17Oct

The NEWS scale: what it is, how it works and its benefits

October 17, 2022 equimed 43

The NEWS scale measures the physiological parameters that classify the patient’s risk for adverse outcomes in the intrahospital setting.

Origin and meaning of the NEWS system

The taking of vital signs in patients and the use of scales for triage is a trend present in many health systems. This is a highly relevant activity because of the information it offers us about the hemodynamic status of the patient.

These scales have been especially valued in the United Kingdom, where numerous scales for the detection and assessment of acutely ill patients began to be created. First they were called EWS or “ Early Warning Scores ”, and when the process was standardized, in 2012 the Royal College of Physicians created a system called the National Early Warning Score ( NEWS ), led by the National Health System (NHS) and aimed at Adults over 16 years of age.

Its objective currently remains the same: to maintain periodic information on the patient ‘s physiological and mental state in order to detect in advance the risk of physiological deterioration. As? Standardizing the monitoring registration process and patient management to obtain an early , timeless and competent detection of the acute patient or in the process of deterioration.

News 2, the most up-to-date version

NEWS2 is the latest and most current version of the National Early Warning Score (NEWS), first standardized in 2012 and updated to NEWS2 in December 2017. This new update was intended to

Specify how the NEWS can be used to detect patients with sepsis and high risk of clinically worsening.
Emphasize that a score of 5 or more is the threshold that should be used as a clinical alert.
Improve the recording of the use and the scores for the saturations of patients with hypercapnic respiratory failure.

For its part, NEWS2 is scheduled to be reviewed in 2023.

What does the News scale measure?

The NEWS is based on a simple aggregate scoring system in which physiological measurements, already recorded in routine practice, are assigned a score when patients present or are being monitored in hospital. Six physiological parameters form the basis of the scoring system:

Respiratory rate (RR)
Oxygen saturation (SpO2)
Temperature
Systolic blood pressure (SBP)
Heart rate (HR)
Conscience level

Each of these indicators has certain thresholds/parameters to which values from 0 to 3 are assigned depending on the variation of the values obtained and a sum of this aggregate is made to calculate the NEWS.

In this way, the NEWS is classified into different degrees of risk:

LOW RISK (score of 0-4)
MEDIUM-LOW RISK (score of 3 in some parameter)
MEDIUM RISK (score of 5-6)
HIGH RISK (score of 7 or more).

Depending on the rating, a degree of risk is assigned and, consequently, a monitoring frequency and a maximum time for a clinical response.

What does the result of the NEWS scale tell us?

Based on the scoring result, the report provides recommendations on the frequency of monitoring, the urgency of clinical review, and the competency requirements of the medical team necessary to carry out an immediate response and with specific interventions.

The result is also a very clear indicator of the importance of guaranteeing that immediate response teams are available 24/7/365, especially in hospitals that care for serious or critical patients, focusing on their decisive role in the first minutes of arrival of the patient in the emergency room.

Benefits of the NEWS scale

As we said, the fundamental objective of these NEWS scales was to facilitate the recognition and management of acutely ill patients who suffered a deterioration in their vital signs, since this is related to a better prognosis, lower costs , etc.

At the same time, it was created to identify, by means of an objective score, the so-called “early warning points” (EWS), that is, those manifestations based on clinical parameters in the patient that can be useful to help determine their state of severity, and the need to undergo immediate clinical interventions.

However, the creation of the NEWS as a standardized scale provides many other advantages:

Facilitate the movement of health personnel between different hospital centers.
Reduce errors.
At present, this scale has become a useful tool for the emergency physician since it has been established as a useful tool to carry out the initial triage.
Its simplicity, since it does not need laboratory tests or others that require a lot of time.
You only need the necessary instruments to calculate it -in addition to clinical judgment- such as a blood pressure monitor, thermometer, pulse oximeter and a stethoscope.
A great immediacy to assess the patient.
And thanks to this score , it is much easier to recognize those patients who are in a potential risk situation.
Prompt recognition makes the chances of treatment success much higher, and the chances of adverse events (cardiorespiratory arrest, admission to the ICU, death…) are lower.

Practical cases

The success of this scale has been demonstrated in numerous studies . Currently, there is evidence that this score should be used to assess exacerbations in acute patients, in prehospital evaluation (in emergency services), to monitor the clinical status of patients in hospitals, nursing homes, to warn of possible deterioration in hospitalized patients and in departments. There are also studies that have evaluated other scales such as the qSOFA scale, although this offers worse results.

At present and after its update to its second version, numerous publications worldwide and various clinical studies have advocated its use, especially focused on emergency services, finding, at the same time, clinical importance in relation to the prognosis of seriously ill patients. through its application from the prehospital setting.

In Spain, this study from the University of Córdoba stands out, on the validation of the “National Early Warning Score 2” (NEWS 2) scale adapted to the Spanish environment , for the early detection of patients at risk of deterioration in emergency services.

Their conclusion is very clear: the NEWS2 scale, after the translation and validation process into Spanish, has proven to be a valid scale for use in the triage consultation of hospital emergency services . In the study setting, the psychometric properties of the NEWS2 scale adapted to Spanish are adequate and have a high predictive capacity to detect adverse events and hospital admissions.

Therefore, the NEWS2 scale adapted to Spanish is presented as a useful triage support tool that can increase or improve the safety of patients in the emergency department and, consequently, the quality of care.

Conclusion

The EWS aims to provide a clinical response by alerting any abnormality in physiological parameters when they are considered to be outside the set range.

The NEWS scale is an effective system for the prevention of mortality, sepsis, hospital cardiac arrest, and a great help in making decisions about the patient’s needs.

In turn, it is a notable predictor in all settings, including primary, hospital, and pre-hospital care. Its impact on nursing is also very positive, since it allows an increase in the autonomous role with the support of this objective tool.

Therefore, with the NEWS system we achieve a globalized categorization in the monitoring of the aforementioned basic physiological parameters.

The best hospital equipment as accompaniment

To prolong the success of the NEWS scale and help in decision-making, it is necessary to have the best medical equipment , the most modern and advanced technology from the leading brands in the medical, clinical and surgical sector.

Connex^®Spot Monitor

Especially with regard to the monitoring of vital signs, at Equimed we bet on Connex Spot Monitor, a comprehensive monitoring system from basic capture of vital signs up to the early warning score and interval or continuous monitoring.

Connex^®Vital Signs Monitor

Or the Connex Vital Signs Monitor , a simple solution for continuous, interval and spot check monitoring, designed to make it easy to capture a patient’s vital signs.

If you want more information about monitoring systems, or request a personalized quote, do not hesitate to contact Equimed.

29Jul

Respiratory rate: what it is, how to control it and equipment to monitor it

July 29, 2022 equimed 42

Evaluating the respiratory rate is one of the main elements to control the health of patients in hospitals. For this, we need to have systems and monitors capable of monitoring what is one of the main vital signs, either manually or automatically.

What is respiratory rate?

Respiratory rate is the number of breaths, inspiration followed by expiration, that any person takes per minute. It is one of the main vital signs, along with blood pressure, pulse, and temperature. The respiratory rate changes depending on many factors of health and activity, and also differs in adults and children.

When a person inhales, oxygen enters their lungs and travels to their organs. As you exhale, carbon dioxide leaves the body. A normal respiratory rate plays a crucial role in maintaining the balance of oxygen and carbon dioxide in the body.

Respiratory rate in adults

The normal respiratory rate for an adult person is between 12 and 20 breaths per minute. At this respiratory rate, carbon dioxide leaves the lungs at the same rate that the body produces it. Respiratory rates lower than 12 or higher than 20 can mean an alteration of the normal respiratory processes, which we will talk about in this article later.

The respiratory rate during rest is about 15 inspirations (inhalations) and expirations (exhalations) per minute.

Generally, it is measured while at rest. It simply involves counting the number of breaths in one minute by counting the number of times the chest rises.

Of course, this respiratory rate is increased by exercising, having a fever, being sick, or having other medical conditions.

How is respiratory rate measured?

To take an accurate measurement, the easiest thing to do is to sit down and relax, preferably on the bed or on a chair. You can then measure your respiratory rate by counting the number of times your chest or abdomen rises in one minute. A full breath comprises an inhalation as the chest rises, followed by an exhalation as the chest falls.

Why is it so important to measure respiration?

Measuring the respiratory rate of a person at rest is essential to basically determine if it is within normal limits. Because a high or low respiratory rate can be a sign of an underlying problem.

Causes and problems in respiratory rate

If we talk about causes of high respiratory rate , doctors call tachypnea a respiratory rate greater than 20 breaths per minute.

The most common causes are:

Anxiety
Fever
respiratory conditions
COPD, asthma, or pneumonia
carbon monoxide poisoning
pleural effusions
pulmonary embolism
Heart problems
dehydration
Allergic reactions
Diabetic cetoacidosis

In the case of low respiratory rate, doctors call a respiratory rate less than 12 breaths per minute bradypnea. Among its causes are:

Airway obstructions and cardiac arrest
Drug overdose
Obstructive sleep apnea
Head injury

Thus, if anyone experiences abnormal breathing rate, they should contact their doctor, and especially seek immediate medical help if they notice abnormal breathing rate, chest pain, bluish skin, gurgling sounds during breathing, or if breathes very few times per minute.

Control respiratory rate in hospitals and health centers

Healthcare facilities have devices and machines, such as respirometers and vital signs monitors, that measure respiratory rate by assessing the ratio of oxygen to carbon dioxide exchange.

In hospitals, the procedure of taking the respiratory rate is very common and frequent. The goal is usually:

Part of the routine taking of a patient’s vital signs and detecting changes in them.
Assess breathing before and after the administration of a medication.
Control patients with risks of respiratory alteration.
Detect changes in breathing to act accordingly and prevent further damage.
Usually, this is done only with a watch with a second hand and notepad to record said frequency. Another method is auscultation with a stethoscope, it is the recommended method in pediatrics.

In this case, we are talking about specific measurements, whether they are routine or not. But what happens when we need constant measurement of respiratory rate and other vital signs?

When a patient is admitted, either in the ICU, UVI, day ward, operating room, etc. Health professionals need to have devices that measure the patient’s respiratory rate 24/7. Whether it is for digital respiratory rate measurement in routine vital signs monitoring, or comprehensive monitoring —from basic vital signs capture to early warning scoring and interval monitoring.

EQUIMED equipment to measure and monitor respiratory rate

At Equimed, we have the best solutions for the automatic measurement of respiratory rate. By combining the Connex Control Monitor with Masimo RRp technology , digital respiratory rate measurement can be included in routine vital signs monitoring with the option of incorporating them into the early warning scale protocol.

Connex^® Spot Monitor

The Connex Spot Monitor is a comprehensive monitoring system, ranging from basic vital sign capture to early warning scoring and interval or continuous monitoring. It enables full vital signs in less than a minute, vivid, easy-to-use touchscreen, and is customizable to the user’s needs with an upgradable design and custom settings.

With this device, omissions and transcription errors are reduced with the automatic transfer of the vital signs of the patients, and it is designed by and for healthcare personnel in order to increase the efficiency and satisfaction of the users. In turn, the optional clinical login screen that allows you to restrict access and protect health information. And it has automatic deletion of patient data after sending it to the RME system.

Connex^® Vital Signs Monitor

For its part, Connex Vital Signs Monitor is a simple solution for continuous monitoring, by intervals and spot check, designed to facilitate the capture of the patient’s vital signs. This device allows you to wirelessly send vital signs from the patient’s bed to your EMR without intermediary steps.

If you want more information about monitoring equipment, or request a personalized quote, do not hesitate to contact Equimed.