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