National Early Warning Score 2 (NEWS2)
N
a
t
i
o
n
a
l
E
a
r
l
y
W
a
r
n
i
n
g
S
c
o
r
e
2
(
N
E
W
S
2
)
Adults and Specialist
Rehabilitation Division
Feedback
•
Number 1 cause of death is failure to recognise and act on
deterioration.
•
NEWS is a common language to replace 60-70 scoring systems in
the UK. It is used to:
–
Assess acute illness severity
–
Detect clinical deterioration
–
Initiate a timely and competent clinical response.
–
Provide guidance on competence and frequency of monitoring.
•
Downward trajectory when patients score 5- high risk of ITU, death,
cardiac arrest
•
NEWS2 has formal endorsement from NHS England and NHS
Improvement to become the early warning score to identify acutely ill
patients including those with sepsis in hospitals in England.
B
a
c
k
g
r
o
u
n
d
t
o
N
E
W
S
W
h
a
t
’
s
?
•
R
e
o
r
d
e
r
e
d
t
o
r
e
f
l
e
c
t
t
h
e
A
B
C
D
E
s
e
q
u
e
n
c
e
(
R
e
s
u
s
c
i
t
a
t
i
o
n
C
o
u
n
c
i
l
U
K
)
•
N
e
w
c
o
l
o
u
r
s
c
h
e
m
e
t
o
m
i
n
i
m
i
s
e
p
r
o
b
l
e
m
s
w
i
t
h
r
e
d
/
g
r
e
e
n
c
o
l
o
u
r
b
l
i
n
d
n
e
s
s
•
6
p
a
r
a
m
e
t
e
r
s
R
R
,
S
p
O
2
,
s
y
s
t
o
l
i
c
b
l
o
o
d
p
r
e
s
s
u
r
e
,
H
R
,
l
e
v
e
l
o
f
c
o
n
s
c
i
o
u
s
n
e
s
s
o
r
n
e
w
c
o
n
f
u
s
i
o
n
*
,
t
e
m
p
e
r
a
t
u
r
e
•
R
a
n
g
e
o
f
b
o
u
n
d
a
r
i
e
s
f
o
r
e
a
c
h
p
a
r
a
m
e
t
e
r
a
r
e
s
h
o
w
n
o
n
t
h
e
c
h
a
r
t
.
•
R
i
s
k
o
f
S
e
p
s
i
s
i
s
e
m
p
h
a
s
i
s
e
d
.
E
x
e
m
p
t
i
o
n
s
•
DO
NOT
USE in CHILDREN or PREGNANT LADIES.
•
Does
NOT
replace competent clinical judgement.
•
A
n
y
u
r
g
e
n
t
c
o
n
c
e
r
n
s
h
o
u
l
d
r
e
q
u
i
r
e
u
r
g
e
n
t
a
s
s
e
s
s
m
e
n
t
i
r
r
e
s
p
e
c
t
i
v
e
o
f
t
h
e
N
E
W
2
s
s
c
o
r
e
.
W
h
a
t
’
s
?
N
E
W
S
2
c
h
a
r
t
i
s
s
a
f
e
r
f
o
r
p
a
t
i
e
n
t
s
w
i
t
h
h
y
p
e
r
c
a
p
n
i
c
r
e
s
p
i
r
a
t
o
r
y
f
a
i
l
u
r
e
T
w
o
(
O
x
y
g
e
n
S
a
t
u
r
a
t
i
o
n
)
S
p
O
2
S
c
a
l
e
s
1.
the existing Scale 1
2.
and a dedicated SpO
2
scoring system for patients with hypercapnic
respiratory failure whose desired oxygen saturations are set at a
lower level (88-92%), with the NEWS2 scoring system adjusted
accordingly.
S
p
O
2
S
c
a
l
e
2
Should only be used in patients confirmed to have hypercapnic respiratory
failure on blood gas analysis on either a prior, or their current, hospital
admission. Often these patients have COPD.
•
The decision to use the new SpO
2
scoring Scale 2 should be made by a
competent clinical decisionmaker and should be recorded in the patient's
clinical notes.
•
In the Adult and Specialist Rehabilitation Setting, this will be determined by
a Doctor, Advanced Clinical Practitioner, or Advanced Nurse Practitioner.
•
Within the Learning Disabilities Service and Prison Healthcare this will be
locally agreed.
•
In all other circumstances, the regular NEWS SpO
2
scoring scale
(Scale 1) should be used.
•
For the avoidance of doubt, the SpO
2
scoring scale not being used should
be clearly crossed out across the chart.
W
h
i
c
h
S
p
O
2
S
c
a
l
e
?
S
u
p
p
l
e
m
e
n
t
a
l
O
x
y
g
e
n
•
Patients requiring supplemental oxygen are at greater clinical risk.
•
A
w
e
i
g
h
t
i
n
g
s
c
o
r
e
o
f
2
s
h
o
u
l
d
b
e
a
d
d
e
d
t
o
t
h
e
a
g
g
r
e
g
a
t
e
N
E
W
S
2
s
c
o
r
e
f
o
r
a
n
y
p
a
t
i
e
n
t
r
e
q
u
i
r
i
n
g
s
u
p
p
l
e
m
e
n
t
a
l
o
x
y
g
e
n
.
•
The mode and rate of oxygen delivery are often poorly
documented.
•
Recording the rate of oxygen flow (L/min) without recording the
mode of delivery or device does not define how much oxygen the
patient is receiving.
•
The
NEWS2 chart has been updated to allow clearer recording of
whether the patient is breathing air or oxygen; the device being
used, if any; and the rate of oxygen delivery.
For the documentation of the oxygen delivery system, use
the device codes as recommended by The British Thoracic
Society should be used (see table).
R
e
f
i
n
e
m
e
n
t
o
f
t
h
e
A
V
P
U
c
l
a
s
s
i
f
i
c
a
t
i
o
n
t
o
i
n
c
l
u
d
e
n
e
w
c
o
n
f
u
s
i
o
n
•
Beyond the recording of level of consciousness using the AVPU
scale, it is well recognised that the onset of acute
'new confusion'
(delirium), can be an important sign that a patient requires urgent
assessment
.
•
New-onset confusion (any new reduction in the Glasgow Coma
Scale or delirium would also fit this criterion) is a sign of potentially
serious clinical deterioration in patients and especially those with
confirmed or suspected sepsis.
•
N
e
w
c
o
n
f
u
s
i
o
n
s
c
o
r
e
s
3
o
n
t
h
e
N
E
W
S
2
c
h
a
r
t
,
i
n
d
i
c
a
t
i
n
g
(
f
o
r
a
s
i
n
g
l
e
p
a
r
a
m
e
t
e
r
s
c
o
r
e
o
f
3
)
t
h
e
p
a
t
i
e
n
t
r
e
q
u
i
r
e
s
u
r
g
e
n
t
a
s
s
e
s
s
m
e
n
t
a
n
d
h
o
u
r
l
y
o
b
s
e
r
v
a
t
i
o
n
s
.
3/1/2025
N
E
W
C
o
n
f
u
s
i
o
n
The NEWS2 Scoring System
S
t
e
p
1
M
e
a
s
u
r
e
a
n
d
R
e
c
o
r
d
t
h
e
6
P
a
r
a
m
e
t
e
r
s
S
t
e
p
2
A
d
d
t
h
e
s
c
o
r
e
s
t
o
g
e
t
h
e
r
t
o
c
a
l
c
u
l
a
t
e
t
h
e
N
E
W
S
2
s
c
o
r
e
A
N
D
c
h
e
c
k
i
f
t
h
e
t
r
i
g
g
e
r
t
h
r
e
s
h
o
l
d
(
3
)
f
o
r
a
s
i
n
g
l
e
p
a
r
a
m
e
t
e
r
h
a
s
b
e
e
n
r
e
a
c
h
e
d
S
t
e
p
3
U
s
e
t
h
e
N
E
W
S
2
s
c
o
r
e
t
o
d
e
f
i
n
e
a
n
d
r
e
c
o
r
d
:
Whether escalation of clinical care is required and its urgency
The competencies of the clinical review required
The frequency of monitoring required
The most appropriate clinical setting for ongoing clinical care
H
o
w
t
o
c
a
l
c
u
l
a
t
e
a
N
E
W
S
2
s
c
o
r
e
?
Note the
Nationally
Recommended
frequency of
observations has
changed to twice
daily
A score of 3 in any
single parameter
prompts medical
review and hourly
obs
Continuous monitoring
(at least every 15 mins)
T
H
I
N
K
S
E
P
S
I
S
!
Is the NEWS2 Score 3 or above?
AND/OR does the patient look sick?
Complete Inpatient Sepsis Screening and Action Tool.
.
In the September 2019 meeting, the Middleton Cheney Neighbourhood Plan discussed various topics including apologies for absence, approval of previous minutes, updates on planned consultant appointments, potential relocation sites for PFA/sports clubs, housing requirements, community spaces, green areas, and more. The meeting also covered details on consultants and upcoming interviews, as well as resident concerns regarding the PFA flyer.
Download Presentation
Please find below an Image/Link to download the presentation.
The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.
E N D
Presentation Transcript
National Early Warning Score 2 (NEWS2) Adults and Specialist Rehabilitation Division Feedback
Background to NEWS Number 1 cause of death is failure to recognise and act on deterioration. NEWS is a common language to replace 60-70 scoring systems in the UK. It is used to: Assess acute illness severity Detect clinical deterioration Initiate a timely and competent clinical response. Provide guidance on competence and frequency of monitoring. Downward trajectory when patients score 5- high risk of ITU, death, cardiac arrest NEWS2 has formal endorsement from NHS England and NHS Improvement to become the early warning score to identify acutely ill patients including those with sepsis in hospitals in England.
Whats ? Reordered to reflect the ABCDE sequence (Resuscitation Council UK) New colour scheme to minimise problems with red/green colour blindness 6 parameters RR, SpO2, systolic blood pressure, HR, level of consciousness or new confusion*, temperature Range of boundaries for each parameter are shown on the chart. Risk of Sepsis is emphasised. Exemptions DO NOT USE in CHILDREN or PREGNANT LADIES. Does NOT replace competent clinical judgement. Any urgent concern should require urgent assessment irrespective of the NEW2s score.
NEWS2 chart is safer for patients with hypercapnic respiratory failure Two (Oxygen Saturation)SpO2 Scales 1. the existing Scale 1 2. and a dedicated SpO2 scoring system for patients with hypercapnic respiratory failure whose desired oxygen saturations are set at a lower level (88-92%), with the NEWS2 scoring system adjusted accordingly. SpO2 Scale 2 Should only be used in patients confirmed to have hypercapnic respiratory failure on blood gas analysis on either a prior, or their current, hospital admission. Often these patients have COPD.
Which SpO2 Scale? The decision to use the new SpO2 scoring Scale 2 should be made by a competent clinical decisionmaker and should be recorded in the patient's clinical notes. In the Adult and Specialist Rehabilitation Setting, this will be determined by a Doctor, Advanced Clinical Practitioner, or Advanced Nurse Practitioner. Within the Learning Disabilities Service and Prison Healthcare this will be locally agreed. In all other circumstances, the regular NEWS SpO2 scoring scale (Scale 1) should be used. For the avoidance of doubt, the SpO2 scoring scale not being used should be clearly crossed out across the chart.
Supplemental Oxygen Patients requiring supplemental oxygen are at greater clinical risk. A weighting score of 2 should be added to the aggregate NEWS2 score for any patient requiring supplemental oxygen. The mode and rate of oxygen delivery are often poorly documented. Recording the rate of oxygen flow (L/min) without recording the mode of delivery or device does not define how much oxygen the patient is receiving. The NEWS2 chart has been updated to allow clearer recording of whether the patient is breathing air or oxygen; the device being used, if any; and the rate of oxygen delivery.
For the documentation of the oxygen delivery system, use the device codes as recommended by The British Thoracic Society should be used (see table).
Refinement of the AVPU classification to include new confusion
NEW Confusion Beyond the recording of level of consciousness using the AVPU scale, it is well recognised that the onset of acute 'new confusion' (delirium), can be an important sign that a patient requires urgent assessment. New-onset confusion (any new reduction in the Glasgow Coma Scale or delirium would also fit this criterion) is a sign of potentially serious clinical deterioration in patients and especially those with confirmed or suspected sepsis. New confusion scores 3 on the NEWS2 chart, indicating (for a single parameter score of 3) the patient requires urgent assessment and hourly observations. 3/1/2025
How to calculate a NEWS2 score? Step 1 Measure and Record the 6 Parameters Step 2 Add the scores together to calculate the NEWS2 score AND check if the trigger threshold (3) for a single parameter has been reached Step 3 Use the NEWS2 score to define and record: Whether escalation of clinical care is required and its urgency The competencies of the clinical review required The frequency of monitoring required The most appropriate clinical setting for ongoing clinical care
Note the Nationally Recommended frequency of observations has changed to twice daily A score of 3 in any single parameter prompts medical review and hourly obs Continuous monitoring (at least every 15 mins)
THINK SEPSIS! Is the NEWS2 Score 3 or above? AND/OR does the patient look sick? Complete Inpatient Sepsis Screening and Action Tool.
