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Early warning scores

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PARVATHY GOPI

Early warning scores (EWS) are used to detect deterioration in patients' condition by categorizing illness severity and prompting medical review at trigger points. EWS systems measure six physiological parameters and assign points for deviations from normal values. The total score determines the monitoring frequency and level of care required, with higher scores indicating greater risk. EWS can help prioritize patient care, streamline communication, and reduce human error by facilitating timely response directly at the point of care. However, EWS only work effectively when staff are properly trained and response systems are in place to deliver the necessary escalated clinical care.

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Early warningscores Mrs.Parvathy Tutor,sjcon
DEFINITION Early Warning Scores have been developed to facilitate early detection of deterioration by categorizing a patients 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 14 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
Early warning scores

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Early warning scores

  • 2. DEFINITION Early Warning Scores have been developed to facilitate early detection of deterioration by categorizing a patients 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)
  • 4. PHYSIOLOGICAL PARAMETERS AGE URINE OUTPUT PAIN GENDER / ETHINICITY & OBESITY CO MORBIDITIES AND IMMUNOSUPRESSION
  • 5. 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.
  • 7. CLINICAL RESPONSE TO NEWS THREE MAIN COMPONENTS FREQUENCY OF MONITORING COMPETENCY OF TEAM URGENCY OF CLINICAL REVIEW
  • 8. CLINICAL PROCESS MEASUREMENT & DOCUMENTATION OF INFORMATION ESCALATION OF CARE EMERGENCY RESPONSE SYSTEMS CLINICAL COMMUNICATION
  • 10. SCORING SYSTEM CONTD Each parameter carries a point. If the patient receive oxygen an additional 2 points will be added with final score
  • 11. A low score : an aggregate NEWS of 14 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
  • 12. 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.
  • 13. NEWS medium scores should be attended by ward level doctor or by a acute care nurse .
  • 14. NEWS high score should be taken care by critical care outreach team and usually transfers patients to high dependency area.
  • 15. 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 .
  • 16. 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 .
  • 17. HELPS TO PRIORTIZE CARE STREAMLINE COMMUNICATION REDUCE HUMAN ERROR RESPONSE RIGHT AT THE POINT OF CARE
  • 18. 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??
  • 19. Respiration 1 Oxygen saturation 0 Supplemental oxygen 0 Temperature - 1 Systolic BP -1 Heart rate - 1 Level of consciousness 3 TOTAL = 7 - RED
  • 20. 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 ???
  • 21. Respiration 3 Oxygen saturation 1 Supplemental oxygen 2 Temperature - 0 Systolic BP -0 Heart rate - 1 Level of consciousness 3 TOTAL = 10- RED
  • 22. 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 ?
  • 23. 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
  • 25. 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