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Safer care through NEWS2 (National Early Warning Score)

The West of England Patient Safety Collaborative has developed a programme, delivered by the West of England AHSN, encouraging the use of a single early warning score – the National Early Warning Score (NEWS) – across the region. NEWS2 is the latest version of the National Early Warning Sore, developed by The Royal College of Physicians (RCP). Find out more on the RCP website.

Currently, all acute trusts, out-of-hours GP services, mental health trusts, community service providers and clinical commissioning groups (CCGs) have all signed up to support the adoption and spread of NEWS2, and communicating this score at the interfaces of care across the system.

The use of early warning scores is being recommended in primary and community care settings.  The National Confidential Enquiry into Patient Outcome and Death report in November 2015 (‘Just Say Sepsis!’) argued that an early warning score should be used in both primary and secondary care wherever sepsis is suspected.  Early warning scores are increasingly becoming part of the lexicon for communication about physiology between all health care providers, enhancing and focusing the handover of technical information about patients, especially those at risk of deterioration.

View a summary of the project in the form of a poster, including results and challenges.

NEWS in practice

We now have a number of examples of patient stories from across the region where NEWS has been used to assess and trigger responses across patient pathways and ultimately improving outcomes for those patients.

One of these examples was a patient in North Somerset who visited his GP with cellulitis but felt very poorly.  The GP used NEWS to assess that the patient was acutely unwell and needed rapid treatment. NEWS was used to track the patient’s condition from primary care, into the ambulance and into the Emergency Department and clearly showed he was deteriorating.  This patient had sepsis but thanks to the early detection of his condition in primary care, it was treated within five hours of seeing his GP and he made a quick and full recovery.

We have produced a short film to tell this story.

NEWS in acute settings

In order to achieve our aims we adopted a breakthrough collaborative model.  The West of England AHSN supported all acute trusts in the region to adopt NEWS, supported by a NEWS Implementation Toolkit. All acute trusts are now using the updated NEWS2, as recommended by the Royal College of Physicians. A free NEWS2 toolkit is now available here.

NEWS in emergency departments

We are supporting the national adoption and spread of the Emergency Department Safety Checklist, piloted at University Hospitals Bristol NHS Foundation Trust and now used by all Emergency Departments in the West of England. The ED Safety Checklist includes the requirement to take hourly observations and calculate NEWS2 scores to track patient acuity in ED. We have developed a free toolkit for implementing the ED Safety Checklist.

NEWS in community settings

We have teamed up with our community providers supporting them with identification of the deteriorating patient in a community setting.  We continue working closely with each CCG to help raise the profile of NEWS2 across the different settings. We have some brilliant examples of NEWS being used in practice.

A next step for our NEWS work is to expand its use into wider community settings. This includes a focus on people with learning disabilities. We have established the West of England Learning Disabilities Collaborative, made up of professionals, experts by experience, families and carers. By applying our learning from the region-wide rollout of NEWS, we aim to reduce premature mortality and improve health outcomes for people with learning disabilities.

Recently, the British Geriatrics Society (BGS) released a paper, COVID-19: Managing the COVID-19 pandemic in care homes, offering 13 key recommendations to help all care home staff, and the NHS staff who work with you, to support residents through the pandemic.

This guidance recommends care home staff should be trained to spot the early warning signs of residents becoming unwell, where possible using the RESTORE2 tool or soft signs using RESTORE2 mini.

We have developed free online videos and virtual (video-based) training to support you, and can also provide coaching, advice and guidance around these tools. The guidance also recommends that care home staff work with residents’ GPs to review Advance Care Plans as a matter of urgency with residents.

Our online training session will help you keep your residents safe and healthy and quickly spot causes of deterioration. Book here for dates in May and June. If you would like to arrange bespoke training for your home, please email ps@weahsn.net

NEWS in primary care

If you would like a simple information sheet explaining what NEWS is and why it’s a relevant tool for primary care download it here.

We have produced supporting information in postcard and business card size. You are welcome to download and use these for free.

If you are an EMIS user you have access to a NEWS template. This video explains how to set up: watch here. We also have a template available in SystemOne, please email patientsafety@weahsn.net for more information.

Tying all of this work together, we have run various collaborative cross-sector learning set events with hundreds of attendees from healthcare providers across the region and beyond.

NEWS in mental health settings

All NHS mental health care providers in the West of England use NEWS to help identify physical deterioration in service users.

We recently teamed up with a medical student from the University of Bristol who was on an elective QI placement with North Bristol NHS Trust, to evaluate use of NEWS in Avon and Wiltshire Mental Health Partnership NHS Trust’s eating disorders unit. Every person admitted to the unit has a personalised NEWS escalation trigger created, which is regularly reviewed to reflect gradual changes in their physiology. This was a truly collaborative project at the intersection between mental and physical health, involving the West of England AHSN and three of our member organisations. To see a presentation about the project, click here.

Publications

BMJ Emergency Medicine Journal: Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out: https://emj.bmj.com/content/early/2019/03/06/emermed-2018-208140 

Resuscitation: Can early warning scores identify deteriorating patients in pre-hospital settings? A systematic review: https://www.sciencedirect.com/science/article/pii/S0300957218308190

BMJ Open: Using the National Early Warning Score (NEWS) outside acute hospital settings: a qualitative study of staff experiences in the West of England: https://bmjopen.bmj.com/content/8/10/e022528.full

British Journal of General Practice: Implementation of the National Early Warning Score in patients with suspicion of sepsis: evaluation of a system-wide quality improvement project: https://bjgp.org/content/early/2020/04/08/bjgp20X709349

British Journal of General Practice: Association between National Early Warning Scores in primary care and clinical outcomes: an observational study in UK primary and secondary care: https://bjgp.org/content/early/2020/04/06/bjgp20X709337

Features

Nursing Standard: Adapting the NEWS early warning tool to assess patients in the community: Read the article

Healthcare Manager: Early warnings save lives: Read the article 

Contact

If you would like to get involved or want more information, please contact the team at patientsafety@weahsn.net.

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NEWS implementation toolkit

National Early Warning Score (NEWS) implementation toolkit

Created for all staff working across commissioning, clinical, hospital and ambulance service settings to support the successful implementation of the NEWS.

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Emergency Department Safety Checklist

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Created to standardise the delivery of basic care in emergency departments, improving safety for patients and resilience during periods of crowding.

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