National Early Warning Score (NEWS)

National Early Warning Score (NEWS)

Standardising the assessment of acute-illness severity in the NHS

Report of a working party July 2012

National Early Warning Score (NEWS)

Standardising the assessment of acute-illness severity in the NHS

Report of a working party July 2012

The Royal College of Physicians

The Royal College of Physicians is a registered charity that aims to ensure high-quality care for patients by promoting the highest standards of medical practice. It provides and sets standards in clinical practice and education and training, conducts assessments and examinations, quality assures external audit programmes, supports doctors in their practice of medicine, and advises the government, public and the profession on healthcare issues.

Citation for this document Royal College of Physicians. National Early Warning Score (NEWS): Standardising the assessment of acuteillness severity in the NHS. Report of a working party. London: RCP, 2012.

Copyright In order to encourage as many people as possible to use the material in this publication, there is no copyright restriction, but the Royal College of Physicians as copyright holder should be acknowledged on any material reproduced from it. Note that high-quality versions of the charts and their explanatory text are available to download, photocopy or print direct from our website at rcplondon.ac.uk/ national-early-warning-score. Please do not use the lower-quality versions of the charts shown in the report itself. The charts must be reproduced in colour and should not be modified or amended. ISBN 978-1-86016-471-2 eISBN 978-1-86016-472-9 ? Royal College of Physicians 2012 Review date: 2015 Royal College of Physicians 11 St Andrews Place Regent's Park London NW1 4LE rcplondon.ac.uk Registered Charity No 210508 Typeset by Cambrian Typesetters, Camberley, Surrey Printed in Great Britain, managed by TU ink Limited

Contents

Members of the working party iv Acknowledgements vi Foreword vii Introduction on behalf of the National Outreach Forum and the Royal College of Nursing viii Preface ix Executive summary x Recommendations xiii

1 Background and introduction 1 Potential benefits of a National Early Warning Score (NEWS) 3 Potential benefits of a standardised NEWS 3

2 Methodology 5 Remit of the NEWSDIG 5 Process of development 5 From evidence to recommendations 7

3 Physiological parameters incorporated into the NEWS 8 Fig 1: Six physiological parameters included in the NEWS 8 Review of the six physiological parameters 9 Additional weighting of the NEWS aggregate score 10 Physiological parameters considered but not included in the NEWS 11

4 How the NEWS works 13 Scoring system for the NEWS physiological parameters 13 Note on use of the charts 13 Chart 1: The NEWS scoring system 14 NEWS thresholds and triggers 14 Chart 2: NEWS thresholds and triggers 15 Evaluation of the NEWS 15

5 Using the NEWS 17 The NEWS chart 18 Chart 3: Observation chart for NEWS 20 Clinical response to NEWS 21 Organisation of the local response to NEWS 21 Urgency of response 22 Frequency of clinical monitoring 22 Appropriate setting for ongoing clinical care 23 Clinical competencies of responders to NEWS 23 Chart 4: Clinical response to NEWS triggers 24

6 Training and implementation of the NEWS 25

7 Future research 26

8 Ongoing review process for the NEWS 27

References 28 Appendix A: Stakeholders consulted in the development of NEWS 29

? Royal College of Physicians 2012

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National Early Warning Score Development and Implementation Group (NEWSDIG)

Members of the working party

Professor Bryan Williams

Chairman of NEWSDIG Professor of medicine, University College London

Professor Sir George Alberti Dr Carol Ball Professor Derek Bell Ms Rachel Binks Ms Lesley Durham

Dr Jane Eddleston Mr Nigel Edwards Mr David Evans Dr Mike Jones Dr Daryl Mohammed Dr Ruth Patterson Dr Jonathan Potter Ms Tracy Scollin Professor Gary Smith*

Dr Keith Steer

Dr Chris Subbe Mr John Welch Ms Niamh Wilson

National clinical director for emergency access (September 2002?March 2009) Imperial College London

Critical care nurse consultant The Royal Free Hampstead NHS Trust

Professor of acute medicine, Imperial College London

Nurse consultant, Airedale NHS Foundation Trust Chair, Royal College of Nursing Critical Care and In-flight Forum (2007?11)

Chair, National Outreach Forum (2005?10) NEWS lead, National Outreach Forum Executive Board (2010 to date) Director and Lead Nurse, North of England Critical Care Network

Clinical advisor on critical care, Department of Health Consultant in intensive care medicine, Manchester Royal Infirmary

CEO, NHS Confederation (May 2010?August 2011) Senior fellow, The King's Fund

RCP Patient and Carer Network Safety engineer and occupational hygienist

Vice-president, Royal College of Physicians, Edinburgh (Scottish Colleges)

London Ambulance Service

Practice development nurse, acute medicine

Clinical director, Clinical Effectiveness and Evaluation Unit (RCP)

Working party administrator (RCP)

Consultant in critical care medicine, Portsmouth Hospitals NHS Trust (until March 2011) Visiting professor, Bournemouth University

Acute medicine representative Lead consultant, Emergency Adult Medicine, The North West London Hospitals NHS Trust

Consultant in acute and intensive care medicine, Ysbyty Gwynedd, Bangor

National Outreach Forum and consultant nurse, University College London Hospitals

NHS London Programme for IT

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? Royal College of Physicians 2012

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