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    National Early Warning Score (NEWS)

    Determines the degree of illness of a patient and prompts critical care intervention.
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    When to Use
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    Why Use

    The NEWS can be used on all hospitalized patients to allow for the early detection of clinical deterioration and potential need for higher level of care.

    • The National Early Warning Score (NEWS) was developed to standardize the approach to detection of clinical deterioration in acutely ill patients in the United Kingdom.
    • This new standard has still not been fully embraced by the medical community in the UK or elsewhere.
    • It is hoped that adopting a single early warning score system will facilitate and standardize training in their use.
    • NEWS should not be used in patients under 16 years of age, and pregnant women.
    • The physiological parameters of the NEWS score were derived from existing early warning systems and agreed on by members of the NEWSDIG group.
    • The NEWS was retrospectively validated against other EWS and found to be more sensitive than most earlier scores. This validation has not yet been published.
    • Patients with low NEWS can continue receiving their usual care and observation.
    • Patients with high NEWS should be watched more attentively and considered for transfer to a higher care unit such as an ICU.
    About the Creator
    Dr. Gary Smith
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    Management

    Once the NEWS identifies a patient at risk of deterioration, the medical team will need to identify the cause and address it accordingly.

    Critical Actions

    • This score can be used by any healthcare worker with proper training in how to use it and interpret the results.
    • It is meant to be used on a regular basis rather than once on admission.

    Formula

    Addition of the selected points; points assigned below:

    Facts & Figures

    See formula table, below.

    Criteria Point Value
    Respiratory Rate (breaths per minute)
    ≤8 +3
    9-11 +1
    12-20 0
    21-24 +2
    ≥25 +3
    Oxygen Saturation (%)
    ≤91 +3
    92-93 +2
    94-95 +1
    ≥96 0
    Any Supplemental Oxygen
    Yes +1
    No 0
    Temperature in °C (°F)
    ≤35.0 (95) +3
    35.1-36.0 (95.1-96.8) +1
    36.1-38.0 (96.9-100.4) 0
    38.1-39.0 (100.5-102.2) +1
    ≥39.1 (≥102.3) +2
    Systolic BP
    ≤90 +3
    91-100 +2
    101-110 +1
    111-219 0
    ≥220 +3
    Heart Rate (beats per minute)
    ≤40 +3
    41-50 +1
    51-90 0
    91-110 +1
    111-130 +2
    ≥131 +3
    AVPU
    A 0
    V, P, or U +3

    Interpretation

    • A low score (NEWS 1–4) should prompt assessment by a competent registered nurse who should decide if a change to frequency of clinical monitoring or an escalation of clinical care is required.
    • A medium score (ie NEWS of 5–6 or a RED score) should prompt an urgent review by a clinician skilled with competencies in the assessment of acute illness – usually a ward-based doctor or acute team nurse, who should consider whether escalation of care to a team with critical-care skills is required (ie critical care outreach team).
      • A RED score refers to an extreme variation in a single physiological parameter (i.e., a score of 3 on the NEWS chart in any one physiological parameter, colored RED to aid identification; e.g., heart rate
    • A high score (NEWS ≥7) should prompt emergency assessment by a clinical team/critical care outreach team with critical-care competencies and usually transfer of the patient to a higher dependency care area.

    Evidence Appraisal

    The six physiological parameters that were proposed to form the basis standardized National Early Warning Score were derived from this study. It retrospectively analyzed data from 35,585 medical admissions.

    Dr. Gary Smith

    About the Creator

    Gary B. Smith, Cert Med, FRCA, FRCP, is a visiting professor at the School of Health & Social Care, University of Bournemouth, UK. He is director of the UK Deteriorating Hospital Patient conference and co-director of the international conferences on Rapid Response Systems. Professor Smith co-developed RSVP (Reason-Story-Vital Signs-Plan), for communicating patient deterioration and the Chain of Prevention, a paradigm for preventing patient deterioration.

    To view Dr. Gary Smith's publications, visit PubMed

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