National Early Warning Score

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Parameters

  1. respiration rate
  2. oxygen saturation
  3. systolic blood pressure
  4. pulse rate
  5. level of consciousness or new confusion*
  6. temperature.
  7. inspired oxygen
What NEWS does?
 • It provides a baseline measure of an individual’s physiological functioning (from a gathered sequence of vital signs recordings); 
• It measures the effectiveness of some treatment interventions when there is a change in NEWS; 
• It provides a risk assessment of an individual based on recorded observations;
 • It can assist in timely escalation of clinical response in the event of an acute physiological deterioration when there is an increase in NEWS.

News2 Example Chart

Example Scenario

Mr Smith is 52 year old gentleman who attends the emergency department with fever, cough and pleuritic pain with following vitals:
  • Respiratory rate: 21/min
  • Oxygen saturation : 93%
  • On air
  • Systolic blood pressure: 120 mmHg
  • Heart rate : 95/min
  • Consciousness: Alert
  • Temperature: 38.5 °C
Mr Smith Scores Example

"Are they conscious?" is either "Yes" or "No" which is too simplistic. Consciousness is a spectrum so we use the AVPU scale to show the casualty's Level of Response (R in DRABC). . If you are reading this you are more than Conscious, you are fully ALERT - as you can answer Who, Where, When and What just happened? Anyone who is not alert is Unconscious, but they may still be able to respond to stimuli. Firstly shout a strong and simple command like "Open your eyes!" The response you get may be overt, they may actually open their eyes and look at you - or it may be subtle, they may simply groan or flinch. In either case this casualty is unconscious but responsive to VOICE. If they don't respond to your voice, do they respond to PAIN?  Pinch the casualty's ear lobe and if no response then pinch the muscle along the top of the shoulder hard or the tricep, always looking at the casualty's face for a response, be it overt or subtle. . If they do not respond to pain, they are unconscious and UNRESPONSIVE. Your casualty can now be categorised using AVPU: "Alert" or "Unconscious but responding to Voice" or "Unconscious but responding to Pain" or "Unconscious and Unresponsive" It is much more useful to know how RESPONSIVE they are rather than if they are conscious or not, and also how they progress through the spectrum. Adapted from an excellent article by Real First Aid.co.uk Have a good weekend folks and try to stay fully conscious!! . . . #consciousness #unconscious #conscious #avpu #responsiveness #levelofresponse #whowherewhenwhat #voiceresponse #painresponse #unresponsive #DRABC #firstaidtraining #savealife #learningisfun #helpingothers #firstaid #giftoflife #firstaidwiltshire #firstaidhampshire #learningtogether #spreadingtheword #friyay #learnsomethinguseful #lovemyjob #supportsmallbusiness #firstaidcourse #mumsintheknow #weekendvibes #itstheweekend #fridayfeeling

What is SBAR? 

SBAR is a tool for communication and stands for:

 • Situation. Patient/ client’s details, identify reason for this communication, describe your concern.
 • Background. Relating to the patient/ client/ service user/ resident significant history; this may include medications, investigations, treatments
. • Assessment. What is your assessment of the patient/ client or situation. This can include clinical impressions/ concerns, vital signs if relevant.
 • Recommendation. Be specific, explain what you need, make recommendations, clarify expectations and confirm actions to be taken.

Mnemónica ISBAR: auxiliar de memória que permite através de formas simples, memorizar construções complexas, para serem utilizadas na transmissão verbal, em que
 I: corresponde à Identificação,
 S: à Situação atual,
B: aos Antecedentes,
 A: à Avaliação,
R: às Recomendações. Identificação: Identificação e localização precisa dos intervenientes na comunicação (emissor e recetor) bem como do doente a que diz respeito a comunicação; Situação atual: Descrição do motivo atual de necessidade de cuidados de saúde; Antecedentes: Descrição de factos clínicos, de enfermagem e outros relevantes, diretivas antecipadas de vontade; Avaliação: Informações sobre o estado do doente, terapêutica medicamentosa e nãomedicamentosa instituída, estratégias de tratamento, alterações de estado de saúde significativas; Recomend

https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/norma-n-0012017-de-08022017-pdf.aspx
Benefits of NEWS
1. Improved patient safety by accurate recording and auditing of vital signs measurements
 2. Saving of training time where staff work in many different organisations: (essentially) one system to be learned than a previous large variety of different EWS systems 
3. NEWS becomes part of the language used in communication between different health care professionals about patients 
4. Formalisation and clarity of escalation responses for patients who deteriorate in physiological condition. 
5. Surveillance of baseline physiology to detect departure from normal physiology; collection of trend information allows monitoring of variance to assure appropriate changes in care where required.
 6. Compliance with national recommendations for acute illness management; national recommendations tend to be based on better evidence than can be obtained locally.

SHOUT

 S Sepsis 

H Hypovolaemia 

O Obstruction 

U Urine Analysis 

T Toxins

SNOOP 

S SEPSIS 

N NEWS 

O OXYGENATION 

O OUTPUT OF URINE 

P PAIN






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