The NEWS Scale Explained

"The NEWS scale provides additional support in the assessment of patients, but it does not provide solutions. Its purpose is simply to assist healthcare professionals in making informed clinical decisions."

What is the NEWS scale, where and how is it used and what are it’s limitations? Laura Pueyo explains in detail how it plays a supporting role in assessing patient health.

Hey guys!

My name is Laura, I am one of the nurses from the NHS.

Today I would like to talk about the National Early Warning Score or NEWS scale, which is a critical tool used by Healthcare Professionals to assess the clinical status of patients and detect early warning signs of deterioration. This scale is a key element of patient safety and improving patient outcomes.

So, what does the NEWS scale tell us exactly and how do we use that scale?

The NEWS scale was developed by the Royal College of Physicians with the objective of creating a standardised and consistent approach to patient observation. The goal was to identify early warning signs of deterioration and prioritise patients who are in need of urgent medical intervention to ensure that appropriate care is provided in a timely manner. They build it gathering clinical information from 2005 to 2012 about several patients and from there built the scale. After that the NEWS scale was updated in 2017 to the NEWS 2, which is the current version used in the NHS.

How Does It Work?

The NEWS scale assigns a score to a patient based on six physiological parameters, including:

• respiration rate,

• oxygen saturation,

• blood pressure,

• heart rate,

• level of consciousness,

• and temperature.

The score is calculated through a 0-to-3-point system for each parameter, and two additional points are added if the patient is receiving oxygen therapy. The overall score ranges from 0 (indicating no signs of deterioration) to 20 (indicating severe deterioration), and healthcare professionals use the score to evaluate the risk of deterioration. So, what we try for those with scores between 0 and 20, is early action to reduce the probability of the patients reaching the 20 points score.

Respiration Rate Is Key

I’d like to remark that the first parameter is the respiration rate which is one of the “forgotten” parameters. The RR is considered a vital sign, and changes in its rate can provide important information about the patient's condition.

An elevated respiration rate, also known as tachypnea, can be a sign of respiratory distress, and could indicate the presence of conditions such as pneumonia, asthma, or heart failure. On the other hand, a decreased respiration rate, also known as bradypnea, can be a sign of central nervous system depression, which could be indicative of conditions such as overdose or head injury.

In the NEWS scale, the respiration rate is assigned a score based on its value. A higher score indicates a more severe illness and a greater need for intervention. For example, an RR of 12-20 breaths per minute would score 0 point, while an RR of > 25 breaths per minute would score 3 points.

In conclusion, the respiration rate is an important component of the NEWS scale and plays a crucial role in the assessment of patients.

Using A Patient Scenario To Explain Further

Mr Blackpool is 60-year-old gentleman who attends the emergency department with fever, cough and pleuritic pain with following vitals:

• Respiratory rate: 21/min

• Oxygen saturation: 93%

• On air

• Systolic blood pressure: 120 mmHg

• Heart rate: 95/min

• Consciousness: Alert

• Temperature: 38.5 °C

According to this tool and referring to the NEWS scoring system this patient would be scoring a 6 due to:

2 points for the Respiration rate, 2 points for the oxygen saturation, 1 point for the pulse and 1 point for the temperature.

What Actions Do We Take Based On These Scores?

So, what recommendations do we get from the calculated score?

If the patient has a score of 0 to 3, they are considered low risk, and their vital signs should be checked every 8 hours.

If the patient has a score of 3 to 6, they are considered intermediate risk like mister Blackpool, and their vital signs should be checked every 4 hours.

If the patient has a score of 7 or more, they are considered high risk, and their vital signs should be checked every 2 hours or more frequently, depending on the risk.

We can measure the risk of deterioration of a patient seeing the scores that the patient had recently.

The NEWS scale also provides guidance on who should be informed about the patient's condition, such as the Senior House Officer (SHO) or the Intensive Care Unit (ICU) doctors.

It also gives recommendations on whether the patient should be transferred for example, if the patient is scoring 10, it will advise us to think to transfer the patient to ICU in the next 2 h.

When To Use The NEWS scale?

So, when do we use the NEWS scale?

We use it always when we assess the vital signs of the patients, we can use it in the GP, emergency departments, inpatients in the hospitals, ICU…

Who Carries Out The Assessment?

It's important to note that the NEWS scale is a tool that should be used by all healthcare professionals who assess patient vital signs, but it should be validated as some scores may be incorrect due to misreading errors. For example, if you enter in the room and the patient is talking normally to you saying he is feeling okay and the score is 15, something might be wrong, so we have to validate the scores.

What Are Its Limitations?

The NEWS scale has some limitations, such as not being suitable for use in patients under 16 years of age, pregnant women, patients with spinal cord injuries or central nervous system disorders, or patients with special needs. Additionally, the scale is used differently in patients with hypercapnia (excessive carbon dioxide in the blood), and in another way in patients with chronic obstructive pulmonary disease (COPD).

The NEWS scale provides additional support in the assessment of patients, but it does not provide solutions. Its purpose is simply to assist healthcare professionals in making informed clinical decisions.

The NEWS score is really useful when we have a couple of scores from a patient, so we can see the tendency of the patient to deteriorate or to improve. This is a continuous assessment that allows health professionals to analyse the phases when the patient is improving or deteriorating.

Complementary To Your Clinical Judgement

To conclude the introduction to this valuable tool, it's important to note that the NEWS scale is just a guide and a reference, not a substitute for clinical judgment. It was designed to assist in making clinical decisions, but it should not be relied upon exclusively. Instead, it should be used in conjunction with other information and clinical assessment to make informed decisions.

The NEWS scale provides additional support in the assessment of patients, but it does not provide solutions. Its purpose is simply to assist healthcare professionals in making informed clinical decisions.

Give It A Go

I encourage you to put your knowledge into practice by assessing your next patient and calculating the score based on the 6 parameters. This exercise will help you better understand the scale and determine if you have a good grasp of its usage, which will ultimately lead to improved care for your patients.

The National Early Warning Score (NEWS) is widely used in the United Kingdom and has expanded to other countries such as Australia, New Zealand, Canada, and some countries in Europe. However, it's important to note that each country may have different guidelines for implementing the NEWS scale and using it in clinical practice.

I hope this video has made it easier for you to understand the significance of the NEWS scale in our healthcare team, as it helps to improve clinical safety and quality of care.

Thank you for taking the time to watch this video.