National Early Warning Scores (NEWS): A Quality Improvement Project

NATIONAL EARLY WARNING SCORES (NEWS): A QUALITY IMPROVEMENT PROJECT

ABSTRACT

Research suggests that a patient suffering from a cardiac and/or respiratory arrest usually exhibits physiological deviations, such as changes in vital signs and/or mental status, at least eight hours prior to the need for more intensive care (Stenhouse et al., 2000).  Numerous early warning score (EWS) tools are available for use in acute care settings to alert nurses to the need for early intervention to prevent continuing decline and mortality.  The National Early Warning Scores (NEWS) is a tool used to predict clinical deterioration, based on physiologic measurements.  A specific score is given to each physiological measurement and aggregated scores from six parameters and the use of oxygen are used to create a composite score to predict the magnitude of decline. 

A prospective quantitative study was conducted in six medical/surgical units in a level I trauma center, over a thirty-day period of time (November 10, 2015 – December 9, 2015), in order to validate the effectiveness of NEWS in predicting clinical deterioration.  Three thousand one hundred and fifty four patient recordings with over 100,000 vital signs revealed that 91 patients scored NEWS ≥5, or a score of 3 in a single parameter and received interventions to prevent further clinical deterioration.  Of the 91 NEWS positive patients, 22 were transferred to a higher level of care, whereas 63 patients stayed on the medical/surgical unit.  Their NEWS returned to acceptable levels after therapies.  Project findings indicate that NEWS supports clinical decision-making processes as it allows for a single measure of an extreme physiologic value or an aggregate score to activate interventions to prevent clinical deterioration. A pilot study conducted in 2014 in one unit and the results were compared with the current study.  The results showed that the number of rapid response and code blue activations decreased after implementing NEWS hospital wide.  The NEWS implementation demonstrated a positive outcome in the study hospital,  and that results encouraged The Department of Health Service to implement NEWS to all DHS acute care hospitals through Electronic Health Record.