The Royal College of Physicians (RCP) has updated its National Early Warning Score (NEWS), first produced in 2012. NEWS2 has now received formal endorsement from NHS England (NHSE) and NHS Improvement (NHSI) to become the early warning system for identifying acutely ill patients, including those with sepsis, in hospitals in England.
The score, often placed on the chart at the end of the patient’s bed but also used in digital forms, is used by doctors and nurses to record vital signs and give each a score. The total score lets them know if a patient is becoming very ill, prompting them to take urgent action to review the care of the patient and call for specialist help if necessary.
- The NEWS2 reports and chart are available to download.
NHSE and NHSI have also incorporated NEWS2 as the early warning system to improve the detection of clinical deterioration due to sepsis in adults. These are major steps towards the ultimate aim, to see NEWS embedded across the NHS to improve the detection of acute illness and improve patient outcomes.
NEWS2 is based on a simple scoring system in which a score is allocated to six physiological measurements already taken in hospitals – respiratory rate, oxygen saturations, temperature, systolic blood pressure, pulse rate and level of consciousness.
The NEWS has been shown to be a highly effective system for detecting patients at risk of clinical deterioration or death, prompting a more timely clinical response, with the aim of improving patient outcomes in the NHS. The NEWS has also been adopted by many hospitals across the world, to improve patient safety and save lives.
The updated version of NEWS2 includes:
- a new section on the NEWS2 chart for scoring oxygen saturation for patients with hypercapnic (often termed 'type 2') respiratory failure, to ensure the most appropriate prescription of extra oxygen if required
- recognition of the importance of new confusion (or delirium) as a sign of potentially important clinical deterioration
- a strong emphasis on the potential use of the NEWS to identify serious sepsis in patients with known or suspected infection, or at high risk of infection. Patients with a NEWS of 5 or more are at serious risk of clinical deterioration and a poor clinical outcome, and need urgent assessment and intervention.
When the RCP launched the NEWS in 2012 it hoped to see the score adopted across the NHS. Since then NEWS has become a global success story, with requests to use NEWS coming from health services across the world from Europe to India and the US, including the US Navy. By making all the materials free of charge to download and use, provided that none of the charts were changed, the RCP has enabled health services across the world to save lives in addition to those saved in the UK. NEWS2 will also be free to everyone.
Professor Bryan Williams, chair of the NEWS Development Group and RCP clinical lead for NEWS, said:
We developed the NEWS to save lives in the NHS. The uptake and impact of the NEWS over the past 5 years has been extraordinary, and beyond even the most optimistic expectations, especially considering that there was no national incentive or directive to implement it. The majority of NHS hospitals are now using the NEWS, and over 150,000 NHS staff have voluntarily completed the online NEWS training and accreditation programme.
As we move into 2018, I am delighted that we have the endorsement of NHSE and NHSI in implementing NEWS2 across the NHS in England.
RCP president Professor Jane Dacre said:
This update will mark the beginning of a new chapter for NEWS, as with the support of NHS England and NHS Improvement, over the next year NEWS will become the default early warning score for NHS trusts and ambulances. Patients will benefit from its implementation, and staff will benefit from not having to learn a new score each time they join a new trust. And I hope that NEWS will continue its global journey, saving lives across the world.