|
|
Policy responses and statements
- Name of organisation:
- Royal College of Physicians of London
- Name of policy document:
- NHS Early Warning Score (NEWS)
- Deadline for response:
- 28 April 2011
Background: The Royal College of Physicians of London,
in its 2007 report “Acute Medicine: the right person, in the
right setting – first time”, recognised that a standardised
early warning score, used across the NHS could provide a step change
in improving clinical outcomes in people with acute illness. Subsequent
to this report, RCPL commissioned a group to develop an NHS Early Warning
Score (NEWS), designed for use across the NHS.
The draft copy of this report has now been circulated, along with
a draft NEWS chart. Stakeholder in acute care in the NHS were invited
to give candid reviews and comments on the draft document. RCPL's intention
is to review the comments of major stakeholders and then generate a
pre-final draft document which will then be submitted to the RCPL's
Council for further review prior to generating the final draft for
publication.
The document will be supported by web-based educational materials,
currently under development, to assist in the training and implementation
of the NEWS. Additionally, downloads of the main document and charts
will also be made available at the time of publication. RCPL's intention
is to see NEWS widely adopted across the NHS, as the main early warning
score. RCPL views the establishment of a single EWS, i.e. the NEWS
as being key to the standardising assessment and response to acutely
ill patients, as well as facilitating education and training in the
management of the acutely ill patient, wherever they might be.
COMMENTS ON
ROYAL COLLEGE OF PHYSICIANS
OF LONDON
NHS EARLY WARNING SCORE (NEWS)
The Royal College of Physicians of Edinburgh has contributed to the
development of this very positive initiative through membership of
the design and implementation steering group. The College is
supportive of the proposals and we would be happy to take the finalised
version through our own Council with a view to a formal endorsement
of the report and resulting NEWS tool once the final version is available. The
College also believes that patient safety across the UK would be improved
if a similar approach could be adopted in the devolved administrations,
and would be pleased to contribute to the promotion of a UK-wide implementation
strategy.
We have a few questions/comments from some of our non-physician Fellows,
who are also broadly supportive of the initiative. If these points
have been discussed previously by the working group, it may be useful
to incorporate this into the final document to inform others who may
raise them again:
-
It may help readers if the order of the parameters in the explanatory
document matches the proposed order in the observation chart.
-
Wider adoption of the score chart may be supported by ensuring
that zero values reflect the normal ranges for each parameter. The
respiratory ranges may merit review in this regard. Also,
it has been suggested that lower pulse rates may merit a higher
score than proposed; namely 41-50 scoring 2, and 51-60 scoring
1, leaving 61-90 as the 0 score.
-
Should blood sugar levels be included with a suggested interval
of <4->14 mmol/l?
-
It would be helpful to understand why pain, although recorded
as a symptom by clinical teams, is not felt appropriate for inclusion
within the NEWS scoring system other than as part of the consciousness
level. Also, our anaesthetist colleagues suggest that the
presence of pain (or lack of response to pain) should always score
3 in an early warning system.
-
It would also be helpful to understand how this scorecard can be
used consistently in pre- hospital care, and the team reviewing the
final version may find a recent commentary in the Journal of Emergency
Medicine helpful (Emerg Med J 2011;28:263 doi:10.1136/emj.2010.106104).
Finally, we understand that despite the wide use of score charts it
has been difficult to demonstrate an improvement in patient outcomes
following their introduction, and that the proposed chart has itself
been evaluated retrospectively rather than prospectively. An
editorial article in the Journal of Anaesthesia supports this point
(British Journal of Anaesthesia 98 (6) 704-6 (2007)). Again,
would further piloting and prospective evaluation support the case
for national adoption?
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[4 May 2011]
|
