National Early Warning Score (NEWS): patient assessment and monitoring system

 National Early Warning Score (NEWS)

The National Institute for Health and Care Excellence (NICE) has stated that all adult patient in acute hospital settings should be monitored using physiological track and trigger systems. Physiological observations should be monitored at least every 12 hours unless a decision has been made at a senior level to decrease or increase the frequency of observations for an individual patient. 

Track and trigger systems allocate points in a weighted manner based on derangements in a patients vital signs. The sum of the allocated points is known as the 'early warning score ' and it directs the patients care. In the UK, numerous early warning system are being used in different hospitals, resulting in a lack of consistency in detecting and responding to patients deterioration. It also leads to confusion and the potential for mistake when healthcare staff move to work in different departments and different hospitals. 

In 2012, the Royal College of physician led the development of the National Early Warning Score ( NEWS ) after working in partnership with patients and a number of professional group. The NEWS is based on the allocation of scores to six physiological parameters. 

• Respiratory rate
• Oxygen saturation 
• Temperature 
• Systolic blood pressure 
• Pulse rate
• Level of consciousness (AVPU).

Above picture shows the NEWS score grid, with the parameter ranges and score for each of the six physiological parameters. The patients observations are documented on the NEWS observation chart, and the NEWS score is then calculated. 

The NEWS clinical response grid provides advice on what action to take for the NEWS score calculated from the patient's observation. The action advised will include the frequency with which observations should be performed, and the clinical response required for that score ( e.g.  a registered nurse should to assess the patient ). However, staff are reminded of the need to use clinical judgment and to summon senior help if they have any concerns about a patient, even if their NEWS score has not triggered a response. 

Blood glucose levels are not included in the NEWS score. but there is a section on the NEWS observation chart in which to record the patients blood glucose concentration. Patient with type 1 or type 2 diabetes will need to have their blood glucose levels monitored post-operatively because they may be unstable due to the patient being NBM or having had their diabetic medication omitted prior to surgery. In addition, the stress response to surgery and the release of catecholamines can lead to raised blood glucose levels in both diabetic and non-diabetic patients. Therefore the monitoring of blood glucose levels in both diabetic and non-diabetic patients. Therefore the monitoring of blood glucose levels post-operatively is important in all patients. 

NEWS is not recommended for use in children or during pregnancy. The Royal College of Physician recommended that for patients with known hypercapnoeic respiratory failure due to chronic obstructive pulmonary disease (COPD), British thoracic society target saturations of 88-92% should be used. These patients will still 'score' if their oxygen saturations are below 92%, unless the score is 'reset' by a competent clinical decision maker and patient -specific target oxygen saturation are prescribed and documented on the NEWS observation chart and in the clinical notes.