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Procedure for Using the National Early Warning Score (NEWS) 2 for the Early Detection and Management of the Deteriorating Patient in Adults (Aged 16 and Above)

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Procedure for Using the National Early Warning Score (NEWS) 2 for the Early Detection and Management of the Deteriorating Patient in Adults (Aged 16 and Above) Procedure for Using the National Early Warning Score (NEWS) 2 for the Early Detection and Management of the Deteriorating Patient in Adults (aged 16 and above) Ref CLIN-0099-v1 Status: Approved Document type: Procedure Contents 1 Purpose ............................................................................................................. 3 2 Related documents ........................................................................................... 3 3 Who this procedure applies to ......................................................................... 4 3.1 Roles and Responsibilities .................................................................................. 4 4 Procedure .......................................................................................................... 5 4.1 Introduction ......................................................................................................... 5 4.2 Background to the Development of the National Early Warning Score ................ 5 4.3 What is the National Early Warning Score .......................................................... 6 4.4 Recording the National Early Warning Score ...................................................... 7 4.4.1 Documentation ................................................................................................ 7 4.4.2 Frequency of Monitoring .................................................................................. 7 4.4.3 Additional Considerations when Monitoring and Interpreting NEWS ................ 8 4.5 Interpretation and Response to NEWS ............................................................... 9 4.5.1 Interpretation of NEWS ................................................................................... 9 4.5.2 Response to NEWS Total .............................................................................. 10 4.5.3 Principles for Using Situation, Background, Assessment, Recommendation and Decision (SBARD) Tool within NEWS Procedure...................................... 10 4.6 Recognise and Respond to the Deteriorating Patient: Quick Reference Guide . 10 4.7 How this Procedure will be Implemented .......................................................... 11 4.8 How this Procedure will be Audited ................................................................... 12 5 Definitions ....................................................................................................... 10 5.1 Training Needs Analysis ................................................................................... 12 6 How the Implementation of this Policy will be monitored ............................ 12 7 References ...................................................................................................... 12 8 Document control ........................................................................................... 14 8.1 Appendix 1 – National Early Warning Score Chart (Adults) ............................... 16 8.2 Appendix 2 – Glasgow Coma Scale Chart ........................................................ 19 8.3 Appendix 3 - Equality Analysis Screening Form ................................................ 21 CLIN-0099-v1 Page 2 of 24 Ratified date: 28 January 2019 National Early Warning Score (NEWS) Procedure (Age 16 and above) Last amended: 28 January 2019 1 Purpose Following this procedure will help the Trust to:- • Standardise practice for all clinical staff in the early recognition and response in the deteriorating patient. • Facilitate early detection by using the National Early Warning Score (NEWS) tool for the appropriate and timely management of clinical deterioration. • Reduce clinical risks associated with inappropriately managed clinical conditions. 2 Related documents This procedure describes what you need to do to implement the Physical Health Assessment and Ongoing Monitoring section of the Physical Health and Wellbeing Policy. The Physical Health and Wellbeing Policy defines standards which you must read, understand and be trained in before carrying out the procedure described in this document. This procedure also refers to:- COPD Guideline Cardiovascular risks (Hypertension and High Cholesterol) Guideline Rapid Tranquillisation (RT) Policy Physical Health and Wellbeing Policy Physiological Assessment Procedure Diabetes Management Guidelines Guidelines for Blood Glucose Monitoring Resuscitation Policy Mental Capacity Act 2005 Policy Policy for Consent to Examination or Treatment Administration of oxygen in an emergency situation for adults and children CLIN-0099-v1 Page 3 of 24 Ratified date: 28 January 2019 National Early Warning Score (NEWS) Procedure (Age 16 and above) Last amended: 28 January 2019 3 Who this procedure applies to This clinical procedure applies to all clinical staff employed by Tees, Esk and Wear Valleys NHS Foundation Trust (TEWV) working within inpatient settings including the care delivered to adults. 3.1 Roles and Responsibilities Role Responsibility Executive Director Responsible for the development, review and monitoring of this procedure Nursing & Governance and practice standards in physical healthcare and for the provision of appropriate training and education to support the delivery of physical healthcare. Medical Staff (including Reviewing National Early Warning Score charts on a regular basis. Physical Healthcare Discuss frequency of recording and requirements to re-set individual Practitioners where patient triggers as part of treatment / care formulation and Multi- available) Disciplinary Team (MDT) report outs. Responding to any staff concerns and to see the patient:- If the score remains 1-4 after 4 hours Immediately if score 5 and above On call medical staff if not on site must respond promptly and consider advising staff to call emergency services if appropriate Attend relevant training to this procedure. Ward Managers / Ensuring that staff have appropriate training and that the National Early Clinical Leads Warning Score process is adhered to and that the National Early Warning Score is discussed regularly at report outs/ward rounds. Attend relevant training to this procedure. Registered Nurses and Ensure the appropriate completion of the National Early Warning Score Healthcare Assistants as per this procedure. Follow the procedure for escalating high scores using the agreed communication tool. Attend relevant training to this procedure. Health Care Assistants should report any escalation to a Registered Nurse but do have authority to call for medical assistance or emergency services if they have sufficient concern about any patient. CLIN-0099-v1 Page 4 of 24 Ratified date: 28 January 2019 National Early Warning Score (NEWS) Procedure (Age 16 and above) Last amended: 28 January 2019 4 Procedure 4.1 Introduction The Trust is committed to improving the physical health of its patients and reducing incidents of harm. This clinical procedure will outline how staff can promote the early detection, prevention and management of physical health deterioration. Physical health deterioration can occur at any stage of a patient’s pathway. Within a mental health and learning disability Trust there are certain periods when our patients may be more vulnerable such as: • during the onset of infection or illness • during procedures such as dental interventions • administration of rapid tranquilisation • during changes of medication • after a fall • during a period of deterioration of their mental health • during an exacerbation of a physical long term condition e.g. Diabetes, Chronic Obstructive Pulmonary Disease (COPD), Cardio Vascular Disease (CVD) The NEWS should not be used in children (aged <16 years) or in women who are pregnant, because the physiological response to acute illness can be modified in children and by pregnancy. The NEWS may be unreliable in patients with spinal cord injury owing to functional disturbances – use with caution. Patients who physically deteriorate present with abnormalities that are detectable by simple measurement of physiological observations. Vigilant clinical staff who are trained to recognise and respond to these signs, can prevent further deterioration (Royal College of Physicians 2012). 4.2 Background to the Development of the National Early Warning Score In 2012 the Royal College of Physicians in partnership with the Royal College of Nursing, standardised the assessment and scoring of six simple physiological observations to be used in all NHS Trusts. This standardised approach was created to enable a process of recording, scoring, recognising and responding to changes and/or deterioration in patients with acute illness. The effectiveness of embedding a National Early Warning Score system is based on two assumptions:- 1. Registered Nurses and Healthcare Assistants have the knowledge and skills to regularly record physiological observations using an agreed NEWS observation chart. 2. If a patient deteriorates, the Registered Nurse or the HCA must escalate physical health care concerns appropriately according to the National Early Warning Score system. CLIN-0099-v1 Page 5 of 24 Ratified date: 28 January 2019 National Early Warning Score (NEWS) Procedure (Age 16 and above) Last amended: 28 January 2019 Benefits of using a National Early Warning Scoring system:- • Improves the quality of patient observation and monitoring • Improves communication within the MDT • Allows for timely discussions to support clinical judgement • Aids securing appropriate assistance for poorly patients • Gives a good indication
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