support adoption of NEWS2.
Common Language
Common Language
NEWS2 provides a standardised means of communicating the level of physiological derangement exhibited by patients amongst a range of healthcare professionals in different settings in a format that is clear, reproducible and universally understood.
Systems of Operation
Systems of Operation
Systems operating with similar levels of risk use universal means of communication reducing the chance of failure.
A clear example of this is air traffic control systems the world over who adhere to the common standards and language in International Civil Aviation Organization to prevent disasters. Imagine what would happen if each airport pursued their own way of working?
Standardisation
Standardisation
The NHS should be no different and NEWS2 provides the basis for standardising our communication, for all staff engaged in assessing patients in the community, prehospitally and in hospital.
Practical Approach
Practical Approach
This is a practical approach with emphasis on a system wide standardisation for the use of the physiological parameters already routinely measured in prehospital care and in hospital care.
How to use NEWS2
How to use NEWS2
NEWS is based on a scoring system in which a score is allocated to the physiological measurements already recorded in our routine practice.
When patients present to the ambulance service or are being monitored in hospital the system is used to measure and monitor for red flags and deterioration.
Six simple physiological parameters form the basis of the scoring system.
1. Respiration rate
2. Oxygen saturation
3. Systolic blood pressure
4. Pulse rate
5. Level of consciousness or new confusion
6. Temperature
When all physiological parameters are completed the scores are combined to give an overall NEWS2 score.
When not to use NEWS2
When not to use NEWS2
NEWS 2 should not be used for any patient requiring treatment at:
Major trauma Centre (MTC)
Hyper Acute Stroke Unit (HASU)
Heart Attack Centre (HAC)
Maternity
News 2 is also not to be used for paediatrics
An explanation of the NEWS2 chart
An explanation of the NEWS2 chart
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Measure and Record
Measure and Record
Measure and record the score for each of the six physiological parameters listed on the NEWS2 scoring system using an ABCDE approach.
Add the scores
Add the scores
Add up the scores and remember to add 2 for any use of supplemental oxygen to derive the final NEWS2 score as indicated on the NEWS2 chart. Remember SpO2 Scale 2 should only be used for patients with known hypercapnic respiratory failure.
Record the score
Record the score
Use the NEWS2 chart to record a current score and combined with your clinical opinion the NEWS2 score will to assist your decision making on the level of clinical care required, its urgency and the most appropriate clinical setting for the care.
Red Flags
Red Flags
Remember the NEWS2 score is in addition to your clinical decision making and at the time of recording will form a measure that will identify red flags and deteriorating patients to either yourself or other care providers during the patient’s journey.
NEWS2 triggers for hospital staff
NEWS2 triggers for hospital staff
In hospital NEWS scores are used as a threshold to trigger certain levels of response. A patient who scores a 3 in any parameter or scores above 5 overall, triggers an urgent response.
Triggers for conveyance
Triggers for conveyance
New 2 score = 0
Plan (Frequency of monitoring) = Consider the need for conveyance
Escalation = Discharge with advice
New 2 score = 1-4
Plan (Frequency of monitoring) = Consider the need for conveyance if appropriate
Escalation = MUST refer the patient
New 2 score = Single Red Score (3)
Plan (Frequency of monitoring) = Convey
Escalation = Consider pre-alert
New 2 score = 5 - 6
Plan (Frequency of monitoring) = Convey
Escalation = If a pre-alert is not placed, a strong rational MUST be documented
New 2 score = 7 or more
Plan (Frequency of monitoring) = Convey
Escalation = Pre alert
Any patient scoring a 3 in any parameter or over 5 over all should be conveyed to hospital, unless it is your clinical judgement that this would not be appropriate.
If this is the case please document on the patients PRF the reason for the decision.
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