DEVELOPMENT SITE ONLY
Please use current guidelines available on the UHNM intranet for patient treatment
Please use current guidelines available on the UHNM intranet for patient treatment
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/Careflow Vitals
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
- SpO2 scales:
- 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
NEWS score =1-2
- 6-hrly observations
- Registered nurse to assess the patient
- Any irregular heart rate requires ECG and escalation
- Complete sepsis assessment as required
- Has the patient been assessed on the correct SpO2 scale?
- Escalate concerns to the team managing to the patient (ward team/home team/outreach)
NEWS score =3-4
- 4-hrly observations
- Registered nurse to assess the patient
- Any irregular heart rate requires ECG and escalation
- Complete sepsis assessment as required
- Has the patient been assessed on the correct SpO2 scale?
- Escalate concerns to the team managing to the patient (ward team/home team/outreach)
NEWS score =5-6
- Hourly observations
- Registered nurse to assess the patient
- Registered nurse to urgently escalate to appropriate team/doctor
- if no response within 30 min escalate further i.e. registrar/consultant
- Complete sepsis assessment
- Monitor fluid balance hourly
- Transfer to higher monitoring area (if appropriate)
- Arrange transfer of care to level 2-3 facility as agreed by senior clinicians/critical care doctor
- Clinical staff to consider ceiling of care and suitability for CPR
NEWS score =7, 8, 9 or more
- Continuous observation as defined by treating clinician
- Registered nurse to assess the patient
- Complete sepsis assessment
- Obtain IV access and blood profile as required
- Monitor fluid balance hourly
- Urgent assessment by senior member of team managing the patient (ward team/home team/outreach)
- If no response within 10 min, escalate to registrar/consultant