Has formal validity of NEWS2 already been established?
Yes – this has been published and is discussed in detail in the NEWS2 document. In addition, the NHS in England is setting out a national ambition to standardise the use of NEWS in acute and ambulance settings during 2018/19.
Can patient weight be added to the chart?
No – this has been considered by the NEWS group, and weight should be recorded on other charts. Patients should be weighed routinely, but weight will not influence the NEWS.
Currently we do not use a general score for patients in ICU / high-dependency unit (HDU), and the score is only calculated on step-down to ward areas. Could this be clarified?
It is recommended that the NEWS score be part of handover for patients stepping down from a higher-dependency area.
‘Alert, Voice, Pain, Unresponsive’ (AVPU) goes against our trust recommendations – please clarify.
This has been clarified in the NEWS review. AVPU works very well and is part of consistent training. If a patient is not alert, then the Glasgow Coma Scale (GCS) chart should be used. The management of patients at night and AVPU / monitoring consciousness have been clarified in the updated report and have been amended to ACVPU, where C represents ‘new confusion’ or any other acute alteration in mental state.
Patients at risk of hypercapnia may be stable on 2 L oxygen to maintain SATS between 88 and 92%, but would automatically trigger a score of 4. Is it the need for oxygen or increasing incremental oxygen support that is more significant? The actual saturation recording may be inaccurate owing to poor peripheral perfusion.
This is an educational issue and is covered in the NEWS2 e-learning tool. The NEWS2 chart has been updated with a new section specifically designed to record oxygen saturations for patients with hypercapnic respiratory failure who have been prescribed a desired oxygen saturation range of 88–92%.
I work on a community intermediate care unit for people aged over 60. Monitoring urine output is often not possible or applicable in our patient group; would it be acceptable for us to use the NEWS documentation with this minor modification?
Urine output is not part of the NEWS scoring system. Yes the NEWS chart can be used in this patient group. It is important to note, however, that the recording of urine output is often important clinically to monitor fluid balance but it is not required for the NEWS.
Our trust has a separate EWS for women admitted to obstetric wards, but uses the general score for pregnant women admitted to general wards. Could this be clarified?
The NEWS is not intended for use during pregnancy. The NEWS can be used for women who are up to 20 weeks pregnant, but after 20 weeks, a specific obstetric score (eg the Maternity Early Warning Score) should be used.
Do physiotherapists and occupational therapists who work in the community need to inform a registered nurse if the NEW score is between 1 and 4? This would limit efficiency of our team.
In teams where the physiotherapists, occupational therapists and others carry out the assessment, they should be the staff to instigate escalated care. The e-learning tool has been developed further to clarify this.
Can we add a space for healthcare assistants to initial that they have notified a registered nurse of an abnormal score?
This is included in the chart.
Is the NEWS2 designed for use by the ambulance service?
Yes, it has been validated as a useful tool to stratify illness severity by the ambulance services. The NEWS is now used by many ambulance services across the UK. There is also a strong recommendation from the Royal College of Emergency Medicine for the NEWS to be used by all emergency departments. This would ensure that the NEWS is used across the emergency care pathway, facilitating safe and more effective and timely triage and safe handover of patients.
Can NEWS2 be used by the independent sector?
Yes. It is already being used in some areas of the private healthcare sector in the UK and in many hospitals internationally. This is important for interoperability.
Has the NEWS2 been adopted by teams working in the community? If so, what has their experience been?
Yes – there has been a steady uptake of the NEWS2 in the community sector (eg community hospitals and nursing homes). Some of the teams have asked the NEWS2 group representatives to visit and give presentations on the NEWS. New exemplars have been added to the e-learning to assist these teams.
Can we use the name ‘NEWS’ if we alter the parameters?
No. This would defeat the object of trying to embed a standardised system across the NHS to improve communication of illness severity and response to acute illness. If the scoring system or chart are altered, then the prior validations of the NEWS are no longer valid and the system is no longer the NEWS. This would be a retrograde step. Some colleagues have fed back that they wanted to change the thresholds as they felt that they were sometimes too sensitive. The response to the NEWS should be decided locally, but this doesn’t require any change to the scoring system or the charts.
Is there a Microsoft Word version available rather than a PDF, so that we can make changes?
No – as it is a standardised chart, changes cannot be made.
Can we add our hospital name or personalise the chart?
Yes – it is anticipated that, in many cases, the NEWS2 chart will be embedded into a larger chart at the bedside that allows additional information about the patient, eg urine output, pain scores, GCS etc to be recorded, alongside the NEWS2 chart.
Can we move the rows around on the chart?
No – they are prioritised for specific reasons. In the updated NEWS2 chart, the order of the rows has been changed to be consistent with the ABCDE order of physiological recording as recommended by the Resuscitation Council (UK).
Will there be competence-based assessments to support the online training?
This is the responsibility of the educational provider at each organisation – some may wish to add this.
Would adapting the chart to a different patient group affect copyright? Is it possible to change the size of the chart?
Any adaptation would mean that it can no longer be called ‘NEWS’. It is important that the NEWS2 chart remains visually consistent.
Should people complete the e-learning before using the chart? For example, agency staff and locums may not have been trained.
The vacancy rates in emergency nursing are currently high, so the Royal College of Nursing is clear about the training given to agency nurses – it is recommended that all emergency nurses complete the e-learning, as well as all other members of staff who have contact with patients on wards, not forgetting the areas in the community where acute and emergency work happens.
Can we quote from the NEWS2 report?
Yes – the official citation is: Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: RCP, 2017.
Is there an app for NEWS2?
An app is being developed and should be available for testing soon. Information will be available on the RCP website when the app is released.
Will NEWS2 be rolled out across the UK?
Sir Richard Thompson, past president of the RCP, stated that it had been the most effective initiative from the RCP in terms of rapid take-up into the healthcare system UK-wide. NHS England has endorsed and recommended the use of the NEWS2 as the early warning system for use across the NHS in England, replacing other early warning systems for adults (but not children or pregnant women who have their own dedicated scoring systems).
Is NEWS2 being used outside the UK?
Yes, we have had enquiries and information on take-up from several European and Far Eastern countries, and the USA.
How do we get hold of mass-produced NEWS2 charts?
The local NHS trust has responsibility for producing NEWS2 charts for individual organisations. Some trusts have already moved to electronic systems that are embedding the NEWS.
What is the copyright situation if NEWS2 is converted for use in an electronic system?
There is no difference – please acknowledge the RCP.
Is it permissible for me to laminate the NEWS2 tool for posting at each bedside?
Could the boxes in the chart be enlarged so that they can be read more easily?
The chart has been redesigned to include all the necessary information and the new NEWS2 chart has a larger format. Electronic systems in the future will resolve this.