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A tool called the National Early Warning Score (NEWS, or NEWS2) was implemented in CST Cerner on October 26, 2022 to assist with early detection and response to clinical deterioration in adult patients. The tool is in place at all VCH, PHC and PHSA hospitals that are live on CST Cerner, and provides a standardised way to identify a sick patient who is deteriorating and requires urgent clinical review.
“MEWS was an early tool we identified, but it was not very well validated,” says Camille Ciarniello, Executive Director, Quality, Patient Safety and Risk Management. “It missed out on some important vital signs, but it was the best we had. Research and experience of others, particularly the National Health Service (NHS) in England would suggest that NEWS2 is a better tool for predicting early clinical deterioration.”
NEWS2 is based on a simple scoring system in which a score is allocated to specific vital signs:
• Systolic blood pressure
• Respiratory rate
• Oxygen saturation
• Level of consciousness
A score (0-3) is allocated to each physiological parameter, with the magnitude of the score reflecting how far the parameter varies from the norm. An additional two points are given for people requiring oxygen.
Nurses receive an alert when NEWS2 is elevated with recommendations for what actions to take. The nurse’s responsibility is to increase frequency of vital signs, discuss the situation with their nursing leader and notify the most responsible physician or designate. The intent is to ensure a timely initial assessment by the appropriate clinical decision maker.
“We took the opportunity with the upcoming CST Cerner go-live at VGH to make it easier for care providers to get a score calculated,” says Camille. “We put in a ‘look back’ feature so that nurses don’t need to take a patient’s temperature every time they take vital signs in order for the score to show up. We also have a new rule that the score will populate even if there isn’t a full set of signs – if a patient’s score is high just because of one vital sign, then we think that is still important news.”
The implementation of NEWS2 supports the Quality: Forward strategic goal to understand, evaluate and prioritize quality, including eliminating preventable harm.