The RCP has welcomed the recommendations of a new Healthcare Safety Investigation Branch (HSIB) report. These include taking a national approach to tackle preventable deaths from deterioration and recommending that NHS Trusts would benefit from using the latest version of the NEWS2 observation chart and protocols.
NEWS2, the National Early Warning Score, was first developed by the RCP in 2012. To help doctors and nurses identify very ill patients whose condition is deteriorating and need more intensive medical or nursing care.
A revised and updated version, NEWS2, was launched in December 2017. NHS Trusts are expected to use NEWS2 to identify deteriorating patients.
The HSIB report ‘Recognising and responding to critically unwell patients’ recognised the national drive to use NEWS2 and the benefit of standardisation across the NHS:
‘One of the key benefits of NEWS and NEWS2 is that it provides standardisation across the NHS and a common language to communicate the physiological condition of a patient between staff. Clinicians, particularly bank and agency staff, move between trusts and so it is beneficial if they do not have to learn local scoring systems and associated escalation protocols.’
The report also recognises that NEWS2 is not intended to be a stand-alone tool and that ‘it is intended to be combined with other relevant charts, clinical investigation results and notes together with clinical observations of the patient.’
The HSIB investigation was triggered following the death of a patient who was taken to hospital 13 days after she had undergone emergency surgery for a perforated duodenal ulcer. The HSIB then mounted a national investigation and reviewed relevant research and safety literature relating to recognition and response to deteriorating patients.
At the time, the hospital was not using NEWS2, but told the HSIB that by March 2019, it would have standardised its escalation plan for ED and wards across all its sites based on the national NEWS2 guidance.
The HSIB report states:
‘There would be benefits to trusts ensuring they are using the latest version of the NEWS2 observation chart and protocols. Any recommended changes to early warning scores, documentation or use would benefit from being tested in practice before widespread implementation.’
The report also recommended several actions for the RCP which are being taken forward.
The RCP NEWS Advisory Group has been set up to review the implementation and evidence around NEWS2. It will:
- Review and monitor the uptake and implementation of NEWS2, consolidating evidence of good practice and identifying any challenges related to implementation.
- Review emerging evidence relating to clinical deterioration and advise whether new evidence warrants that NEWS guidance should be revised.
- Recommend further research and evaluation in this field.
- Review and respond to clinical enquiries.
- Provide oversight of the NEWS e-learning module and app developed by OCB Media, and link to other learning materials.
- Provide insight into national and international developments relating to NEWS, deteriorating patients, and sepsis and advise on how the RCP should respond or engage.
This HSIB investigation confirms the value of the RCP’s NEWS2 in identifying deteriorating patients.
Professor Andrew Goddard, RCP president, said:
‘This HSIB investigation confirms the value of the RCP’s NEWS2 in identifying deteriorating patients. The report identifies several areas where the RCP can review the training and implementation around NEWS2, and we will be taking these issues forward through our advisory group, which is in place to do this.’
When the RCP published the National Early Warning Score in 2012, we could hardly have imagined the international success story it has become.
NEWS2 Development Group lead Professor Bryan Williams, said:
‘When the RCP published the National Early Warning Score in 2012, we could hardly have imagined the international success story it has become. By making the NEWS materials free of charge, we have enabled implementation not only in the UK, but across the world, saving thousands of lives.’