INTRODUCTION
- National early warning scoring (NEWS) is a track and trigger protocol that monitors vital observations to detect subtle changes in patient physiology
- score will trigger responses in accordance with escalation strategy
- NEWS is an aid to clinical decision making
- not a replacement for professional judgement
- senior clinical advice can be requested without reaching a NEWS trigger
OBSERVATIONS
- When taking patient observations, record on NEWS chart
NEWS scoring items
- Respiration counted over 1 full minute
- Oxygen: must be prescribed
- SpO2 scales:
- scale 1 – patients without hypercapnia
- scale 2 – Patients with hypercapnia (validated by a clinician and documented in patient’s notes)
- during each set of observations registered nurse validates rate and method of delivery of oxygen
- Temperature
- Blood pressure
- Heart rate
- ACVPU score (Alert, Confusion, Voice, Pain, Unconscious)
ESCALATION STRATEGY
- Patients with increased NEWS score are at risk of sudden deterioration and/or cardiac arrest
- Any deterioration/sudden change in NEWS score will prompt patient review in accordance with the escalation strategy below
NEWS score =0
- Minimum 6-hrly observations
- Escalate any new irregular heart rate
NEWS score =1-2
- Minimum 6-hrly observations
- Inform registered nurse who must assess the patient
- Check pulse for irregular heart rate
- if irregular, perform ECG
- escalate any new irregular heart rate
- Registered nurse to consider:
- checking blood glucose
- sepsis screening tool if appropriate
- is the patient’s condition causing concern?
- has the patient been assessed on the correct SpO2 scale?
- Registered nurse to assess if escalation is required
NEWS score =3-4
- Minimum 4-hrly observations
- Inform registered nurse who must assess the patient
- Check pulse for irregular heart rate
- if irregular, perform ECG
- escalate any new irregular heart rate
- Registered nurse to consider:
- checking blood glucose
- sepsis screening tool if appropriate
- is the patient’s condition causing concern?
- has the patient been assessed on the correct SpO2 scale?
- Registered nurse to assess if escalation is required
Individual score =3
- Extreme value
- Inform registered nurse and ward-based team for review
- commence sepsis screening tool if not already done (consider a temperature of less than 36°C)
- consider oxygen, IV access and bloods
- check for irregular heart rate – consider ECG
- cas the patient been assessed on the correct SpO2 scale?
- is it a new confusion?
- assess frequency of observations
NEWS score =5-6
- Increase frequency of observations to a minimum of hourly
- Inform registered nurse who must assess the patient
- Registered nurse to urgently contact:
- the appropriate nurse practitioner/team doctor or outreach team for an urgent review
- nurse in charge
- if there is no response within 30 minutes escalate further e.g. SpR
- Clinical staff to consider:
- checking blood glucose
- sepsis screening tool if not already done
- has the patient been assessed on the correct SpO2 scale?
- oxygen, IV access and bloods
- 12 lead ECG and escalate any new irregular heart rate
- hourly fluid balance
- is it a new confusion?
- ceiling of care and suitability of CPR
NEWS score =7, 8, 9 or more
- Continuous observation as defined by treating clinician
- consider monitoring in a higher area
- Inform registered nurse who must assess the patient
- Registered nurse to urgently contact:
- the appropriate SpR, nurse practitioner/team doctor or outreach team for an urgent review
- nurse in charge
- if there is no response within 10 minutes escalate further e.g. SpR/consultant
- Clinical staff to consider:
- checking blood glucose
- sepsis screening tool if not already done
- has the patient been assessed on the correct SpO2 scale?
- oxygen, IV access and bloods
- 12 lead ECG and escalate any new irregular heart rate
- hourly fluid balance
- is it a new confusion?
- ceiling of care and suitability of CPR
- Senior clinicians/critical care doctor to arrange transfer of care to level 2–3 facility
© 2022 The Bedside Clinical Guidelines Partnership.
Created by University Hospital North Midlands and Keele University School of Computing and Mathematics.
Research and development team: James Mitchell, Ed de Quincey, Charles Pantin, Naveed Mustfa