A tool called the National Early Warning Score (NEWS, or NEWS2) is being implemented in Cerner on October 26, 2022 to assist with early detection and response to clinical deterioration in adult patients. The tool will be in place at all VCH/PHC/PHSA hospitals and provide a standardised way to identify a sick patient who is deteriorating and requires urgent clinical review.
What do I need to know about NEWS2?
- NEWS2 is a well-validated early warning score system.
- It is based on a simple scoring system in which a score is allocated to specific vital signs:
- Systolic blood pressure
- Respiratory rate
- Oxygen saturation
- Level of consciousness
- A score (0-3) is allocated to each physiological parameter, the magnitude of the score reflecting how far the parameter varies from the norm.
- An added feature of this tool over others is that there are 2 scales for SpO2. It is an MD/NP responsibility to determine which scale is appropriate:
- Scale 1 (Normal) is the default scale as it meets the needs of the majority of patients
- Scale 2 (Hypercarbic) is tailored for patients with chronic hypercarbic respiratory failure who would benefit from a lower SpO2 goal while on oxygen therapy.
- A provider order is needed to switch from Scale 1 to Scale 2. The option to use NEWS Scale 2 is available as an option on the COPD powerplan or can be ordered Ad Hoc.
- An additional 2 points are given for people requiring oxygen, giving a possible total of 0-20.
How will I be notified of an elevated NEWS2 score?
- Providers can visualize a NEWS2 score in Results Review and iView, but will not receive an alert.
- Nurses will receive an alert when the NEWS2 score is 3 or more for a single parameter, or an aggregate of 5 or more. The nurse’s responsibility is to increase frequency of vital signs, discuss the situation with their nursing leader and notify the MRP or designate.
- The intent is to ensure a timely initial assessment by the appropriate clinical decision maker.
What is my responsibility when I am informed of an elevated NEWS2 score?
- The provider’s responsibility (as currently laid out in the protocol), is to:
- Ensure all care aligns with the patient’s goals of care
- Make decisions about initial treatment and next steps, and reassess the patient in person in a timely manner
- Place orders, document, evaluate, re-evaluate and escalate as needed
- Royal College of Physicians website on NEWS2 https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2 which includes their:
- Executive summary: https://www.rcplondon.ac.uk/file/8504/download
- Final report: https://www.rcplondon.ac.uk/file/8636/download
- Supplementary guidance https://www.rcplondon.ac.uk/projects/outputs/news2-additional-implementation-guidance
- Some recent review papers on NEWS2:
- Zhang K, Zhang X, Ding W, et al. The Prognostic Accuracy of National Early Warning Score 2 on Predicting Clinical Deterioration for Patients With COVID-19: A Systematic Review and Meta-Analysis. Front Med (Lausanne). 2021;8:699880. Published 2021 Jul 9. doi:10.3389/fmed.2021.699880
- Echevarria C, Steer J, Bourke SC. Comparison of early warning scores in patients with COPD exacerbation: DECAF and NEWS score. Thorax. 2019;74:941-946.