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(INEWS) V2 (Previously NEWS) National Clinical Guideline No Irish National Early Warning System (INEWS) V2 (previously NEWS) National Clinical Guideline No. 1 September 2020 National Patient Safety Office Oifig Náisiúnta um Shábháilteacht Othar The Nati onal Early Warning Score (NEWS) Nati onal Clinical Guideline has been updated and revised by the Irish Nati onal Early Warning System (INEWS) Guideline Development Group (GDG) under the auspices of the HSE Nati onal Deteriorati ng Pati ent Recogniti on and Response Improvement Programme (DPIP). Using this Nati onal Clinical Guideline This Nati onal Clinical Guideline applies to adult (≥ 16 years) non-pregnant pati ents in acute setti ngs. It does not apply to children or pati ents in obstetric care. This Nati onal Clinical Guideline is relevant to all healthcare professionals working in acute setti ngs. Disclaimer NCEC Nati onal Clinical Guidelines do not replace professional judgment on parti cular cases, whereby the clinician or health professional decides that individual guideline recommendati ons are not appropriate in the circumstances presented by an individual pati ent, or whereby an individual pati ent declines a recommendati on as a course of acti on in their care or treatment plan. In these circumstances the decision not to follow a recommendati on should be appropriately recorded in the pati ent’s healthcare record. Users of NCEC Nati onal Clinical Guidelines must ensure they have the current version (hardcopy or soft copy) by checking the relevant secti on in the Nati onal Pati ent Safety Offi ce on the Department of Health website: htt ps://www.gov.ie/en/collecti on/c9fa9a-nati onal-clinical-guidelines/ Published by: The Department of Health, Block 1, Miesian Plaza, 50-58 Lower Baggot Street, Dublin 2, D02 VW90, Ireland. Tel: +353 (1) 6354000 www.health.gov.ie ISSN 2009-6259. © Department of Health, 2020 Citati on text Department of Health (2020). Irish Nati onal Early Warning System V2 (NCEC Nati onal Clinical Guideline No. 1). Available at: htt ps://www.gov.ie/en/collecti on/c9fa9a-nati onal-clinical-guidelines/ In text citati on (Department of Health 2020) i Membership of the Guideline Development Group (GDG) The GDG was co-chaired by Dr Miriam Bell, Project Lead, Guideline Revision, National Deteriorating Patient Recognition and Response Improvement Programme (DPIP) and Mr Richard Walsh, Director of Nursing National Acute Medicine Programme. This National Clinical Guideline is supported by the Health Service Executive Clinical Design and Innovation; Acute Operations Division; Office of the Nursing and Midwifery Services Director; National Quality Improvement Team; Quality Assurance and Verification; and by the National Clinical Programmes for Sepsis, Acute Medicine, Surgery, Emergency Medicine, Critical Care, COPD and Paediatrics. Membership nominations were sought from a variety of clinical and non-clinical backgrounds to ensure representativeness of all key stakeholders within the acute setting sector. GDG members included those involved in nursing, medical, and health and social care clinical practice, education, administration, research methodology, relevant national clinical programmes and three persons representing patients and the public (Table 1). GDG Terms of Reference can be seen in Appendix 1. DPIP Steering Group provided oversight (Appendix 2). Additional clinical input was sought through focus groups with non-consultant hospital doctors and through the establishment of a Consultant Advisory Group (CAG) to advise on key clinical issues which emerged as a result of the guideline revision process. CAG membership and letter of invitation from Chief Clinical Officer can be seen in Appendices 3 and 4 respectively. Table 1: INEWS GDG membership Name Job title and affiliation Miriam Bell Project Lead, Guideline Revision, National Deteriorating Patient Recognition (Co-Chair) & Response Improvement Programme (DPIP) Richard Walsh (Co-Chair) Director of Nursing, National Acute Medicine Programme Avilene Casey National Lead, DPIP Siobhan Connors Critical Care Outreach, Tallaght University Hospital, Dublin Eileen Cotter Nurse Practice Development Department, South Infirmary Victoria University Hospital, Cork Derek Cribbin Nurse Lead, National Clinical Programme Critical Care Marina O’Connor Nurse Practice Development Co-ordinator, Our Lady of Lourdes’s Hospital, Drogheda Christine Sheehan Advanced Nurse Practitioner, Critical Care, University College Hospital Galway Jason Horan Consultant in Emergency Medicine, Mayo University Hospital Brendan Leen Regional Librarian, HSE South Rosemary Kratschmar Patient Representative Moira Skelly Patient Representative Damien Douglas Patient Representative Ann-Marie Redmond Nurse Practice Development Co-ordinator, Wexford General Hospital Sinead Horgan Group Sepsis Lead, South/South West Hospital Group Trisha Rafter Resuscitation Training Officer, St. Columcille’s Hospital, Dublin Deirdre Staunton Resuscitation Training Officer, Sligo University Hospital Liz Casey Resuscitation and EWS Training Officer, Sepsis Nurse Lead, Mayo University Hospital ii Joe Fahy Resuscitation Training Officer, NEWS, PEWS and Sepsis Nurse Lead, University Hospital Ballinasloe Anne Scahill Resuscitation Officer and NEWS, PEWS, IMEWS, Sepsis Nurse Lead, Roscommon University Hospital Ann Dwyer Clinical Nurse Manager 2, Trauma and Orthopaedics, Tallaght University Hospital Maura Moran Senior Occupational Therapist, Acute Medicine, Beaumont Hospital Eimear Duff NCHD (Intern), St. James’s University Hospital, Dublin Lylas Aljohmani NCHD (Registrar), St. James’s University Hospital, Dublin Yvonne Young Group Sepsis Lead, University of Limerick Hospital Group Peter O’Toole Advanced Nurse Practitioner, National Clinical Programme, COPD Emma Gorman Clinical Specialist Physiotherapist, Critical Care, Mater Misericordiae University Hospital, Dublin Serena Brophy Project Lead, Service Improvement, DPIP Irene Regan Chief Medical Scientist, Children’s Health Ireland at Crumlin Ciara Hughes Programme Manager, DPIP & Sepsis Ronan O’Cathasaigh Project Lead, Education, DPIP Credits The role of the NCEC is to prioritise, quality assure and recommend clinical guidelines to the Chief Medical Officer for endorsement by the Minister for Health. It is intended through Ministerial endorsement that full implementation of the guideline will occur through the relevant service plans. The NCEC and the Department of Health acknowledge and recognise the Chair(s) and members of the GDG for development of this guideline. The NCEC and Department of Health wish to express thanks and sincere gratitude to all persons contributing to this National Clinical Guideline; especially the three patient representatives Rosemary Kratschmar, Moira Skelly and Damien Douglas, who gave of their time on a voluntary basis. iii Acknowledgments The following credits and acknowledgements are made by Ms Avilene Casey, Nati onal Lead, HSE Deteriorati ng Pati ent Recogniti on and Response Improvement Programme (DPIP): Ms Avilene Casey wishes to acknowledge the NEWS GDG members for their valued contributi ons and consistent work on the revision of this guideline. The sharing of the GDG members’ service intelligence, tacit knowledge and clinical experti se enabled a robust and thorough revision of the NCG No.1 Nati onal Early Warning Score (2013). She would parti cularly like to acknowledge the three pati ent representati ves Rosemary Kratschmar, Moira Skelly and Damien Douglas who gave of their ti me voluntarily and contributed meaningfully to the guideline revision. The sharing of their personal experiences of using the services provided their GDG colleagues with insight into the service user experience and the need to value and act upon pati ent/family/carer concerns. Avilene would like to acknowledge Dr Miriam Bell, Project Lead, DPIP for her leadership of the guideline revision process. Our working partnership facilitated robust debate and challenge to our extant understanding of early warning systems. Her substanti al intellectual leadership and facilitati on skills enabled full interdisciplinary contributi ons at all stages of the process. Through her informed criti cal appraisal, analysis and interpretati on of evidence from numerous sources she used emerging evidence and the arti culated clinical experti se of GDG, CAG and focus groups to write and prepare the fi nal guideline. The Consultant Advisory Group (CAG) members are acknowledged for giving of their ti me, knowledge and clinical experti se at a crucial ti me in the guideline revision process. Avilene would like to acknowledge Ms Shelley O’Neill and Dr Sinead O’Neill, HRB-CICER, who undertook the systemati c review of the literature, and Mr Brendan Leen, Regional Librarian, HSE South all of whom provided excepti onal support to the GDG throughout the guideline revision process. Also acknowledged are the three expert external reviewers – Professor Imogen Mitchell, Professor Peter Watkinson and Dr Mandy Odell – who provided feedback on the revised guideline. The draft guideline public consultati on process att racted substanti al feedback and those who took the ti me to submit feedback are acknowledged. Ms Avilene Casey, Dr Miriam Bell and Mr Richard Walsh agreed the additi onal clinical questi ons for the systemati c review of the literature with Ms Shelley O’Neill and Dr Sinead O’Neill, Health Research Board – Collaborati on in Ireland for Clinical Eff ecti veness Reviews (HRB-CICER) and with the NCEC. Dr Sinead O’Neill and Ms Shelley O’Neill carried out the literature review. Dr Miriam Bell collaborated
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