Early warning scores

Mrs. Parvathy

Tutor, sjcon

DEFINITION

• Early Warning Scores have been

developed to facilitate early detection

of deterioration by categorizing a

patient’s severity of illness and

prompting nursing staff to request a

medical review at specific trigger

points utilizing a structured

communication tool (Mitchell et al.,

2010)

HOW EARLY WARNING

SCORE WORKS ???

PHYSIOLOGICAL PARAMETERS

• AGE

• URINE OUTPUT

• PAIN

• GENDER / ETHINICITY &

OBESITY

• CO MORBIDITIES AND

IMMUNOSUPRESSION

INCLUSION CRITERIA FOR

EARLY WARNING SCORES • Acute hospital setting

• All patients above 16 yrs of age –

initial assessment

• Outpatients / and day care patients

who comes for invasive procedures or

those who receive anesthesia.

EXCLUSION CRITERIA

CLINICAL RESPONSE TO

NEWS• THREE MAIN COMPONENTS

FREQUENCY OF MONITORING

COMPETENCY OF TEAM

URGENCY OF CLINICAL REVIEW

CLINICAL PROCESS

MEASUREMENT & DOCUMENTATION OF INFORMATION

ESCALATION OF CARE

EMERGENCY RESPONSE SYSTEMS

CLINICAL COMMUNICATION

NEWS SCORING SYSTEM

SCORING SYSTEM …CONTD

• Each parameter carries a point. If the

patient receive oxygen an additional 2

points will be added with final score

• A low score : an aggregate NEWS of

1–4

• A medium score: a NEWS aggregate

score of 5 or more, or a RED score, ie

an extreme variation

• A high score: an aggregate NEW score

of 7 or more

• A low NEWS score can be attended

by competent registered clinical nurse

• RN can determine the frequency of

monitoring / or need for escalation of

care.

• NEWS medium scores should be

attended by ward level doctor or by a

acute care nurse .

• NEWS high score should be taken

care by critical care outreach team –

and usually transfers patients to high

dependency area.

FREQUENCY OF CLINICAL

MONITORING

• Patients who scored zero should be

monitored every 12 hours

• Medium scored patients should be

evaluated every 4 hours

• High score patients should be evaluated

hourly .

RELEVANCE OF EWS IN

INDIA

• Acute /Tertiary care hospitals in India

are overloaded – helps to relieve

burden of care

• EWS helps on call teams to prioritize

their works – which case need most

urgency in attending

• A modified tool accurate to Indian

setting can be developed according to

hospital protocols .

HELPS TO PRIORTIZE CARE

STREAMLINE COMMUNICATION

REDUCE HUMAN ERROR

RESPONSE RIGHT AT THE POINT OF CARE

CASE STUDY – 1

• Mr. R is a 75 year old man , found

lying on the street by police. On

assessment his BP is 100/75 mm Hg ,

Pulse rate is 110 beats / mts,

respiration is 9 breaths/ mts

temperature is 102 F and SPO2 is

98%. Classify the patient??

• Respiration – 1

• Oxygen saturation – 0

• Supplemental oxygen – 0

• Temperature - 1

• Systolic BP -1

• Heart rate - 1

• Level of consciousness – 3

• TOTAL = 7 - RED

CASE STUDY – 2

• Mr. John ,34 year old was admitted to

EMD after he was found unconscious in

his apartment by his wife . On

examination

• Respiratory rate was 26 breaths/mt

• Heart rate – 102 beats/mt

• SPO2- 94@2l O2

• Temperature- 98.6 F

• BP- 120/80 mm Hg- classify ???

• Respiration – 3

• Oxygen saturation – 1

• Supplemental oxygen – 2

• Temperature - 0

• Systolic BP -0

• Heart rate - 1

• Level of consciousness – 3

• TOTAL = 10- RED

CASE STUDY 3

• Mrs.Roger a 45 year old women

presented to OPD with complaints of

head ache. On examination

• Respiratory rate – 16 breaths/mt

• Heart rate – 78 beats/mt

• BP- 180/220 mm Hg

• SPO2- 98 % @ room air

• Classify the patient ?

• Respiration – 0

• Oxygen saturation – 0

• Supplemental oxygen – 0

• Temperature - 0

• Systolic BP -3

• Heart rate - 0

• Level of consciousness – 0

• TOTAL = 3 - MEDIUM SCORE

• EXTREME VARIATION

TAKE HOME MESSAGES

EWS SYSTEM WILL WORK

ONLY IF

STAFFS ARE TRAINED IN NEWS

RESPONSE SYSTEMS AND STAFF ARE IN PLACE TO DELIVER CARE

MEASURE AND RECORD THE SYSTEM FOR EACH SIX PARAMETER

AGGREGRATE THE SCORE AND ADD 2 IF OXYGEN SUPPLEMENTED